Anal Abscess: Treatment Options and Concerns

Anal abscess

I noticed swelling around the anus for the first 3 to 4 days but didn't pay much attention to it.
However, on the second day, I discovered a lump on the right side of the anus, which didn't cause much discomfort at first.
By the fourth day, I was experiencing pain whether I was standing or sitting, to the point where it was unbearable, and I also felt chills.
I went to see a doctor, who diagnosed me with an anal abscess.
He mentioned that I might need to have it incised to allow the pus to drain, but it could also resolve on its own with medication.
He indicated that the cyst was very close to the anus and should rupture in a few days.
Since I was hesitant about the incision, during the digital examination, the doctor noted that there might have been inflammation inside the anus previously, but it had resolved on its own.
I did not experience pain during the examination, and the doctor prescribed antibiotics, stool softeners, an ointment, and a pill about the size of Tylenol.

I'm concerned about whether the abscess should be surgically drained by the doctor or if it can safely rupture on its own.
Would the latter option be problematic? If it ruptures, will it definitely lead to a fistula, or does a rupture automatically mean it has become a fistula? This is what I'm most worried about.
Currently, I'm waiting for it to rupture on its own.
After taking the medication, I no longer feel pain, although I can still feel a hard lump, and of course, the pain returns once the medication wears off.
I have a four-day supply of medication.

Mr. Chen, 20~29 year old female. Ask Date: 2018/07/14

Dr. Li Zhonghuai reply Surgery

Hello! When dealing with a perianal abscess, it is important to check for the presence of a fistula.
If a fistula is present, it should be addressed simultaneously; otherwise, there is a risk of recurrence! It is recommended to consult a colorectal surgeon for management.
Changhua Hospital cares about you!

Reply Date: 2018/07/14

More Info

Anal abscesses are painful collections of pus that can develop near the anus due to infection, often resulting from blocked anal glands. Your experience of swelling and pain in the anal area, particularly the right side, suggests that you may indeed have an anal abscess. The pain you described, especially when standing or sitting, along with chills, indicates that the infection may be significant and could require intervention.

Treatment Options
1. Observation and Medication: In some cases, if the abscess is small and not causing severe symptoms, doctors may recommend a conservative approach. This includes antibiotics to treat the infection, stool softeners to ease bowel movements, and topical treatments to reduce discomfort. However, this approach is generally more suitable for smaller abscesses that are not causing significant pain or systemic symptoms.

2. Incision and Drainage: The most common and effective treatment for an anal abscess is incision and drainage (I&D). This procedure involves making a small cut in the abscess to allow the pus to drain out. This not only relieves pain but also helps to clear the infection. While it may seem daunting, this procedure is typically performed under local anesthesia and is relatively quick.
3. Spontaneous Rupture: Sometimes, an abscess can rupture on its own, which may provide temporary relief. However, this is not always a desirable outcome. If the abscess ruptures internally, it can lead to the formation of a fistula, which is an abnormal connection between the anal canal and the skin. This can complicate recovery and may require further surgical intervention.

Concerns and Considerations
- Risk of Fistula Formation: If the abscess ruptures, there is a risk that it may develop into a fistula. Not all ruptures lead to fistulas, but if the abscess is deep or if there was prior inflammation, the risk increases. A fistula can cause ongoing discomfort and may require surgical repair.

- Pain Management: While antibiotics and pain medications can help manage symptoms, they may not address the underlying issue. If the abscess is not drained, pain may persist, and the infection could worsen.

- Follow-Up Care: Regardless of whether you choose to wait for spontaneous rupture or opt for surgical drainage, follow-up care is essential. If symptoms worsen or do not improve, further evaluation may be necessary.

Conclusion
In your case, while the option of allowing the abscess to rupture on its own exists, it carries risks, particularly the potential for developing a fistula. Given the severity of your symptoms, including significant pain and systemic signs like chills, it may be prudent to consider the incision and drainage option. This approach is generally more effective in providing relief and preventing complications.
It’s crucial to maintain open communication with your healthcare provider about your symptoms and treatment options. If you have concerns about the procedure or its implications, discussing these with your doctor can help you make an informed decision that aligns with your health needs.

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