Anal abscess or perianal abscess Although it is a disease with an unfamiliar name, it is a common anorectal condition as frequent as hemorrhoids. Dr. Theerasan Tantitemit, a colorectal surgeon at Phyathai 2 Hospital, explained that an “anal abscess” is an abscess that occurs around the anus. Normally, the human body has about 8-10 mucus-producing glands (Anal glands) located around the anus about 1 cm inside from the anal opening. If these glands become blocked and infected, they develop into a hidden abscess. More than 50% of abscesses cannot burst on their own and require surgery to remove the abscess.
Causes of the disease
The exact cause of anal abscesses cannot be clearly identified. To simplify, it is similar to acne or appendicitis, which can occur suddenly without prior symptoms. However, frequent bowel movements and vigorous wiping with toilet paper causing irritation around the anus may be risk factors that increase the chance of developing an anal abscess.
Risk groups for anal abscess
- People who have frequent bowel movements 3-4 times a day are more at risk of developing anal abscesses than the general population because they strain more than those with less frequent bowel movements.
- It is more common in younger people than in the elderly because the mucus-producing glands in older adults atrophy with age, and the anal sphincter muscles are less tight than in younger people, reducing the chance of injury.
- This disease occurs in both males and females, but men often have more complicated symptoms because their sphincter muscles are stronger.
- For patients with low immunity, such as those with diabetes, liver disease, immunodeficiency, or the elderly, anal abscesses can be particularly dangerous because the abscess may spread to cause bloodstream infection. However, most patients experience severe pain that prompts them to seek hospital care before the condition worsens to that stage.
Initial symptoms indicating anal abscess
- Patients often have swelling and pain around the anus continuously. Even when not having a bowel movement, they feel pain, especially when coughing or sneezing, which may suggest the presence of an anal abscess inside the anus.
- Some patients may also have a fever when symptoms worsen.
- Some have pus oozing from the anus in cases of chronic anal abscess.
Treatment approach for “anal abscess”
- Traditional surgery: The doctor will slightly cut the anal sphincter to allow the pus in the abscess to drain completely. This method offers a 90-100% chance of complete cure. However, if the surgeon is inexperienced, excessive sphincter muscle may be removed, causing problems with fecal incontinence after surgery.
Because nearly one hundred percent of “anal abscesses” can be treated with surgery and cannot be cured with medication, patients often worry about not being completely cured, needing multiple surgeries due to incomplete drainage channels connecting one point to another, and fear of fecal incontinence after surgery due to excessive removal of sphincter muscles. Therefore, there are now treatment options that help patients avoid sphincter muscle removal and prevent complications related to fecal continence.
- Sphincter-sparing surgery, known as the LIFT technique (Ligation of intersphincteric fistula tract technique), offers an 80-85% chance of cure for anal abscess. The advantage is that the sphincter muscle is not cut, so continence function remains the same as before surgery. The surgery duration ranges from about 30-90 minutes depending on the size and complexity of the abscess location.
The LIFT technique must be performed by colorectal surgeons with direct expertise because they have more surgical experience and understand the characteristics of anal abscesses better, allowing for more effective treatment planning. In cases where patients have undergone 2-3 surgeries without complete cure, doctors will recommend an initial MRI diagnosis to help ensure accurate treatment and increase the chance of success.
Advantages of the LIFT technique
- Some patients can undergo the procedure under local anesthesia, while others may require spinal anesthesia (epidural block) before surgery. Overall, the pain during surgery is less than that of hemorrhoid surgery.
- The wound heals quickly, with a recovery time of about 1-2 weeks before patients can return to normal work.
The chance of recurrence depends on the patient’s physical condition and the complexity of the disease. However, proper self-care after surgery, strict adherence to the doctor’s instructions, and allowing the wound to heal fully before returning to work can significantly reduce the risk of recurrent anal abscess.
