What is a perianal abscess?
The sudden appearance of a lump around the anus is a common phenomenon in life. The common causes are "getting angry", constipation, staying up late, sitting for a long time, etc. Patients or non-anorectal doctors (especially doctors in primary clinics) often diagnose hemorrhoids. Hemorrhoids are given infusions, oral medications and other treatments, but the effect is not satisfactory. The lumps often increase, the pain is aggravated, and even fever. . So besides hemorrhoids, what other diseases do lumps around the anus often cause? Let me talk about another common anorectal disease-perianal abscess. Perianal abscess is an acute purulent infection that occurs around the anus and rectum. The source of infection is at the junction of the anal canal and rectum in the anus. It is a tissue structure called anal sinus. The infection bacteria are mainly Escherichia coli in the stool. This disease is different from infections in other parts of the body. Its particularity is that once it occurs, there is basically no possibility of self-healing or drug cure. Therefore, misdiagnosis and treatment often happen, which not only wastes money, but also delays the condition. The age of onset of the disease is mainly young and middle-aged people aged 20-40, and it is more common in men.
How does perianal abscess form?
Although infections are prone to occur around the anus, there are all incentives. What is the cause of the onset of perianal abscess? By asking the medical history of some patients, we can get inspiration from leukemia, Crohn’s disease, tuberculosis, and diabetes. Weakness, decreased resistance and improper diet are the main causes of local infections. Many patients complained of irregular life before the onset of illness, lack of sleep, overwork, long-distance driving, excessive drinking, or excessive consumption of seafood, spicy, meat, etc.
What is the pathogenesis of this disease? There is a kind of tissue called anal glands in the perianal area. The glands are located in the anal sphincter. Its opening is in the anal sinus on the dentate line of the anus. The secretions of the anal glands enter the rectal cavity through the opening in the anal sinus to lubricate the intestine. Tao role. The disadvantage is that the opening of the anal sinus is upward like a pocket, and the dirt in the intestinal cavity is easy to stay here. After these dirt enter the anal sinus, it can be infected and cause anal sinusitis. The inflammation reaches the anal gland orifice and the anal gland duct. The anal glands spread, and finally enter the space around the anorectum through the lymphatic vessels, causing the soft tissues to infect and purify and form this disease.
How do you know that you have a perianal abscess?
The main symptom of perianal abscess is pain in the anus, followed by most patients who can feel a lump around the anus, but the lump is not obvious from the appearance of the skin around the anus, and some patients can clearly see the lump in the anus. If all patients do a careful digital anorectal examination, almost a harder mass can be palpable, with obvious tenderness.
Anal pain caused by perianal abscess is continuous and has nothing to do with whether to pass stool. When the pain is severe, restlessness, loud coughing, standing from a sitting position and other actions can cause pain to increase, especially when driving through a speed bump. Pain, accompanied by fever, causes loss of appetite, and symptoms such as difficulty in defecation. With this disease, different degrees of fever can occur. White blood cells increase. The degree of fever and white blood cell increase marks the depth and extent of the abscess, and is also one of the indicators to judge the severity of the disease.
Superficial perianal abscesses are generally easy to identify, but the patients themselves are easily treated as hemorrhoids, including some non-anorectal doctors at the grassroots level. For deep abscesses, it is more likely to be misdiagnosed because only fever is the main cause and anal pain is not obvious. The local manifestation of this kind of patients is not pain, but anorectal swelling, frequent and inexhaustible defecation, which is easy to be ignored. Even some patients with fever are treated as "shanggan" and antibacterial and anti-inflammatory treatments for bronchitis, but the effect is not good, and the disease is diagnosed after consultation. Some patients are diagnosed late, have extensive local necrotizing fasciitis, and systemic sepsis. Patients of this degree may need to be operated in stages, causing great physical and mental pain and a heavy economic burden.
Why should the perianal abscess be treated promptly?
As mentioned earlier, once a perianal abscess occurs, there is no possibility of self-healing and medication. Only surgery can cure it. Timely treatment of perianal abscesses can first prevent the infection from spreading to the whole body and form sepsis, which is life-threatening; second, it can prevent the infection from spreading to the surroundings, leading to "horseshoe-shaped" abscesses and forming complex anal fistulas; third, it can prevent the abscess from rupturing Later it becomes an anal fistula; fourth, it can relieve pain earlier; fifth, it prevents damage to the anal sphincter and affects anal function.
There are one-time operations and two operations for perianal abscess. What is going on?
Perianal abscess can generally be cured once, and two operations are mainly based on the following considerations: ⑴Combined with other serious medical diseases, the body cannot bear the pain and injury of one operation; ⑵In women during pregnancy, simple treatment to relieve symptoms, not easy to do complicated Surgical operation and complicated anesthesia; (3) Older age and weak body; (4) The internal ostium is difficult to determine, and the blind radical treatment causes great damage, and the chance of recurrence and formation of anal fistula after surgery is high; (5) The traditional method is used, first incision and drainage, and after the fistula is formed , The second stage is treated as anal fistula
We believe that unless the physical condition does not allow it, an operation should be taken as soon as possible to avoid the formation of anal fistula and then the operation, which can alleviate the patient's pain, save time and cost. As for whether there will be a recurrence after the operation, it is entirely due to the doctor's ability to accurately locate the direction of the internal mouth and sinus of the infection. If the positioning is wrong, the operation will be divided into two operations, and it is difficult to guarantee that there will be no recurrence after the operation.
How should perianal abscess be treated?
The principle of treatment of perianal abscess is that once the diagnosis is clear and the part has become pus, surgery should be done. However, for those who cannot be operated due to some special circumstances, conservative treatment can be temporarily performed. For example, the local infection is only manifested as an inflammatory mass, and it has not been successful. Pus, or abscess with leukemia, heart disease and other serious systemic diseases. Conservative treatment is mainly anti-inflammatory, divided into systemic administration and local administration. Anti-Gram-negative bacilli and anti-anaerobic drugs such as cephalosporins, ofloxacin, metronidazole, ornidazole can be used systemically. At the same time, it can cooperate with Chinese medicine. Chinese medicine treatment. Locally give Chinese medicines such as heat-clearing and detoxifying, promoting blood circulation and removing blood stasis for external washing or making ointment for external application, such as Qudu Decoction, Jinhuang ointment, and removing poison ointment. If the anal pain is severe, analgesics such as Dulanding, Qiantongding, Diclofenac Sodium Lidocaine, etc. can be appropriately selected.
The purpose of surgical treatment of perianal abscess is to thoroughly cut the abscess cavity and the internal opening of the source of infection, so that the pus can flow out, the wall of the abscess cavity will gradually fall off, and then the abscess cavity will be slowly filled by granulation growth, and finally the abscess cavity will be cured. During the operation, attention should be paid to determine the internal orifice accurately, the incision should be sufficient, the compartment in the abscess cavity should be opened, no dead space is left, the drainage is smooth, and the internal orifice is high, the suture-hanging operation should be performed.
When does a perianal abscess become an anal fistula?
If the perianal abscess is treated promptly and reasonably, it can be cured at one time without forming an anal fistula. Anal fistula usually becomes anal fistula under the following conditions: ⑴ The abscess ulcerated spontaneously after becoming pus, and did not undergo surgical treatment after the ulceration. (2) Only the surface of the abscess cavity was cut to drain the abscess, but the entire abscess cavity and internal opening were not cut. ⑶ The internal opening was not accurately positioned during one-time surgical treatment, or multiple internal openings were not completely discovered, resulting in failure of the operation and postoperative recurrence. ⑷The postoperative wound treatment is not in place in time, the skin is "bridging" healed prematurely, and the granulation deep in the wound does not fill the abscess cavity. After the perianal abscess becomes anal fistula, it can be treated according to the anal fistula.
Is hospitalization required for perianal abscess surgery? How long is the hospital stay?
Only the superficial subcutaneous abscess around the anus can be treated without outpatient surgery. Most patients with perianal abscess require hospitalization for surgical treatment. The postoperative hospital stay varies from 1-2 weeks. Generally, you can leave the hospital within 5-7 days. After you leave the hospital, you can basically go to work. Come to the outpatient clinic every 3-5 days to receive dressing changes and treatments. At home, you can take a bath with Chinese medicine every morning and evening to take care of your wounds. Generally, there is no need to live for more than 20 days or even one month. This will delay work and be detrimental to personal financial burden and hospital bed turnover.
Can perianal abscess be prevented?
Although infection and suppuration are prone to occur around the anorectal area, it can be prevented if we pay attention to it at ordinary times. The prevention method is summed up with a 12-character policy, which is: "Regular daily life, regular diet, and combination of work and rest". Daily routines require us to have a regular life, including the development of regular bowel movements every day, which helps to maintain a certain degree of body resistance and maintain normal stool. A regular diet requires eating less fat, sweet, spicy, and stimulating products, and avoid overeating. The combination of work and rest requires us to exercise properly, especially not to be over-fatigued, to avoid long-term sedentary, to get up and exercise every 1 hour or so, and to do levator anus exercises to promote perianal blood circulation.