Specialties

Perirectal Abscess/Fistula

Central Carolina Surgery in Greensboro, Burlington & Asheboro, NC

An abscess is a pocket of infection creating pus. It is very painful. Many abscesses can occur when a gland / pore becomes clogged. The gland cannot drain and becomes plugged with sweat/mucus/oil build up. Infection can set in. The body forms a response & pus can form. Most abscesses get better when the pus can drain out. If it cannot drain, the infection can grow, spreading into deeper tissues to cause a deep abscess, a fistula tunnel, fasciitis/gangrene that kills deep tissues and can even threaten life.

Antibiotics are helpful in treating the infection & prevent new abscesses from forming elsewhere. Antibiotics are often not enough to cure an abscess. If an abscess is larger than a grape, it will not heal with antibiotics alone & requires drainage of the pus to allow the infection to drain.

Abscesses can form near the anus, often just inside where an anal crypt gland gets plugged & and abscess can form. Patents with certain health conditions (smoking, diabetes, inflammatory bowel disease, immunosuppressed on steroids of chemotherapy) are more likely to get more severe infections & worsening abscesses. These can be extremely painful given their sensitive location that the abscess can form.

These suggestions can help to control pain:

  • Warm soaks. This helps more than any topical medication. Use up to 8 times a day. Usually sitz baths or sitting in a warm bathtub helps. Sitting on moist warm towels is helpful. Sometimes it can help the abscess spontaneously drain on its own. Switching to ice packs/cool compresses can be helpful.
  • Normalize your bowels. Extremes of diarrhea or constipation will make hemorrhoids worse. One soft bowel movement a day is the goal. Fiber can help get your bowels regular.
  • Wet wipes instead of toilet paper.
  • Pain control with a NSAID such as ibuprofen (Advil) or naproxen (Aleve) or acetaminophen (Tylenol). Narcotics are constipating and should be minimized if possible.

Some practical hints to help:

  • Control diabetes aggressively. Glucoses > 180 result in a poor immune system that allows the infection to worsen
  • STOP SMOKING. Smokers develop worse infections and take longer to heal. They are more likely to get a recurrent abscess or develop a fistula.

Surgical Treatment

Most perirectal abscesses, especially ones larger than a grape, require drainage to help the infection heal. They should not be ignored because a perirectal abscess can spread deeply and threaten your life. This involves an evaluation by a surgeon to decide if it can be done with the help of local anesthetic (novacaine – like injection to numb the area) in the office to avoid the cost & inconvenience of the operating room. Sometimes, the abscess is too large or complicated and requires an operation under general anesthesia.

Antibiotics are often prescribed to help the infection heal and prevent a new infection from forming elsewhere. Often packing is left in the drained abscess cavity to help the infection drain. This usually falls out on its own. Sometimes the wound must be packed to help the deeper areas heal & keep the skin from closing too soon (and allowing a new abscess to form). You will need to be followed by your surgeon closely to make sure the wound completely heals.

Anal Fistula

Sometimes the perirectal abscess does not completely close & a tunnel forms between the anus and the outside skin, called a fistula. Fistulas do not close on their own. The fistula tunnel often gets re-plugged up & new abscesses form, worsening the problem. Often fistulas require surgery to help remove or open up the abnormal tunnel. Complicated fistulas involving the anal sphincter may require thread/ribbon setons to slowly cut the fistula open, advancement flaps of the rectum needed to remove & seal the anal side of the fistula, or a LIFT procedure is needed to close the fistula tunnel hidden in the sphincter muscle. Your surgeon will help evaluate & recommend what is the best option for you.

Our perirectal abscess/fistula patients come to us from Winston-Salem, Burlington, High Point, Greensboro, Kernersville and close-by locations.