Do patients with perianal abscess need surgery?

Whether perianal abscess requires surgery depends on the patient's condition. Because each patient's condition is different, it is necessary to pay attention to a more comprehensive examination and then decide whether surgical treatment or conservative treatment should be adopted after understanding the condition.

1. First, a clear answer: If an abscess has formed, surgical incision and drainage is required. Acute suppurative infection occurs in the anal canal, the soft tissue around the rectum, or the surrounding space, and an abscess is formed, which is called an anal canal and rectal abscess, or simply perianal abscess. Its characteristic is spontaneous rupture, or the formation of anal fistula after surgical incision and drainage. It is a common anorectal disease and also the acute stage of the anal canal and rectal inflammatory pathological process, while anal fistula is the chronic stage. Common pathogens include Escherichia coli, Staphylococcus aureus, Streptococcus and Pseudomonas aeruginosa, occasionally anaerobic bacteria and Mycobacterium tuberculosis. It is often a mixed infection of multiple pathogens, and it has recently been found to be related to anal line damage.

2. Subcutaneous abscesses around the anus are the most common, and are mostly caused by anal gland infection spreading outward through the subcutaneous part of the external sphincter or directly outward. A few perianal abscesses can be resolved with antibiotics, hot sitz baths, and local physical therapy, but most require surgical treatment.

Sometimes perianal pain may be caused by an inflammatory mass in the perianal area, but it does not necessarily mean an abscess has formed. You can self-identify it by touching the surface of the mass with your hand and feeling obvious fluctuations, which is a sign of abscess formation. If an abscess has formed, surgical incision and drainage must be performed, and the wound dressing must be changed after the operation to promote healing. If an abscess has not formed, surgery is not recommended. Antibiotics can be used for treatment. Hot water sitz baths can help reduce local swelling. Ichthyol ointment can be applied to the surface of the mass to promote rupture of the abscess.

3. Perianal abscess may develop into anal fistula. If it is not treated for many years or is treated incorrectly, it may become cancerous. Moreover, perianal abscess is different from infection in other parts of the body. Once it occurs, it cannot be healed by itself or by drugs. It can only be cured by surgical incision. Conservative treatment can only relieve symptoms, and perianal abscess must be completely treated surgically.

4. In short, to summarize: the main symptoms of perianal abscess are: persistent throbbing pain in the perianal area, aggravated by pressure during defecation or coughing, redness and swelling of the perianal skin, accompanied by nodules or tenderness, and a sense of fluctuation after the abscess is formed. Symptoms of systemic infection are not obvious. Treatment: early application of antibiotics, warm water sitz baths, local physical therapy, and early incision and drainage of abscesses. Note on diet: Eat less or no spicy food, eat more vegetables and fruits, and keep bowel movements smooth.