Perineal Abscess

An abscess is a sac filled infection. The perineum is the area between the anus and the scrotum in the male and between the anus and the vulva (the labial opening to the vagina) in the female. The size of the abscess varies. If it remains open and begins draining, it can form a fistula. A fistula is a tract that drains the abscess to the surface. The peak incidence of this problem is in the third to fourth decades of life. Men are affected more frequently than women.

CAUSES

There are numerous causes for this type of infection.

In women

  • The spread of cancer from pelvic organs such as the uterus and ovaries or the spread of infection from special glands located near the vagina.

  • Problems that occur at the time or soon after delivering a baby:

  • Infected lochia (the fluid that weeps from the vagina for a week or so after delivery of a baby).

  • Stool contaminating an episiotomy (a surgical procedure for widening the outlet of the birth canal to facilitate delivery of the baby and to avoid a jagged rip of the perineum).

  • Poor hygiene could all contribute to forming an abscess of the perineum.

In men

  • Infection of the prostate gland or the spread of cancer from the prostate.

In men and women

  • Complication of surgery to the rectum.

  • Diseases of the colon (such as Crohn's disease).

  • The spread of cancer from the rectum.

  • It is also more common when the immune system is depressed:

  • Patients receiving chemotherapy.

  • Patients with AIDS.

SYMPTOMS

Pain, swelling, and redness in the area of the abscess are the most frequent symptoms. The redness may go beyond the abscess and appear as a red streak on the skin. There is often a visible lump or a lump that can be felt when touching the area. Bleeding, pus-like discharge, fevers, and general weakness may also be present.

DIAGNOSIS

An examination by your caregiver will establish this ailment. A digital rectal exam, and in women, a careful vaginal exam, is sometimes necessary. Sometimes looking into your rectum with a special instrument is needed.

TREATMENT

Incision and drainage is one common treatment of an abscess. This can sometimes be done in an office, emergency department, or surgical center with a local anesthetic. For larger or deeper abscesses, an operation is required to drain the abscess. Antibiotics are sometimes used if there is cellulitis (infection of the surrounding tissue). Antibiotics are medications that kill bacteria germs. Antibiotics may also be used if there are immune problems or heart valve problems.

Packing of the wound is sometimes done to produce good drainage. Frequent sitz baths may be recommended to help the wound heal in from the base and sides so that the risk of continued infection and recurrence is reduced.

HOME CARE INSTRUCTIONS

  • If a gauze pack is used in the abscess, it can usually be removed in 2 to 3 days or as directed.

  • If one or more drains have been placed in the abscess cavity, be careful not to pull at them. Your caregiver will tell you how long they need to remain in place.

  • Use warm sitz baths 3 to 4 times per day and after bowel movements.

  • Keep the skin around the abscess clean and dry. Avoid cleaning the area too much or scratching.

  • Avoid using colored or perfumed toilet papers.

  • Use pain medication, antibiotics, or other medications that your caregiver tells you to use.

SEEK MEDICAL CARE IF:

  • You have problems having a bowel movement or passing your urine.

  • The gauze packing or the drain(s) come out before the planned time.

  • Swelling or pain in the affected area does not seem to be improving as expected.

  • You feel you have side effects from prescribed medication.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop problems moving or using your legs.

  • You develop severe or increasing pain.

  • Swelling of the affected area suddenly gets worse.

  • You have increased bleeding or passing of pus.

  • You develop chills or fever above 101° F (38.3° C).

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.