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Peri-rectal abscess
Also known as: Anal Abscess, Ischio-Rectal Abscess
One gay man - who feared being outed - was too afraid to see a doctor for the severe pain and swelling he felt in his lower rectum. He waited until the infection ruptured up into his abdomen and he collapsed at home with peritonitis.
Intro
A perirectal abscess is an infection that most often begins in your anal or rectal canal and spreads to the fatty tissue surrounding it. The abscess can burrow toward your skin where - if untreated - it can rupture.
What is it?
A perirectal abscess is a bacterial infection that most often begins in the small glands inside your anus. Your pain worsens as the infection grows and spreads to the area around your rectum. A cavity filled with pus (yuck) develops and the skin over it becomes red and swollen. The infection can become so severe that you develop high fevers and other signs of infection.
Diagnosis
Your doctor can usually diagnose the infection just by seeing the swollen, red skin beside your anus. If the abscess is early or burrowing away from your skin (up along your rectum toward your abdomen) your doctor may need to get a CT scan to see the infection.
Symptoms
Early on you may only notice a feeling of pressure in your rectum. As the infection progresses, you will probably feel a tender, hot to the touch, lump under the skin beside your anus.
How is it acquired?
Although it can develop from an injury during sex, this is very rare. By far, the most common cause is a piece of stool that gets caught in your anal glands and starts a small infection that grows and grows. The infection is caused by bacteria in your stool.
How to treat it?
If the infection is caught very early (before a true cavity filled with pus develops), antibiotics and warm soaks might do the trick. But when an abscess has fully developed, you need to have the pus drained. This usually requires surgery to fully eradicate the infection. Antibiotics alone are not sufficient.
If your abscess is large, your doctor may suggest that you have the surgery in an operating room with full anesthesia. This is a good suggestion because draining a large abscess can be quite painful.
If your abscess bursts on its own, you might think that you don't have to go to a doctor because it is already drained. WRONG! When an abscess ruptures on its own, it does not drain enough to heal the infection. A surgeon needs to open the skin wide enough to get out all of the pus.
Once the abscess is drained, you will need to keep it clean and open. This often requires soaking in sitz baths. If the skin closes before the abscess heals from the inside out, another infection will develop. Occassionaly, an abscess does not fully heal after it is drained and a fistula-in-ano develops. You will then need another operation to cure the fistula.
Myths dispelled
Here are some facts to clear up some common misconceptions.
A perirectal abscess is rarely (and I mean rarely) caused by rough sex or toys. And even if a perirectal abscess bursts on its own, it still needs to be evaluated by a doctor.
Prevention
There is no way to prevent it. If you have severe pain in your anus or rectum, your doctor might give you antibiotics to cure the infection before the abscess has a chance to develop. It is, however, very rare to catch the infection at this early stage.
Incubation period
An abscess begins as a tiny infection that gradually grows. Most patients experience increasing pain and swelling for almost a week before going to the doctor.
Sex
A peri-rectal abscess is rarely caused by an injury during sex or an STD.
by Stephen E. Goldstone, M.D., F.A.C.S.
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