1 May 2017

Take 5: Perianal abscesses

Clinical

A perianal abscess can sometimes be quite difficult to detect.

While the typical symptoms of perianal abscess are swelling, redness and fluctuance, sometimes the abscess has no telltale signs.

Perianal abscesses are a collection of pus in the tissue around the anus. It is usually caused by a blocked anal gland that leads to infection, which tracks out to the perianal skin.

“An abscess sometimes can be quite difficult to see,” says Dr John Lumley, a colorectal surgeon and the director of colorectal diagnostics.

“[Patients] may have the typical pain but they may not have the typical swelling and redness because they are a little bit deeper.

“Often they are impossible to examine digitally. They are just too sore.

“If you can see the typical signs … well that’s clearly an abscess and usually, at that stage, there is a lot of pus there and they will need drainage.

“But in the early presentations where they don’t have this swelling throbbing pain often there is very little to see.”

In this video, Dr Lumley discusses:

– What history should be taken with these patients?

– What should be sought on examination?

– Any investigations that should be performed?

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