Location of different types of perianal abscess
Anal abscess or more accurately “perianal” abscess is where you get an abscess or spot around your pack passage.
This is very common and almost as common as getting a spot on your face or anywhere else on your body.
They present as a painful lump around your back passage. They may burst themselves releasing pus and blood or you may have it incised with a small operation.
The majority of abscesses heal fully after drainage. Some however result in a small hole around the back passage that discharges blood and/or pus. This usually means you have a fistula.
Sometimes people present with a fistula having never had an abscess.
Fistulas around the anus can be quite unpleasant for you. The area is often very sore and moist. Under wear is often stained and you may feel as if you are “never clean” down there. Fistulas can also mean you get recurrent abscesses in the area.
A fistula is where there is an abnormal connection between the inside of your back passage and the hole on the outside that is discharging pus and blood. This means there will be a hole somewhere along the inside of your back passage. It is important to get a fistula treated especially if you are getting recurrent abscesses.
Some perianal fistulae can be quite complex
When I see you in clinic I will examine the area thoroughly, I may do a rigid sigmoidoscopy in clinic to assess fully. Sometimes fistulas are simple and I may recommend surgery. Usually I will want to find out more about the fistula before deciding on the most appropriate treatment and this may involve a MRI scan.
The vast majority of fistulae are very simple and can be treated with a small operation. This involves a general anaethetic (being put to sleep) and laying open or cutting open the fistula. This means the fistula will heal and no further treatment is necessary. This is only suitable for the most simple of fistula where only a small amount of anal muscle is involved (and the hole on the inside of you back passage is low down on the muscle). Where the hole on the inside of your back passage is higher up it is not possible to cut the fistula as your back passage will be cut and you will loose control. In this situation I will place a plastic string (seton)in to the fistula – this means that all the bacteria and “muck” from the inside of your back passage does not get trapped in the fistula (because it slides down the plastic string to the outside world) and you will stop getting recurrent infections). This will also involve a short anaesthetic and a day case operation. Once the infections have settled we will explore more permanent solutions in detail in clinic.
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