What is the treatment for an anal abscess?

From the Guidelines

Anal abscesses should be treated with prompt surgical drainage, specifically incision and drainage, as recommended by the most recent guidelines 1. The primary treatment involves a procedure where a surgeon makes a small cut in the abscess to allow the pus to drain out. This procedure is usually performed under local anesthesia in an outpatient setting. After drainage, the wound may be left open to continue draining and heal from the inside out. Pain management typically includes over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), though stronger prescription pain medications might be needed initially. Some key points to consider in the treatment of anal abscesses include:

• The role of antibiotic therapy, which may be considered in the presence of sepsis, surrounding soft tissue infection, or disturbances of the immune response 1
• The potential benefits of sampling drained pus in high-risk patients or those with risk factors for multidrug-resistant organism infection 1
• The importance of prompt treatment to prevent serious complications, including sepsis
• The possibility of anal fistula formation, which may require additional treatment In terms of specific treatment recommendations, incision and drainage is the strongly recommended approach for anal abscess treatment 1. Antibiotics may be prescribed in certain cases, such as significant surrounding cellulitis, diabetes, immunocompromised status, or systemic infection. Common antibiotic choices include amoxicillin-clavulanate (Augmentin) or ciprofloxacin plus metronidazole, but the specific regimen should be guided by the presence of risk factors for multidrug-resistant organism infection and other individual patient factors 1. Warm sitz baths can help with pain relief and healing, and patients should be informed about the potential for anal fistula formation and the importance of follow-up care.

From the Research

Treatment Options for Anal Abscess

• The primary treatment for anal abscesses is incision and drainage, which is considered the golden standard of acute treatment 2
• Pre- and perioperative imaging with magnetic resonance imaging, endoanal ultrasonography, or CT can facilitate correct incision and drainage 2
• Antibiotics are not recommended as a conservative approach for treating abscesses, but may be used postoperatively to prevent fistula formation 3

Role of Antibiotics in Preventing Fistula Formation

• A systematic review and meta-analysis found that postoperative antibiotics may reduce the risk of fistula formation by 36% 3
• However, the quality of evidence is low, and further randomized trials are needed to fully clarify the role, duration, and type of antibiotics best suited for postoperative prevention of fistula 3

Management of Specific Types of Abscesses

• Ultrasound can be valuable in diagnosing abscesses that are not clinically evident and in guiding incision and drainage procedures 4
• Packing may not be necessary for small abscesses, and alternatives such as needle aspiration and loop drainage may be suitable 4
• Oral antibiotics can improve outcomes after incision and drainage, but this improvement must be weighed against potential risks 4

Evaluation and Management of Perianal Abscess and Anal Fistula

• Perianal sepsis can range from acute abscess to chronic anal fistula, and surgery is the main treatment 5
• Several procedures have been developed, but the risks of recurrence and impairment of continence still seem to be an unresolved issue 5
• A position statement by the SICCR provides evidence-based recommendations to improve individualized management of patients with perianal abscess and anal fistula 5