An anorectal abscess is a pus-filled cavity caused by bacteria invading a mucus-secreting gland in the anus and rectum.

• Bacteria infect a gland in the anus or rectum and create an abscess.
• The infection produces pus and causes pain and swelling.
• The diagnosis is based on an examination and the results of imaging tests if needed.
• Cutting and draining the abscess is the best form of treatment.

An abscess may be deep in the rectum or close to the opening of the anus. An abscess develops when bacteria invade a mucus-secreting gland in the anus or rectum, where they multiply. Although the anus is an area that is rich in bacteria, infection generally does not occur because the internal sphincter acts as a barrier and blood flow to the area is rich. When infection does occur, it usually is caused by a combination of different types of bacteria. An abscess can cause substantial damage to nearby tissues and may lead to fecal incontinence. People who have Crohn's disease are at particular risk of abscesses. Sometimes, abscesses are a complication of diverticulitis or pelvic inflammatory disease.

Symptoms and Diagnosis

Abscesses just under the skin can be swollen, red, tender, and very painful. Abscesses deep in the rectum often cause fewer symptoms but may cause fever and pain in the lower abdomen. A doctor can usually see an abscess if it is in the skin around the anus. When no external swelling or redness is seen, however, a doctor can make the diagnosis by examining the rectum with a gloved finger. A tender swelling in the rectum indicates an abscess. If the doctor suspects a deep abscess, magnetic resonance imaging (MRI), computed tomography (CT), or ultrasonography can determine the extent and location.

Treatment

Antibiotics have limited value except for people who have a fever, diabetes, or an infection elsewhere in the body. For an abscess just under the skin, treatment consists of cutting into the abscess and draining the pus after a local anesthetic has been given. For a deeper abscess, the person is usually hospitalized, and the abscess is drained in the operating room after general anesthesia has been given. Even with proper treatment, in about two thirds of people, an abscess leads to the formation of an abnormal channel from the anus or rectum to the skin (anorectal fistula).

Last full review/revision October 2007 by Parswa Ansari, MD; Norman Sohn, MD