Perianal Abscess

　　Etiology of perianal abscess

　　1. Infections caused by anal fissures, hemorrhoids, anal sinusitis, perianal skin folliculitis and perianal skin diseases can lead to perianal abscesses. Certain diseases such as ulcerative colitis, aplastic anemia, and general malnutrition can weaken the body and reduce resistance, thereby triggering perianal abscesses.

　　2.感染性因素：它是引起本病的主要原因。因肛裂、痔疮、肛窦炎、肛门周围皮肤毛囊汗腺炎及肛门周围皮肤病等感染，可形成肛门直肠周围脓肿。还有某些疾病如溃疡性大肠炎、再生障碍性贫血、全身营养不良等，使身体虚弱，抵抗力减低，而诱发肛门周围脓肿。

　　3. 也有认为是医源性因素：内痔插枯痔丁或注射疗法，因操作不当或药剂不洁感染形成粘膜下脓肿。直肠周围注射化学药物刺激，引起组织坏死，造成肛门脓肿。乙状结肠镜检查，造成腹膜穿孔感染，引起肛门脓肿。局部麻醉感染，或油溶液注入后吸收不良，而形成脓肿。

　　4.手术后因素：临床上亦可见到肛门直肠手术引起感染，而形成的直肠周围脓肿，以及尿道术后感染、会阴术后感染、产后会阴破裂缝合后感染、尾骶骨骨髓炎术后感染等引起的脓肿。

　　肛周脓肿除了其临床表现外，还可引起其他疾病。本病可以引起低位肛瘘、坐骨直肠窝脓肿，不治疗可能引起更大的疾病—直肠癌。

　　肛周脓肿的典型症状

　　症状主要以肛门周围红肿有硬结肿块、发热、疼痛为主。有慢性和急性之分。肛周持续性剧痛受压或咳嗽时加重，行走不便、坐卧不安，随之会出现全身不适，精神疲惫乏力、体温升高、食欲减退、寒战高热等全身中毒症状。

　　全身感染症状不显局部检查：肛旁皮肤有明显红肿伴硬结和触痛，可有波动感，必要时可行穿刺证实，如不及时切开常自行破溃形成低位肛瘘感染，也可向上穿透肛周筋膜扩散至坐骨直肠窝，早期有时误诊为血栓性外痔，但后者边界清楚周围皮肤无炎性反应。

　　How to prevent perianal abscess

　　1. Actively prevent and treat other anorectal diseases, such as anal sinusitis, anal papilloma hypertrophy, anal fissure, inflammatory hemorrhoids, rectitis, etc., which can be treated promptly, correctly, and effectively, can avoid and reduce perianal infections, abscesses, and fistulas.

　　2. Preventing constipation and diarrhea is of great significance in preventing perianal and rectal infections. It can avoid and reduce the damage or inflammation of the mucosa and epithelial tissues in the anal and rectal area, and can reduce the incidence of abscesses and fistulas.

　　3. In case of perianal and rectal infections, seek medical treatment at a regular hospital as soon as possible, and adopt effective anti-infection measures, including systemic and local treatment, to prevent the spread and diffusion of inflammation. Do not lightly believe in quacks or so-called 'hereditary' propaganda, which may delay diagnosis and treatment.

　　4. Maintain cleanliness and hygiene of the anal area, change underwear frequently, and persist in washing the anal area after each defecation, which has a positive effect on preventing infection. Avoid diarrhea and constipation, which can stimulate inflammation of the anal crypts and trigger perianal abscesses. Therefore, preventing constipation and diarrhea is of great significance in preventing the formation of perianal abscesses.

　　5. Constipation can cause anal congestion and dry stool friction, which can lead to anal abscesses. Some people may repeatedly wipe the anus due to fear of dirt, which can cause anal mucosa to evert, exposing the anal sinuses outside the anus. This, along with mechanical stimulation, can cause congestion, edema, and subsequent infection and inflammation, leading to anal sinusitis. Anal sinusitis can develop into anal abscesses. Therefore, after defecation, it is recommended to rinse the anus with warm water, use a soft and clean old towel to blot the water droplets around the anal skin, rather than wiping the anus, and definitely not using coarse, hard, low-quality toilet paper to wipe the anus vigorously.

　　6. Prompt treatment of systemic diseases that can cause perianal and rectal abscesses, such as ulcerative colitis, intestinal tuberculosis, and Crohn's disease.

　　7. Timely treatment of systemic diseases that can cause perianal and rectal abscesses, such as ulcerative colitis, intestinal tuberculosis, Crohn's disease, and others.

　　Laboratory tests required for perianal abscess

　　Rectal examination, puncture aspiration of pus, and anal canal ultrasound examination are used. The following are abnormal manifestations in patients with perianal abscess:

　　1. There may be burning or jumping pain around the anus, which worsens during defecation or walking, and some may have difficulty urinating.

　　2. It may be accompanied by symptoms such as chills, fever, and general malaise.

　　3. There is an increase in blood leukocyte and neutrophil counts.

　　4. There may be hard nodules or masses around the anus, with increased local temperature, tenderness, or fluctuation. Abscesses located above the levator ani can be palpated as tender masses during rectal examination, and pus can be aspirated through rectal puncture.

　　Dietary taboos for patients with perianal abscess

　　Diet should not be too refined, and it is best to avoid foods with strong刺激性, as this is beneficial for the defecation. Maintain a cheerful mood, regulate diet, and refrain from smoking and drinking. Fruits are an indispensable part of our lives. When suffering from perianal abscess, it is important to be selective about the fruits consumed, choosing watermelons, apples, pineapples, oranges, pears, and other fruits that have the effect of moistening the intestines and promoting defecation. Vegetables such as spinach, celery, winter melon, luffa, pumpkin, mung beans, soybeans, rapeseed, cauliflower, mushrooms, kelp, radishes, and lotus stems are light and contain a lot of fiber. They can clear heat and detoxify. Regular consumption of these vegetables can alleviate local anal swelling and pain, as well as symptoms of pus and watery discharge. It is also important to note that when taking medication for perianal abscess, some drugs and foods should not be consumed simultaneously. For example, when taking heat-clearing and detoxifying agents, it is advisable to avoid eating fish, shrimp, lamb, coriander, chives, and other foods. It is also best not to eat bamboo shoots, dog meat, seafood, and other foods.

　　Develop good hygiene habits, develop the habit of washing the local area after each defecation to prevent infection.

　　Once a perianal abscess is diagnosed, it should be operated on immediately. The earlier the surgery, the better the effect. The surgical treatment methods for anal abscesses can be divided into two types:

　　1. One method is to first incise and drain the abscess, then perform radical surgery after the abscess cavity shrinks or becomes pus, which takes a relatively longer time for treatment. This method was commonly used in the past.

　　Another method is to incise and cure the anal abscess once and for all, avoiding the pain of a second surgery, with a relatively shorter treatment process, so this method is currently most commonly used to treat anal abscesses.

　　Western Treatment:

　　Perianal abscesses are mainly treated with anti-infection therapy and incision and drainage for abscess formation. A few perianal abscesses can be resolved with traditional Chinese medicine, antibiotics, hot sitz baths, and local physical therapy, but most patients require surgical incision and drainage of the abscess to prevent spread and alleviate the patient's pain.

　　Conservative Treatment:

　　For example, perianal abscess in newborns is an acute suppurative infection around the anal and rectal area of newborns. The source of infection is an organ called the anal sinus at the junction of the anal canal and rectum inside the anus. The main pathogenic bacteria are Escherichia coli in the feces. Once infection occurs, there is no possibility of self-healing. Newborns have delicate skin, low immunity, and poor resistance. Excessive secretion of sebaceous glands, plus the long-term use of diapers, easily leads to dermatitis, causing the hair follicles, sweat glands, and sebaceous glands to become infected and form abscesses. In recent years, due to the widespread use of artificial feeding and diapers, perianal abscesses in newborns have been increasing year by year. Most perianal abscesses in newborns are subcutaneous infections, located shallowly. Conservative treatment has small trauma, little pain, and fast recovery without scars, which is easily accepted by parents. Only a few cases require surgical treatment if conservative treatment is ineffective.