Anal Abscesses Causes, Symptoms, Diagnosis, Treatment, Prevention

Anal Abscesses Causes, Symptoms, Diagnosis, Treatment, Prevention

Anal Abscess Overview

An abscess results from an acute infection of a small gland just inside the anus, when bacteria or foreign matter enters the tissue through the gland. Certain conditions - colitis or other inflammation of the intestine, for example - can sometimes make these infections more likely.

After an abscess has been drained, a tunnel may persist connecting the anal gland from which the abscess arose to the skin. If this occurs, persistent drainage from the outside opening may indicate the persistence of this tunnel. If the outside opening of the tunnel heals, recurrent abscesses may develop.

Surgical incision and drainage is the most common treatment for all types of anal abscesses and is usually successful.

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Causes and Rick Factors of Anal Abscesses

An anal abscess can have many different causes. These include:

  • Infection of an anal fissure. An anal fissure is a small superficial tear in the skin of the anal canal.
  • Sexually transmitted infections.
  • Blocked anal glands.

Risk factors for anal abscesses include:

For adults, using condoms during sexual intercourse, including anal intercourse, can help prevent anal abscesses. For infants and toddlers, frequent diaper changes and proper cleaning during diaper changes can help prevent anal fissures and perianal abscesses.

Symptoms of Anal Abscesses

Superficial anal abscesses are often associated with:

Pain, which is usually constant, throbbing, and worse when sitting down

Skin irritation around the anus, including swelling, redness, and tenderness

Discharge of pus

Constipation or pain associated with bowel movements

Deeper anal abscesses may also be associated with:

  • Fever
  • Chills
  • Malaise
Sometimes, fever is the only symptom of deep anal abscesses.

When to Seek Medical Care

If a person suspects they have a perirectal or perianal abscess they should see a health care practitioner. The diagnosis is not always easy to make, and the health care practitioner may need to do tests or consult with specialists.

Go to an emergency department when you have any of the following symptoms:
  • High fever or shaking chills 
  • Significant rectal/anal pain 
  • Inability to have a bowel movement, or a painful bowel movement 
  • Persistent vomiting 
  • Any other unusual signs or symptoms that may indicate an emergency condition

Anal Abscess Diagnosis

The health care practitioner will ask questions about the patient's condition. Give the health care practitioner all necessary information. Discussing the details may be embarrassing, but health care practitioners and other medical personnel are required to maintain confidentiality. Honest responses to the health care practitioner's questions will help provide the patient faster appropriate care.

  • The health care practitioner will then examine the patient and should explain the parts of the exam may be uncomfortable and will be careful to protect the patient's modesty.
  • The health care practitioner should provide clear answers to any questions the patient asks; they should understand the treatment plan.
  • Sometimes the diagnosis is obvious, and no tests are needed. At other times, blood and urine tests and special imaging tests such as X-ray, CT scan, MRI, and ultrasound may be needed. The health care practitioner may also consult other specialists to confirm the diagnosis or to come up with the best treatment plan.

Treatment of Anal Abscesses

Prompt surgical drainage is important, preferably before the abscess erupts. Superficial anal abscesses can be drained in a doctor's office using a local anesthetic. Large or deeper anal abscesses may require hospitalization and the assistance of an anesthesiologist.

After the procedure, most people are prescribed medications for pain relief. For otherwise healthy people, antibiotics are usually not needed. Antibiotics may be required, though, for some people, including those with diabetes or decreased immunity.

Sometimes, fistula surgery can be performed at the same time as abscess surgery. However, fistulas often develop four to six weeks after an abscess is drained. Sometimes a fistula may not occur until months or even years later. So fistula surgery is usually a separate procedure that can be performed on an outpatient basis or with a short hospital stay.

After abscess or fistula surgery, discomfort is usually mild and can be controlled with pain medications. People can expect to lose only a minimal amount of time from work or school.

People are usually advised to soak the affected area in a warm water (sitz) bath three or four times per day. Stool softeners may be recommended to ease the discomfort of bowel movements. Some people may be advised to wear a gauze pad or mini-pad to prevent the drainage from soiling their clothes.

Complications after surgery can include:

  • Infection
  • Anal fissure
  • An abscess returning
  • Scarring

After an anal abscess or fistula has properly healed, it's unlikely that the problem will come back. To prevent one from doing so, however, it's important to follow the advice of your doctor or colon and rectal surgeon.

Anal Abscess Follow-up

Patients may have pain for several days following surgery, but should improve over time.

  • Patients may not have stitches. Infected wounds such as abscesses are left open to drain. If they were stitched shut they would just fill with pus again. There may be packing left in the wound, which usually will be removed by the health care practitioner after a few days.
  • Patients may need to take an antibiotic and pain medication for several days, depending on their condition.
  • Using stool softeners and adhering to good hygiene, such as sitz baths after every bowel movement, decreases the patient's discomfort and helps recovery.


Discomfort after fistula surgery can be mild to moderate for the first week and can be controlled with pain pills. The amount of time lost from work or school is usually minimal.

Treatment of an abscess or fistula is followed by a period of time at home, when soaking the affected area in warm water (sitz bath) is recommended three or four times a day. Stool softeners may also be recommended. It may be necessary to wear a gauze pad or mini-pad to prevent the drainage from soiling clothes. Bowel movements will not affect healing.


If properly healed, the problem will usually not return. However, it is important to follow the directions of a colon and rectal surgeon to prevent recurrence.