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Antibiotics for Anorectal Abscess


Anal Rectal Abscess Perianal Abscess Perirectal Abscesses Antibiotics Treatment

Anorectal Abscess

Anal Abscess and Fistula

Microbiological Analysis of Perianal Abscess and its Treatment Anorectal Abscesses Fistulas And Pilonidal Disease

Trouble starts when an abscess near a patient's anus bursts through to his skin. It probably originated in an anal gland, and may communicate through a tiny opening with his anal canal, at the pectinate line. A connection betweeen the skin and the anus (a fistula) is the reason why about half of these abscesses recur, or discharge persistently on to the perianal skin as chronic fistulae in ano. Abscesses (with no opening to the skin), sinuses (with an opening to the skin, but not to the anus), and fistulae (with openings to both) are thus part of the same disease process. Most abscesses settle by discharging spontaneously, or being drained, but a serious life-threatening infection can sometimes spread through a patient's perineum, or deeply into his pelvis.


Perianal or anoractal abscess is a localized collection of pus near the anus close under the skin, or deeper adjacent to the rectum. Perianal abscess is a common condition. It is more common in patients with Inflammatory Bowel Disease (in particular Crohn's disease), Diabetes Mellitus and AIDS. Anorectal abscess leads to fistula in-ano formation on discharge to skin or after surgical drainage. It is a very painful condition.

Its exact incidence is unknown. A fistula-in-ano complicates 30-50% of perianal abscesses.

Perianal abscess occurs as a result of a blocked anal gland that subsequently becomes infected. These are more common in patients with Diabetes Mellitus, Crohn's disease, and patients who are immuno compromised for any reason.

Anoractal abscess could be:

  • Perianal
  • Ischiorectal
  • Submucous
  • Pelvi-rectal

PERIANAL ABSCESS. It is one of the most common sites for abscess formation in this region. It is present in 60% of the patients. It occurs following suppuration of an anal gland or thrombosed pile. It is present in the area of subcutaneous part of external sphincter. It is seen in patients of all ages. It is diagnosed easily clinically. It can be treated effectively by incision and drainage.


Perianal Abscess

ISCHIORECTAL ABSCESS. It is the next common abscess in occurence than perianal abscess. It is seen in 30% of patients. The infection of this area occurs due to lateral extension through external anal sphincter. The infection may spread through lymphatic or haematogenous route. The ischiorectal space filled with fat is vulnerable to infection because of its poor blood supply. The speed of abscess formation is very quick.


Ischiorectal Abscess

The ischiorectal space is connected posteriorly with the opposite side. The abscess can extend to the other side if not treated in time. It may lead to horse shoe abscess formation. It presents with severe constitutional symptoms such as high fever and throbbing pain. It is seen more commonly in men than women.

It is treated surgically through cruciate incision and whole of abscess is drained. If it is associated with internal opening into the anorectum, the treatment of fistula-inano is performed.

SUBMUCOUS ABSCESS. It is a less common type of abscess of this area. It is seen in only 5% of patients. It may occur following an injection for the treatment of haemorrhoids. It is easily diagnosed clinically and can easily be treated by incision and drainage of pus.

PELVI-RECTAL ABSCESS. It is collection of pus between pelvic peritoneum and levator ani muscle. It is practically a pelvic abscess. It follows appendicitis, salpingitis, Crohn's disease, diverticulitis and perameteritis. It may follow over enthusiastic use of probes to follow the fistula track as well.

Anal Abscess Symptoms

The symptoms of an anal abscess are rather distinctive once closely paid attention to.
  • Painful swelling in perianal area

  • Inability to sit on chair

  • Difficulty in micturition

  • Acute retention of urine

  • Fever (swinging pyrexia)

  • Rigors

  • Painful defecation

  • Chills

  • Stool incontinence

  • Rectal bleeding

  • Constipation

  • Fever

The first anal abscess symptom / sign is usually escalating pain in the anal area or buttocks and a lump or swelling in the anal area.

Painful bowel movements, lower abdominal pain, and fatigue are anal abscess symptoms that also then usually follow shortly.

The symptoms of anal abscess that suggest the infection is starting to go systemic include fever, fatigue, and night sweats, along with severe pain from any rolling or change of position.

Another symptom that you are suffering from an anal abscess rather than a hemorrhoid are that anal abscesses usually worsen quickly, within one or two days, while hemorrhoids take longer to develop.

In addition, if you are suffering from an anal abscess, most standard hemorrhoid treatments will be ineffective against it's symptoms.

CLINICAL COURSE

Anorectal abscess is such a painful condition that patient almost always rushes for early treatment. If left alone, the pus is likely to discharge to the skin. It leads to formation of fistula-in-ano in many cases (30-50%). The fistula does not heal spontaneously. Surgical treatment is always required and is successful. Neglected fistulas can result in repeated abscesses and multiple openings.

Abscess that is deeper, involving the upper portion of the anal sphincters (further away from the anus) is more complex and requires specialist treatment to avoid the complication of faecal incontinence if the external sphincter is damaged.

Home remedy or doctor treatment for anal abscesses?

While there are a few home remedies to relieve the immediate symptoms of an anal abscess, if you have any reason to suspect that an abscess is the source of your problems, you should see a doctor immediately.

Anal abscesses are not always easy to diagnose even with the facilities of a hospital, so the earlier you go in the better.

Always go to the emergency room immediately should you experience high fever, shaking chills, significant pain, extreme pain or inability with bowel movements, or persistent vomiting. These are all extreme anal abscess symptoms that can indicate the infection has entered your bloodstream, and serious damage or death may result.

If you are not experiencing symptoms that extreme, you may be able to make a more normal appointment to see your usual physician within a few days.

Anal Abscess Treatment

The treatment for abscesses of any kind, including anal abscess, usually involves a surgical procedure to drain the abscess cavity, followed by a round of antibiotics to eliminate any lingering infection, and pain management medication to make you as comfortable as possible.

Antibiotics have a difficult time working on an anal abscess, or any abscess, prior to drainage because the collection of pus lowers the pH so far that no antibiotic can work, which is why a two pronged approach is used in treatment.
Antibiotics for Anorectal Abscess chloramphenicol and metronidazole.

You may also need to get an update on your tetanus booster to fully protect against a secondary complication.

The incision that is made to drain the abscess will not be stitched shut, but rather left open so that the abscess can continue to drain over a few days.

If an abscess is stitched shut, it stands a good chance of reforming in the closed cavity, so instead the cavity is packed with sterile bandages and carefully monitored for recurring infection instead.

SURGICAL TREATMENT is the only method for effective treatment of ano-rectal abscesses. It can be drained under general anesthesia. Surgery is undertaken immediately when the patient is fit and ready for anesthesia. One should not wait for abscess to become fluctuating because then it is too late. It should be drained and left open when it is still indurated. A cruciate incision is made for continuous and uninterrupted drainage. There is little role for antibiotics unless the patient is systemically unwell.

After surgery, your doctor will want to perform another round of blood and urine tests to ensure your full recovery.

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