Symptoms of Diverticulitis in the Perianal Region
Diverticulitis does not occur "around the butt hole" – you are likely experiencing a perianal or perirectal abscess, which presents with completely different symptoms than colonic diverticulitis. 1
Critical Distinction: Perianal Abscess vs. Diverticulitis
Perianal and perirectal abscesses originate from obstructed anal crypt glands, not from colonic diverticula, and require immediate surgical drainage. 1 These are distinct clinical entities that are frequently confused due to their similar-sounding names.
Symptoms of Perianal/Perirectal Abscess (What You Likely Have):
Severe pain around the anus is the most common symptom, which must be differentiated from anal fissure, thrombosed hemorrhoids, levator spasm, sexually transmitted diseases, proctitis, and cancer 1
Visible swelling near the anus with associated cellulitis and exquisite tenderness, particularly with low abscesses (intersphincteric, perianal, and ischiorectal types) 1
Few systemic symptoms with low abscesses, though you may have localized warmth and redness 1
Pain referred to the perineum, low back, or buttocks if the abscess is deeper (supralevator or high ischiorectal space), with potentially significant systemic symptoms like fever 1
Fever and systemic illness are more common with high (submucosal, supralevator) abscesses, which may have few local symptoms 1
Symptoms of Actual Colonic Diverticulitis (Different Location):
For comparison, true diverticulitis affects the colon (large intestine), not the anal area:
Left lower quadrant abdominal pain is the hallmark symptom, not perianal pain 2, 3
Fever, change in bowel habits, nausea accompany the abdominal pain 2
Abdominal tenderness on examination in the left lower quadrant, not around the anus 2
Abdominal distention, anorexia, constipation, diarrhea, and dysuria may occur 3
Immediate Action Required
If you have pain and swelling around the anus, you need prompt surgical drainage – an undrained perianal abscess can expand into adjacent spaces and progress to generalized systemic infection. 1
Perianal abscesses require incision and drainage as the primary treatment 1
Antibiotics are recommended if systemic signs of infection are present, in immunocompromised patients, if source control is incomplete, or in cases with significant cellulitis 1
Empiric broad-spectrum antibiotic therapy should cover Gram-positive, Gram-negative, and anaerobic bacteria 1
Common Pitfall to Avoid
Do not assume perianal symptoms are related to diverticulitis – these are anatomically and pathologically distinct conditions requiring completely different management approaches. 1 Perianal abscesses require surgical intervention, while uncomplicated colonic diverticulitis in immunocompetent patients often does not even require antibiotics. 4