Abscesses & Fistulas

Anal Abscesses and Fistulas

An anal abscess is an infected, pus-filled cavity near the anus or rectum. In up to half of patients with abscesses, an anal fistula will occur, which is a tunnel under the skin that connects the infected glands to the abscess.

An abscess can be painful. Generally, surgical drainage is the preferred treatment. WakeMed’s colorectal surgeons are experienced with surgical options for effective relief.

What Are the Symptoms and Risk Factors of Anal Abscesses and Fistulas?

Signs that you may have an anal abscess and/or fistula include:

• Rectal pain
• Rectal swelling
• Redness in the anal area
• Fever
• Rectal bleeding

An anal abscess is generally caused by some kind of infection or damage to the anal area, including:

• Infected or blocked anal glands
• Anal fissure
• Sexually transmitted diseases

Risk factors of developing anal abscesses include:

• Crohn’s disease
• Ulcerative colitis
• Diverticulitis
• Diabetes
• Anal intercourse

How Are Anal Abscesses and Fistulas Diagnosed?

Our doctors will start by taking a full medical history and performing a physical examination of the anal area.

We may perform more tests, including:

• Digital rectal examination, in which the doctor inserts a lubricated, gloved finger into the rectum to feel for any abnormalities
• Proctoscopy, which uses a thin tube to look at the inside of the anus and rectum. Sometimes, it can also be used to remove tissue samples.
• Ultrasound
• Computed tomography (CT) and magnetic resonance imaging (MRI) scans

How Are Anal Abscesses and Fistulas Treated?

Small and superficial abscesses can be drained by a colorectal surgeon in the doctor’s office, using only a local anesthetic.  Larger ones may require a short stay in the hospital.

Surgical options to treat fistulas include:

• Fistulotomy: An outpatient procedure that opens up the fistula using an incision
• Endoanal advancement flap: Used for complex fistulas, it covers the fistula opening with healthy tissue from the rectum
• LIFT technique (Ligation of intersphincter fistula tract): A complex technique in which the surgeon widens the fistula tract and then removes the infected tissue
• Fistulectomy: A surgical procedure that completely removes the fistula
• Fistula plug: A minimally invasive procedure in which a conical device is sutured in the fissure

After surgery for either an abscess or fistula, patients may experience some discomfort as the area heals. Sitting in warm baths and using pain medication can help.

Learn more about what to expect from colorectal surgery.

Make an Appointment

If you or someone you care for is experiencing worrisome symptoms, we encourage you to make an appointment with one of our adult gastroenterologists, pediatric gastroenterologist or colorectal surgeons.