Can Perianal Abscess Cause Urinary Retention?
Yes, perianal abscesses can occasionally cause urinary retention, though this is not a typical presentation. 1
Clinical Recognition
Urinary retention is a recognized but uncommon complication of anorectal abscesses that should prompt immediate evaluation and treatment. 1
- The 2021 WSES-AAST guidelines explicitly state that "occasionally patients with anorectal abscesses will present with urinary retention" 1
- A 1995 retrospective study of 92 patients identified urine retention as one of the major complications of perirectal abscesses 2
- A 2021 case report documented a 53-year-old male with a four-day history of urinary retention as the primary presenting symptom of an occult perirectal abscess, notably without perirectal pain 3
Mechanism and Anatomical Considerations
Deeper abscesses—particularly intersphincteric and supralevator types—are more likely to cause urinary retention due to their proximity to pelvic structures. 1
- These deeper abscesses may present with pain referred to the perineum, low back, and buttocks, or with symptoms mimicking intra-abdominal conditions 1
- The inflammatory process and mass effect from the abscess can compress or irritate adjacent urological structures 2, 3
- Intersphincteric abscesses are often occult on external examination but cause significant pain on digital rectal examination 4
Clinical Pitfall to Avoid
Do not assume urinary retention in a male patient is simply benign prostatic hyperplasia without performing a thorough digital rectal examination. 3
- The case report emphasizes that perirectal abscess is a relatively rare cause of urinary retention but can present without the typical perirectal pain 3
- Digital rectal examination revealed the abscess in 94.6% of patients in one series, making it an essential component of evaluation 2
- Pain on digital rectal examination is characteristic of deeper abscesses, particularly intersphincteric and supralevator types, where DRE reveals a tender, indurated area above the anorectal ring 4
Management Implications
When urinary retention occurs with a perianal abscess, this indicates a more severe presentation requiring emergency drainage. 5
- Emergency drainage is indicated for patients with sepsis, severe sepsis, septic shock, immunosuppression, diabetes mellitus, or diffuse cellulitis 5
- The presence of urinary retention as a complication suggests significant mass effect or inflammatory burden, warranting urgent surgical intervention 2
- Abscess resolution occurred in all patients after adequate drainage in the 1995 study, with antibiotics playing only an adjunct role 2