Perianal Abscess Surgery

Diagnosis of perianal abscesses

First, you will come in for a consultation with one of our colorectal surgeons. They will start by diagnosing your condition with a medical history and physical examination. During the examination, a healthcare professional may do a digital rectal exam to feel for any fluctuant masses that may indicate an abscess. These initial steps are often enough to make a diagnosis.

Laboratory tests may be done to check for elevated white blood cell counts, which can indicate an infection, but a normal count doesn’t rule out an abscess. MRI is especially useful in diagnosing perianal abscesses, especially in immunocompromised patients, as it can show soft tissue detail.

Anorectal ultrasound can be used for diagnosis, but is often poorly tolerated due to the pain involved. A combination of physical examination, laboratory tests and imaging studies is the best approach to diagnose perianal abscesses and plan treatment.

Preparation for perianal abscess surgery

Preparation for perianal abscess surgery involves several key steps to ensure the procedure goes smoothly. A preoperative assessment by the surgical team and anaesthetist is essential to assess your overall health and determine the best approach for anaesthesia. This assessment helps identify any potential risks and tailor the surgical plan accordingly.

You will most likely be required to fast from midnight the night before surgery to minimise the risk of complications during anaesthesia. Signing a consent form is also necessary, which means you understand the procedure and agree to the treatment. These preparations are crucial for the success of the surgery and your safety.

Anaesthesia options

Various anaesthesia options are available to manage pain and discomfort during perianal abscess surgery. Local anaesthesia is often used for suitable smaller, less complicated abscesses, while general anaesthesia is chosen for larger or complex cases.

The procedure

The primary treatment for a perianal abscess is a procedure called incision and drainage, aimed at relieving the infection and preventing further complications. During this minor surgery, a small incision is made to release the built-up pus, which helps reduce pressure, ease pain, and promote healing.

To ensure effective drainage and lower the risk of fistula formation, the incision is often made in a cruciate (cross-shaped) pattern. In some cases, the surgeon may remove small skin flaps to improve drainage and support the healing process.

The procedure is typically straightforward, with patient safety and comfort being top priorities throughout. After drainage, a bandage is applied, and stitches are usually not necessary.

Post-surgery care

Post-surgery care is important for recovery from perianal abscess surgery. You will experience some discomfort, which may get worse before it gets better. Painkillers are prescribed to manage this, and it’s important to take them as directed to get the best pain relief.

Hygiene is key post-surgery. You should wash the area after passing stool to keep the wound clean. Wearing a gauze pad or mini pad can help with drainage from the wound. Follow-up visits are not usually necessary, but you should be aware of any complications and seek medical advice if needed.

Wound care

Wound care is crucial for healing after perianal abscess surgery. You shouldn’t use soaps or perfumed products when cleaning the area to avoid irritation. Finger irrigation of the wound should be done once or twice a day to keep it clean.

Bathing the wound in warm water daily can help with healing and pain relief. Using alcohol-free wipes after bowel movements is recommended to keep the area clean and prevent infection.

Back to normal activities

Returning to normal activities after perianal abscess surgery depends on the individual’s recovery. You should avoid heavy lifting and strenuous exercise for at least the first week. Listen to your body and follow your healthcare provider’s advice on when to go back to normal activities. Take it slow with daily tasks to not hinder the healing process.

While the recurrence of a perianal abscess is low if treated properly, complications can still happen. One of the complications is the formation of an anal fistula which can occur if the abscess bursts or is not fully treated. Up to 8% of patients may develop anal fistulas after an abscess.

Monitoring for signs of more serious infections and other complications is important. Symptoms such as severe pain, fever or significant drainage should be seen by a doctor immediately. Being vigilant and seeking timely medical attention helps minimise risks and ensures a smoother recovery.

Long-term recovery

Long-term recovery from perianal abscess surgery takes about 3-4 weeks, during which you might experience mild to moderate discomfort. Pain usually improves within a few days, and patients can gradually go back to their normal activities.

Most people can then also go back to work, depending on the type of work and their comfort level. In most cases, a follow-up appointment is not necessary unless issues arise, so patients can focus on their recovery without frequent hospital visits.

Prevention tips

Preventing future perianal abscesses involves good hygiene in the anal and genital areas. Managing underlying medical conditions such as diabetes or inflammatory bowel disease can also reduce the risk of developing abscesses and may require antibiotics.

Incorporate these prevention measures in your daily routine to avoid the pain and discomfort of perianal abscesses. Being proactive and aware of your health can reduce the risk of recurrence.