Definition
An anal abscess is a cavity, usually filled with pus and inflammatory fluid, which is located in the area of the anus and usually causes severe discomfort when sitting or walking.
Cause and forms of the anal abscess
Unlike an anal fistula, an anal abscess does not cause the formation of a connecting duct from the anus to other organs. The abscess is closed and has no opening. Depending on its stage, it contains pus or inflammatory fluid, which increases in quantity and causes the abscess to swell in an unopened state.
The anal abscess is usually a disease of the glands located in the area of the anus, which are also called proctodeal glands. Inflammation of these glands can lead to a corresponding abscess formation. In addition, an anal abscess in the area of the anus can also result from the conduction of inflammation and diseases of internal organs.
Examples of this would be
- Appendicitis or a
- Inflammation of an unnoticed bulging of the bowel (diverticulosis), also known as diverticulitis. In extreme cases, a steady spread of this inflammation can lead to abscess formation. Chronic inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis can also lead to such a formation.
In addition to the acquired causes described here, congenital malformations of the rectum and anus can also lead to a painful anal abscess in the area of the anus. Depending on the location of the abscess, different forms are distinguished:
- Anal abscesses located just under the skin are also called subcutaneous abscesses. – If the anal abscess is formed by wiping the epidermis and the mucosal layer, the abscess formation is also called submucous abscess. – If the anal abscess spreads between the anal sphincter muscles, it is called an intermuscular abscess,
- When the anal abscess spreads from the ilium to the anus is called an ischiorectal abscess. – There are also pelvirectal and ileorectal abscesses.
Symptoms of anal abscess
Patients who have a developing anal abscess usually describe moderate to severe pressure pain in the area of the abscess formation, especially when sitting. Also during bowel movement, sometimes very strong pain in the area of the anal abscess is described. In many cases, the anal abscess can be seen and palpated in its place of origin.
If pressure is exerted on the swelling, severe pain is also reported. . In some cases, general symptoms such as worsening of the general condition or fever are described.
It can also happen that the abscess opens up on its own and empties the corresponding purulent fluid. Preliminary stages of complete evacuation are also described and are usually described as a chronic weeping condition. Acutely inflamed anal abscesses are very painful.
Pain in the area of the rectum and anus is usually accompanied by fever, fatigue and a general feeling of illness. Due to the inflammation, the skin in the anal region is reddened and swollen. When the inflammation has subsided and the pus has emptied to the outside, the pain subsides for the time being.
At this stage the inflammation causes severe itching and irritation of the skin around the anus. Apart from the patient interview, the physical examination is the main part of the diagnosis of an anal abscess. In addition to the rectal examination with the finger, the anal abscess can also be examined by endoscopy of the rectum.
It is important to differentiate between an anal abscess and a fistula. The second condition would be characterized by a corresponding gait. In order to make this duct visible, either an ultrasound can be used for the examination or a colour injection can be used to see whether a duct is present.
In most cases, a blue colour is injected into the area around the swelling and it is seen whether the colour emerges elsewhere. This would indicate the presence of a fistula tract; the treatment would therefore be different from that of an anal abscess. To diagnose an anal abscess, the doctor examines the anal region.
Doctors who deal specifically with diseases of the rectum and anal region are called proctologists. If an anal abscess is suspected, the family doctor can issue a referral. In the case of small abscesses, one can also consult the dermatologist. If the abscess has to be removed surgically, a surgeon is the right person to contact and is responsible for further treatment.
