Perianal abscesses: When pain below the waistline won't ease

Perianal abscesses are the most common type of abscess in the area around the anus. They often start right at the edge but can quickly dig deeper into surrounding tissues if you try to tough it out.

Dr Mark Siboe, a general and laparoscopic surgeon, says he sees this problem all the time.

"In a month, I operate on 10 patients and refer more than five more to government facilities due to cost implications. Of these, 60 percent are men," he shares.

When it comes to butt abscesses, Dr Siboe adds, "men aged between 30 and 50 are affected by cryptogenic abscesses (where the source of infection is unknown or cannot be identified after thorough investigation) twice as often as women."

As for the cost of treatment? Dr Siboe explains that it really depends on where you go. "Generally, it can be as low as Sh30,000, but as high as Sh120,000–Sh150,000, especially if the case is complicated."

So, why do some people develop abscesses while others don't? The answer lies in risk factors. Anything that weakens your immune system or slows down wound healing increases your risk—think cigarette smoking, HIV, taking immunosuppressive drugs, or living with diabetes.

Add obesity, a sedentary lifestyle, or chronic constipation, and your risk goes higher. Crohn's disease—a chronic inflammatory bowel disease that can affect any part of the digestive tract but often strikes the intestines—is another cause of perirectal abscesses.

Early signs

Catching a perianal abscess early makes all the difference. Dr Siboe explains, "The early warning signs include intense anal pain, swelling, redness, fever, and a tender, fluctuant mass near the anus. The pain worsens with sitting or bowel movements."

On the other hand, diagnosis is straightforward but thorough. It starts with your medical history and a clinical exam (including a digital rectal exam). For deeper or more complex cases, you might need imaging like an MRI, along with blood tests to check for infection.

When it comes to treatment, urgency matters. "The treatment option is prompt surgical incision and drainage," says Dr Siboe. "Once it's done, there will be no need for antibiotic administration unless certain medical issues necessitate the use."

And after surgery? Wound care is crucial. "The wound should be left open without applying a dressing. We instruct patients to use either a sanitary napkin or a diaper to manage the drainage, to apply an ice pack to the area on the day of the surgery, and to take a sitz bath in warm water several times a day starting on postoperative day one," he explains.

Recovery involves regular sitz baths, pain management, and sometimes further wound checks. Patients are encouraged to manage pain, use laxatives or fibre supplements to avoid constipation, and stick closely to post-op instructions. Complete healing can take up to eight weeks.

Bursting the myths

While perianal abscesses have a pesky habit of returning, there are steps to help prevent them. Dr Siboe recommends ensuring the abscess is completely drained the first time, controlling blood sugar in diabetic patients, treating Crohn's disease, eating a high-fibre diet, keeping the area clean, and following up with your doctor to rule out fistulas.

"Because of a high recurrence rate, all patients need to be followed up until there is complete healing, which may take up to eight weeks," he notes.

Many patients, unfortunately, make avoidable mistakes—delaying care, self-treating with ineffective remedies, skipping follow-ups, misusing antibiotics, or not managing chronic illnesses like diabetes. All of these can spell trouble.

Despite how common perianal abscesses are, plenty of myths persist. Dr Mark Siboe points out, "Some common misconceptions about abscesses are that they can resolve without treatment, antibiotics alone are sufficient, poor hygiene is the main cause of abscesses, and packing always helps."

However, the fact is without drainage, infection worsens. Surgery is the cornerstone. Gland infection is primary cause of abscesses and packing can increase pain without improving outcomes.

In the end, how soon you seek treatment can make all the difference. As Dr Siboe puts it, "Patients with early diagnosis and treatment tend to have good outcomes, but those who have a delay in treatment usually have a prolonged hospital course, need for repeated surgical treatments, and are at higher risk of recurrence."

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