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Anal Abscess

Overview
Anal abscess is a disease that causes pain in the anal area due to infection in small glands in the anal wall. The internal anal valve (sphincter ani internus) functions to prevent infection from the intestinal cavity to the tissue around the anus (perianal). However, if the infection from the intestine manages to penetrate this valve, the spread of infection can reach the perianal tissue and cause an anal abscess.
Abscesses that occur often appear in the form of pus-filled blisters and swelling in the anal area.

When touched, this swelling can feel warm and reddish in color. But in the abscess that is located deep, sometimes it cannot be seen or palpated. Based on the location of the abscess due to the spread of infection, the anal abscess can be distinguished as follows:
  • Perianal abscess (the most common type of anus abscess).
  • Ischiorectal abscess is in the postanal cavity.
  • Abscess in the supralevator cavity.
  • Abscess in the intersphincter cavity.
Symptoms
Symptoms of anus abscess that appear in patients vary depending on the location of the appearance of an abscess. If an abscess occurs in the perianal area, the symptoms that appear are:
  • Continuous pain in the anus, feels piercing, and gets worse when sitting.
  • Skin irritation around the anus is accompanied by redness, swelling and hardening of the skin.
  • Pus out of the anus.
  • Constipation and pain caused by bowel movements.
In abscesses that occur in the deeper anal region, such as the supralevator abscess, symptoms that can appear include: Fever, Cold and Unwell.

In some cases of anus abscess which is located deep, sometimes even only symptoms of fever appear so that it is quite difficult to diagnose and require MRI assistance or CT scan

Cause
The cause of anus abscess in a person can vary. However, this condition can generally be caused by the following:
  • Infection of the anal fistula (a small gap that forms on the skin in the anal canal).
  • Sexually transmitted infections.
  • Blockage of the anal gland.
 Person can get an anal abscess more easily if:
  • Suffering from inflammation of the diverticulum.
  • Take anti-inflammatory drugs, such as prednisone.
  • Become a recipient of anal sex.
  • Has diabetes.
  • Inflammation of the pelvis.
  • Inflammation of the digestive tract, such as Crohn's disease or ulcerative colitis.
Diagnosis
Anal abscesses, especially perianal abscesses that do not cause systemic symptoms, can be diagnosed through tracing symptoms and examining the anus condition. To help with the diagnosis, the doctor will also examine the related conditions, for example:
  • Sexually transmitted infections.
  • Inflammatory diseases of the digestive tract.
  • Diverticulum disease.
  • Rectal cancer.
In patients suspected of having an internal anal abscess, such as a superelevator abscess, a diagnosis can be made with the scanning method. Among others are ultrasound, MRI and CT scans. There are also a number of complex cases of anal abscesses that present systemic symptoms. To help diagnose complex anal abscesses, endoscopy can be examined. The aim is to see abscesses and fistulas, and determine their location, spread and size.

Complications
If not treated properly, an anus abscess can cause complications as follows:
  •  Fistula
  • Bacteremia (bacteria entering the circulatory system) and sepsis, and the spread of infection from the anus to other organs.
  • Faecal incontinence.
  • The abscess becomes malignant.
Treatment
The presence of an abscess in the anus indicates that the infection is severe enough and requires surgical treatment. However, during the surgical preparation stage, an anus abscess patient can be given antibiotics. Surgery to treat an anal abscess needs to be done as soon as possible because delaying surgery can cause chronic tissue damage.
The surgical methods that can be done to treat an anal abscess include the following:
  • Surgery for perianal abscess. Abscesses need to be removed surgically before they rupture and cause complications. Unlike other surgeries, anus abscess surgery does not require emptying the digestive tract. Before surgery, the patient will be given local anesthesia first. Surgical abscess is done by making incisions in the abscess area, followed by removing and drying pus from the abscess. The incision made is usually enough with a small incision to reduce the risk of fistula formation. Pus removed from the abscess is then analyzed to find out the type of bacteria that causes the infection. After surgery, the incision is closed with an iodine-containing antiseptic gauze. After 24 hours, the patient is required to soak his buttocks in water containing medicines 3 times a day, and once every time he defecates.
  • Surgery for supralevator, ischiorectal, and intersphincter abscesses. The third principle of surgery is almost the same as surgery in cases of perianal abscesses. However, surgery for supralevator abscess, ischiorectal and intersphincter requires a more complicated process because it is located inside, and must be done in the operating room. To remove pus from an abscess, an incision is made in the area that has the greatest swelling. After an incision is made, pus is released through a small tube and is assisted by pressing on the abscess so that the pus can come out maximally. For this surgery, the patient can be given local anesthesia or general anesthesia if deemed necessary.
  • Surgery and treatment of fistulas. Fistula is one of the complications that can arise due to abscess. Fistula surgery can be performed together with abscess surgery. However, sometimes a new fistula appears several weeks to a few months later, so surgery for the fistula is performed separately with abscess surgery.
Some complications that can occur after surgery for abscesses and fistulas include:
  • Infection
  • Anal fissure.
  • Reappearance of abscess after surgery.
  • Scars on the incision area.
To help treat postoperative abscesses and reduce the risk of postoperative complications, patients can be given several types of drugs, such as:
  • Patients can be given antibiotics before and after an abscess surgery. The antibiotics given are adjusted to the bacteria that causes abscesses that have been diagnosed first through bacterial culture. Some types of antibiotics that can be given include ampicillin (either given alone or in combination with sulbactam), imipenem and cilastatin, cefazolin, and clindamycin.
  • Often before and after an abscess surgery, the patient will experience pain and discomfort in the abscess area. Therefore anelgesic drugs can be given to relieve the pain. Examples of painkillers that are often given are
  • This drug can help provide a synergistic effect if given together with meperidine. In addition, antiemetics can eliminate the feeling of vomiting arising from the side effects of medication that appears. An antiemetic example that can be given is promethazine.
After surgery and treatment, patients are required to carry out routine control to the doctor concerned for 2-3 weeks. This consultation aims to monitor surgical wound healing and control the possibility of fistulas appearing in patients. Death from abscesses and complications of abscess surgery are quite rare. However, it should be borne in mind that fistulas can be formed sometime after pus abscess is removed. In addition, complications can also arise due to surgery. Therefore, postoperative control is very important.




• George BD. Anal and perianal disorders. Medicine. 2007;35(3):147-52. • Perianal Abscess Drainage - Michigan Medicine - University of Michigan • Anorectal Abscess and Fistula - St. Joseph Mercy Ann Arbor • Neurosurgery (2018). Brain Abscess. • NHS Choices UK (2016). Health A-Z. Brain Abscess. • Rickard MJ. Anal abscesses and fistulas. ANZ journal of surgery. 2005;75(1-2):64-72. • NIH (2017). MedlinePlus. Brain Abscess. • Sud A, Khan A. Benign anal conditions: haemorrhoids, fissures, perianal abscess, fistula-in-ano and pilonidal sinus. Surgery (Oxford). 2014;32(8):421-6. • Wint, et al. Healthline (2017). Brain Abscess.

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