Peri-Rectal Abscess and Anal Fistula Treatment

Peri-Rectal Abscess and Anal Fistula TreatmentA peri-rectal abscess is an infected boil-like swollen pocket filled with pus found near the anus or rectum.  Most anal abscesses are a result of infection from small anal glands. It may be red in color and warm to the touch. A peri-rectal abscess can lead to the formation of an anal fistula which is a painful infected tunnel that runs from inside the anus to somewhere in the skin around it. An anal fistula can be present with or without an abscess, but the two are commonly associated with one another and can be treated simultaneously if occurring at the same time.

Indications: 

A peri-rectal abscess is an infection and should not go without treatment. Antibiotics alone will not usually cure an abscess and an incision and drainage is usually required. The size and involvement of the abscess with surrounding tissues will determine if it can be safely drained in the clinic setting or if surgery under anesthesia is required.

Surgery is almost always necessary to cure an anal fistula that is present with or without an active abscess.

Pre-Op Evaluation and Prep: 

Patients will have a physical exam by the surgeon to discuss symptoms and determine if surgery is needed. You may need to take or continue antibiotics before surgery. Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems.

You may be instructed to stop taking some medications before surgery. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements. For more information related to preparation for surgery click here.

Procedures: 

Incision and Drainage of Peri-Rectal Abscess: A surgical incision and drainage is the most common treatment for all types of anal abscesses and is usually successful. Abscess drainage may be performed in the office under local anesthetic or in an operating room under general anesthesia. The surgeon will make an incision on the skin near the abscess to drain it. The skin may be left open to heal and covered with a gauze dressing. If the abscess is associated with an anal fistula, a drain may also be placed to allow the fistula tract to heal from the inside out.

Anal Fistulotomy: The surgical procedure for treating an anal fistula involves locating and opening up the fistula  tract, connecting the internal opening within the anal canal to the external opening and creating a groove that will heal from the inside out. A seton drain may be placed if we are unable to perform a fistulotomy.

Recovery:

This varies from patient to patient. Most patients feel relief from a painful abscess almost immediately. Many patients return to desk type work the next day. You will probably have lifting restrictions for at least 48 hours. It is rare for patients to need extended time off of work.

While recovery instructions may be tailored to individualize a plan of care based upon your specific needs, these instructions are common following abscess drainage and anal fistulotomy surgery:

  • You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home.
  • When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.
  • Avoid fried foods, milk products and citrus juices for around one day after your surgery. Suggestions for foods to eat include soup, sandwich, pasta, potatoes, toast, and applesauce.  
  • You may place a hygiene pad in your underwear to collect any drainage you have.  We recommend having gauze pads or hygiene pads available as needed for the first week after the procedure.
  •  If you have a drain placed, a dressing will still be taped over your incision. Gauze or hygiene pads should still be available to use for drainage.
  • You will probably be instructed to shower 24 hours after your procedure.  
  • Starting the morning after your procedure, you will be instructed to take a sitz bath at least three times a day and after a bowel movement.  This is just sitting in a tub of warm water for 10-15 minutes.  Warm (sitz) baths increase blood flow and help relax the muscles in the area of your procedure in addition to keeping the area clean.
  • Although you are likely to feel completely numb for several hours after the procedure, you will be given a prescription for pain medication following your procedure. The recovery nurse will discuss a pain control plan with you specific to you and your needs and we recommend you follow the pain control plan for at least the first few days following your procedure. Make plans to avoid driving for at least 4 hours after taking a prescription pain pill. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.
  • It is often suggested to start taking a stool softener the day following your procedure. You will want to continue this regimen as long as you are taking narcotic pain medications. You will be instructed to take Miralax starting the day after surgery and continue to take that while on narcotic pain medication.
  • In addition to the stool softener it is recommended to include fiber in your diet.  Eat two servings of a high fiber fruit or vegetable with each meal.  You can also take a fiber supplement such as FiberCon tablets.  Start with two tablets a day and you can take up to six tablets a day.

For additional information for after surgery preparation click here.

To Schedule an Appointment

To find out more about Peri-Rectal Abscess and Anal Fistula services offered at CSA Surgical Center in Columbia, Missouri please call Columbia Surgical Associates at 573-443-8773 and schedule an appointment.