Introduction
A perirectal abscess is the acute appearance of a collection of purulent fluid that forms from glandular pockets in the anus or rectum. The prevalence of anorectal accesses is higher than what is actually seen in formal care facilities because a large portion of people with anorectal symptoms do not seek treatment. There are approximately 100,000 cases per year in the United States, and the average age for appearance of anal abscess and fistula disease is age 40. Males are twice as likely to develop an abscess compared with women (Breen, 2014). The following paper will explore the causes of anorectal abscess, diagnostic tools, common signs and symptoms, and treatment options.
Causes of Perirectal Abscess
Anorectal abscesses are somewhat common and can cause substantial pain. The majority of abscesses are related to an acute infection in the inner glands of the anus. The actual abscess can become clogged by bacteria, fecal matter, or foreign material. If the abscess becomes clogged it can potentially tunnel to tissue surrounding the anal or rectal area. This material accumulates in a pocket and is called an abscess (Buckmire, 2012). The abscess begins as perirectal cellulitis caused by infection of an anal gland, which causes inflammation. The inflammatory process takes over and eventually extends to tissue surrounding the rectum. The specific bacteria that are responsible for the clogged abscess include: E. coli, staphylococci, streptococci, and mycobacterium tuberculosis. Possible aggravating or provoking factors include: infected anal fissures, a necrotic thrombotic hemorrhoid, injury from enema, recent surgery of anorectal area, an abrasion of the anal canal, colitis, Crohn’s Disease, and tuberculosis (Buckmire, 2012).
Diagnostic Tools
A diagnosis is usually made by inspection and palpation. If indicated, a rectoscopy may be performed. However, this tool may be contraindicated in a patient with an acute abscess due to pain. Special imaging may be indicated for deeper abscesses such as: transanal endosonography and MRI (Mappes, 2013).
Clinical Manifestations
As the clogged material tunnels outward from the canal, the inflammation may be seen as redness in the perianal area. The abscess will manifest as a painful mass with varying symptoms depending on the severity. The symptoms are worse in a patient with a compromised immune system and a diabetic patient (Parswa, 2014). A superficial abscess will present with symptoms such as pain, swelling, tenderness, and fever. The location of the abscess also causes pain upon walking and sitting, and because of the close proximity to the anal canal it may cause painful defecation (Mappes, 2013). Deep abscesses do not present with the same typical symptoms as a superficial abscess. Instead, the deep abscess presents with pelvic pain and an elevated temperature (Mappes, 2013). It is possible for the abscess to become a medical emergency if it spreads throughout the perineum because this results in systemic sepsis (Parswa, 2014).
Treatment
There are several treatment options for a perirectal abscess. An abscess may burst externally or may require surgical incision and drainage. It is not uncommon for the abscess to heal and close on its own. However, in about half of all patients there is a remaining connection that results in a perianal or perirectal fistula (Parswa, 2014). The abscesses that do not heal on their own may require surgery. The location of the abscess determines the surgical approach. The primary surgical procedure is incision and drainage of the abscess (Breen, 2014). The location of the abscess will determine whether the procedure will be performed in an outpatient setting, and the depth of the abscess will determine the anesthesia to be used. If the abscess is located within the outer anal canal, an excision will be made to allow drainage and to prevent closure of the skin. An intermuscular abscess is to be drained transanally to the inside of the anal canal. “The abscess cavity is opened by incision of the anoderm and the internal sphincter overlying the abscess” (Mappes, 2013). Secondary includes drug therapy with the use of antibiotics. Complications for the abscess patient include systemic infection, fistula formation, recurrence, and scarring. However, there is a successful outcome for most patients when treatment is prompt (Luzietti, 2012).
End of Paper
In conclusion, a perirectal abscess is an acute illness that has potential to become life-threatening but this outcome can be prevented with prompt treatment. As a nurse it is important to educate patients to seek medical attention as soon as signs and symptoms arise. It is also important to educate patients and medical personnel about the risk factors: individuals with diabetes, compromised immune systems, inflammatory bowel disease, or those who engage in receptive anal sex (Luzietti, 2012). Education is the key to prevention but does not guarantee adherence.
References
Breen, E. (n.d.). Perianal abscess: Clinical manifestations, diagnosis, treatment. Retrieved April 22, 2015, from http://www.uptodate.com/contents/perianal-abscess-clinical-manifestations-diagnosis-treatment
Buckmire, M. (n.d.). Abscess and Fistula Expanded Information. Retrieved April 22, 2015, from https://www.fascrs.org/patients/disease-condition/abscess-and-fistula-expanded-information
Luzietti, R. (n.d.). Perianal Abscess. Retrieved April 24, 2015, from http://fitsweb.uchc.edu/student/selectives/Luzietti/Painful_anus_perianal_abscess.html
Mappes, H. (n.d.). Anal Abscess and Fistula. Retrieved April 22, 2015, from http://www.ncbi.nlm.nih.gov/books/NBK6943/
Parswa, A. (n.d.). Anorectal Abscess. Retrieved April 22, 2015, from http://www.merckmanuals.com/professional/gastrointestinal_disorders/anorectal_disorders/anorectal_abscess.html
