Can Anal Abscess Coexist Without Surgery? the Risks

Can an anal abscess coexist with other conditions?

In January, I discovered a hard lump and initially thought it was an inflamed abrasion.
Later, I noticed it had grown larger and was painful when pressed, which prompted me to see a doctor.
I was subsequently diagnosed with a suspected anal abscess.
It is located near my anal opening, and while it was painful to press initially, I have been taking traditional Chinese medicine.
Although I am no longer in pain, the lump has not decreased in size nor has it grown larger.
A few weeks ago, during a procedure for internal hemorrhoid ligation, I asked the doctor if surgery was necessary.
He mentioned that since it has been a long time since January, surgery might be unnecessary, as there may not be much to remove and it could be fibrosis.
He advised me to coexist with it.
I would like to inquire: is this doctor's perspective correct? I do not have a fever or any other uncomfortable symptoms.
It is painful when I press hard, but not when I press lightly.
The lump feels oval-shaped, approximately 2 cm in length and less than 1 cm in width.
After coexisting with it for so long, what risks might I face? Should I stop taking medication and seek a doctor to have it surgically opened?

Xiao Bai, 30~39 year old female. Ask Date: 2024/03/11

Dr. Zhang Shuhao reply Surgery

Based on the description, it appears that there has been no pain or other discomfort for some time, indicating that the anal abscess may have resolved.
Tissue inflammation or fibrosis can also present as a lump, so the doctor's suggestion to coexist with the mass is reasonable, especially if you currently have no noticeable discomfort.
However, if there are symptoms such as swelling, pain, or fever, or if there are underlying chronic conditions like diabetes, it is important to seek medical evaluation to determine if incision and drainage are necessary.
If you have any uncertainties or questions regarding the current diagnosis or treatment plan, please do not hesitate to discuss them further with your doctor.

Reply Date: 2024/03/11

More Info

Anal abscesses are localized collections of pus that can occur near the anus, often resulting from infection of the anal glands. Your situation, where you have a hard lump near the anal area that has not resolved despite treatment, raises several important considerations regarding the management of anal abscesses.

Firstly, it is essential to understand that while some anal abscesses may resolve on their own, many require surgical intervention for complete resolution. The fact that you have had this lump for several months without significant change, and that it is painful when pressed, suggests that it may not be resolving naturally. The doctor’s advice to "coexist" with the abscess may be based on the absence of systemic symptoms like fever or significant discomfort, but this does not necessarily mean that the abscess is harmless.

The risks of leaving an anal abscess untreated can include:
1. Infection Spread: If the abscess is not drained, the infection can potentially spread to surrounding tissues, leading to more severe complications such as cellulitis or even sepsis in rare cases.

2. Fistula Formation: Chronic abscesses can lead to the development of anal fistulas, which are abnormal connections between the anal canal and the skin. Fistulas can cause ongoing drainage and discomfort and often require surgical intervention.

3. Persistent Pain or Discomfort: Even if the abscess does not grow, it can cause ongoing pain or discomfort, particularly when sitting or during bowel movements.

4. Fibrosis: As your doctor mentioned, if the abscess persists for a long time, it may become fibrotic, meaning that the tissue can harden and become less responsive to treatment. This can complicate any future surgical interventions.

Given these risks, it is advisable to seek a second opinion from a colorectal surgeon or a specialist in gastrointestinal disorders. They can perform a thorough examination, possibly including imaging studies, to assess the nature of the lump and determine the best course of action.
If the abscess is indeed present and causing symptoms, surgical drainage is often the most effective treatment. This procedure is typically straightforward and can provide immediate relief from pain and discomfort. The surgeon will likely make a small incision to drain the pus and may also clean the area to prevent recurrence.

In summary, while your current doctor may have a conservative approach, it is crucial to weigh the potential risks of leaving an anal abscess untreated against the benefits of surgical intervention. Given the duration of your symptoms and the nature of the lump, pursuing further evaluation and possibly surgery may be the best course of action to ensure your health and comfort.

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