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Drainage of Anal/Rectal Abscesses
 

You have either a perianal abscess, an infection around your anus that began in a mucous-secreting gland in the anal canal, or a pilonidal abscess, an infection in a hair follicle trapped under the skin overlying the tailbone. In either case, you did nothing to cause the infection and you could have done nothing to prevent its development.

Treatment

Drainage is the most reliable way to treat these abscesses. First the doctor injected a local anesthetic around the abscess to allow the drainage to be as painless as possible. Next, an incision was made into the abscess to drain the pus as well as to remove a portion of the skin to allow drainage while your body heals the abscess. A gauze wick was then placed into the wound, which can be removed tomorrow morning in the bath tub. In addition, if you have Crohn's disease, are a diabetic, a patient with an artificial heart valve or joint, or one who has a decreased immunity we may also prescribe an antibiotic for the next week.

After Treatment Symptons and Care

You will have pain after the local anesthetic wears off. We typically prescribe a Hydrocodone product since it typically does not cause problems with constipation. We prefer you not take aspirin or products containing aspirin for at least seven days as they may promote bleeding. It may take two to four weeks for the wound to heal, and during this time you may experience some bleeding, discharge, pus, or itching. This is part of the normal healing process. You may apply gauze, or cotton dressings to the wound as needed. We prefer you to take a bath (using warm to hot water, with no additives or bath oils) at least 2-4 times per day (10-15min each), as this will help to promote drainage and healing.

About half of patients with perianal abscesses will need no further treatment. The other half can develop a communication between the inside where the process started and the outside where the drainage occurred, known as a fistula, or tunnel. If you develop a chronic fistula, surgery may be necessary (see our separate discussion on fistula's). Pilonidal abscesses typically come back, possibly requiring further surgery.

Diet

It is important to keep your bowel movements soft and regular. Eat foods high in fiber and drink lots of water (6-8 glasses a day). If you are constipated, take a fiber supplement like Citrucel® or a psyllium product such as Konsyl®. Prune juice or small doses of milk of magnesia may also be used.

Activity

Avoid strenuous activity for the rest of the day. Tomorrow you should be able to resume your normal activities.

Call the office if you have any of the following problems:

• Excessive pain unrelieved by your pain medication
• Increasing pain several days after treatment
• Fever / Chills
• Difficulty urinating
• Severe bleeding that won't stop with direct pressure using Kleenex or gauze
• Severe constipation (no bowel movement for three days)
• Diarrhea (more than three watery bowel movements within 24 hours)