Do You Need Surgery for an Abscess Without Visible Wound?

If an anal abscess has drained without any external wound, is it still necessary to perform a fistula surgery?

Hello, Doctor! I noticed something unusual around February 20th.
I felt a small lump near my anus extending towards the groin, which was painful.
By February 26th, the pain became unbearable while riding my bike.
On February 27th, I visited a specialized clinic for abscess treatment.
During the examination, pus was discharged from my anus, which provided significant relief; even urinating and riding my bike no longer caused pain, and the small lump I could feel also stopped hurting and shrank.
However, later I started feeling chills.
On February 28th, I went to a large hospital where the doctor prescribed antibiotics and pain relievers for inflammation.
Given that the pain has subsided, do I still need surgery? If surgery is necessary, would it involve complete excision of the fistula, and would suturing the wound lead to faster recovery?

A Bao, 30~39 year old female. Ask Date: 2017/03/01

Dr. Ke Fangxu reply Surgery

If an anal abscess has ruptured and there is no pain or signs of infection, oral antibiotics are sufficient.
Whether a fistula will form in the future is uncertain, and performing surgery at this time is not meaningful.
Even if surgery were to be done, the wound would not be sutured, and recovery would definitely be slower than the current situation.
Please follow the physician's instructions for medication and take warm sitz baths regularly.

Reply Date: 2017/03/01

More Info

When considering whether surgery is necessary for an abscess, especially one that has shown improvement after drainage, several factors must be taken into account. Based on your description, it appears that you initially experienced significant discomfort, which was alleviated after the abscess was drained. This is a positive sign, as it indicates that the immediate issue has been addressed. However, the decision to proceed with surgery or further treatment depends on several considerations.

First, it is essential to understand the nature of the abscess and any underlying conditions that may have contributed to its formation. Abscesses can occur due to infections, blockages in glands, or even as a result of inflammatory conditions. If the abscess was caused by an infection, the antibiotics you are taking are crucial in preventing further complications. The fact that you are no longer experiencing pain is a good indicator that the infection may be resolving.

However, the presence of a "small bump" that was initially painful and is now less so raises questions about whether there is still an underlying issue. If the bump persists, it could indicate that there is still some infection or that the abscess has not fully resolved. In such cases, further evaluation is necessary. A follow-up with your healthcare provider is essential to determine if imaging studies, such as an ultrasound, are needed to assess the area for any remaining fluid collections or abnormalities.

Regarding the need for surgery, if the abscess has fully drained and there are no signs of ongoing infection, surgery may not be necessary. However, if there is a concern about a fistula (an abnormal connection between the abscess and the skin or another organ), surgical intervention may be warranted. Surgical options can include the complete excision of the abscess cavity and any associated fistulous tracts. This can help prevent recurrence and ensure proper healing.

If surgery is deemed necessary, the procedure typically involves making an incision to remove the entire abscess and any infected tissue. In some cases, the surgeon may choose to leave the wound open to allow for continued drainage, which can help prevent the formation of a new abscess. The wound may be packed with gauze to promote healing from the inside out. If the abscess is extensive or if there is significant tissue damage, the surgeon may opt to close the wound with sutures after ensuring that all infected material has been removed.

In terms of recovery, the healing process can vary depending on the extent of the surgery and the individual’s overall health. Generally, patients can expect some discomfort and swelling post-surgery, which can be managed with pain medications. Follow-up appointments will be necessary to monitor healing and to ensure that there are no complications, such as infection or recurrence of the abscess.

In conclusion, while your symptoms have improved significantly, it is crucial to consult with your healthcare provider to assess the need for further intervention. They can evaluate the current state of your abscess and determine the best course of action, whether that be continued conservative management or surgical intervention. Always prioritize open communication with your healthcare team to ensure the best outcomes for your health.

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