Anal abscess or perianal abscess is a condition that most people are not very familiar with, but in fact, it is a common disease, no less than other colorectal and anal diseases. Although the symptoms in the early stages are not severe, it causes considerable pain and suffering. Most patients often feel embarrassed and hesitate to see a doctor because they mistakenly believe this disease is caused by uncleanliness. Dr. Theerasanti Tantitemit, a colorectal and anal specialist surgeon at Phyathai 2 Hospital has provided knowledge and explained various aspects about anal abscess as follows..
“Normally, the human body has about 8-10 mucus-producing glands (Anal glands) located around the anal margin about one centimeter inside the anus. If these glands become blocked and infected, they turn into an internal abscess. In more than 50% of cases, the abscess cannot burst on its own and requires surgery to remove it. The exact cause of anal abscess is unclear. To make it easier to understand, 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 increase the risk of developing an anal abscess.”
Early symptoms.. risk of anal abscess
Patients often experience swelling and pain around the anal margin continuously, even when not having a bowel movement. It can be suspected that there is an anal abscess inside the anus. Patients usually feel more pain during defecation. Some may have a fever or pus discharge in cases of chronic anal abscess.
Who is at risk of anal abscess?
People who have frequent bowel movements 3-4 times a day are more at risk of developing anal abscess. It is mostly found in younger people rather than the elderly because the mucus-producing glands in older adults tend to 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 compromised immunity, such as those with diabetes, liver disease, immunodeficiency, or the elderly, anal abscess can be particularly dangerous because the abscess may spread to cause bloodstream infection. However, most patients feel severe pain and seek hospital care before the condition becomes that serious.
Anal abscess vs hemorrhoids (treatment) are different
For hemorrhoids, about 10% of patients require surgery because it can be treated with behavioral modification, rubber band ligation, or injection. However, for anal abscess, to achieve a complete cure, patients should undergo surgery performed by a specialist for the best outcome.
Concerns commonly faced by patients with anal abscess..
- Fear of not being completely cured and needing multiple surgeries because the abscess opening does not close properly, creating a tunnel from one point to another.
- Fear of fecal incontinence after surgery due to excessive removal of sphincter muscles.
Because of this, some patients with chronic anal abscess avoid seeing a doctor, enduring pain that disrupts daily life. If left untreated for about 15 years or more, it may increase the risk of cancer. It is best for patients to see a specialist for proper diagnosis and treatment.
Surgical treatment for anal abscess… helps reduce concerns
- Traditional surgery involves slightly cutting the anal sphincter to allow the pus to drain completely. This method offers a 90-100% chance of cure but may cause side effects if the surgeon is inexperienced and removes too much sphincter muscle, leading to difficulty controlling bowel movements after surgery.
- Sphincter-sparing surgery, known as the LIFT technique (Ligation of intersphincteric fistula tract technique) offers an 80-85% chance of cure and has the advantage of preserving bowel control as before surgery. The operation takes about 30-90 minutes depending on the size and complexity of the abscess location.
Dr. Theerasanti recommends “Although general surgeons can perform anal abscess surgery, for the most accurate diagnosis and appropriate treatment, it is better to see a colorectal and anal specialist. Specialists have extensive surgical experience and a deep understanding of anal abscess characteristics, allowing them to plan more effective treatment. In cases where patients have had 2-3 surgeries without a cure, the doctor will recommend an initial MRI examination to help ensure precise treatment and increase the chance of success.”
Regarding the surgical procedure, some patients can have local anesthesia, while others may require spinal anesthesia (epidural block) before surgery. Overall, the pain during surgery is less than hemorrhoid surgery. The LIFT technique results in faster wound healing and a recovery time of about 2-3 weeks before returning to normal work. Traditional surgery may cause some discharge for about a month due to lymphatic fluid leakage.
The chance of recurrence depends on the patient’s physical condition and the complexity of the disease. The doctor advises that proper self-care after surgery, strict adherence to medical advice, and allowing the wound to heal fully before returning to work can help reduce the risk.
