Perianal abscess has become a common disease that bothers everyone, and patients with perianal abscess can be very painful, the incidence is getting higher and higher in recent years, and from infants to young adults may suffer from it, and patients are often overwhelmed, so I was invited by Rizhao City TV to do a special lecture on perianal abscess, and here I share some frequently asked questions with you.
Q: What is perianal abscess? What are the characteristics of perianal abscess?
I will first give you a brief introduction of what is perianal abscess, which is an abscess formed by acute and chronic infection in the space around the rectum of the anal canal and is called anal canker in Chinese medicine. It is common in all seasons, but it is more common in summer, when the temperature is high, it is easy to sweat, lose more body fluids and become constipated, plus some people eat spicy food, like to drink and eat too much grease, resulting in dampness and heat, which can be injected into the anus and lead to perianal abscess. The primary diseases that cause the infection are anal fissure, sinusitis, constipation, diarrhea and so on. It is characterized by rapid onset and obvious pain, which can be sudden, many patients just drank wine at night and found severe pain in the anus the next day, the powerful may have a fever, which may form an anal fistula over time, usually occurring in young adults aged 20-30 years old, more common in men, the ratio of men to women can reach 6:1, and male androgen secretion, anal gland secretion is related.
Q: What are the specific symptoms of perianal abscess?
The symptoms of perianal abscess differ according to the site of onset, and we divide perianal abscess into two categories according to the site of onset.
(1) low abscesses (abscesses with the pus cavity in the lower part of the anal raphe, which we use the anal raphe as the boundary): such as subcutaneous abscesses of the anus, abscesses in the scirorectal space, abscesses in the posterior anal canal space, and low hoof abscesses.
(2) High abscesses (abscesses with the pus cavity in the upper part of the anal raphe): such as submucosal abscesses of the rectum, pelvic rectal gap abscesses, posterior rectal gap abscesses, and high hoof-shaped abscesses.
The clinical manifestations of the two types of perianal abscesses are not identical. Low abscess can have no systemic symptoms because the location of abscess is relatively shallow, and the local symptoms are mainly localized. As soon as many people walk in from the clinic, I know what kind of disease they have by looking at their gait. High abscesses are deeper, above the anal raphe, and the toxins are absorbed quickly, so the systemic symptoms are obvious, such as fever, general discomfort, tiredness and weakness, and the blood picture can be elevated on routine blood tests, somewhat like the symptoms of the flu. But many high-status abscesses develop from low-status. So some abscesses have all the symptoms of high status abscesses. Both local pain and systemic symptoms are present.
Q: Some small infants also get perianal abscesses, what should I do once I get one?
In clinical practice, we often see such patients, especially infants born within 3 months of age, because the intestinal immune structure of infants is not yet mature and the immune function is weak during this period, which means that the rectal mucosa does not have a perfect barrier to bacteria, so once diarrhea occurs, it is easy for the anal glands to become infected and develop. Generally, by about 14 months of age, the infant’s immune function is enhanced, and the incidence of the disease will be reduced. This disease is also more common in males than females, and the ratio can reach 9:1, which is higher than the ratio of male to female in young adults. It is possible that perianal abscesses in infants and children will slowly get better on their own, and they can be washed after defecation to maintain local hygiene, but our experience is that it is better to deal with them and release the pus to prevent further development of the disease. If the child has recurrent attacks that affect the growth and development of the child, radical surgery can be performed under basic anesthesia.
Q: Is it congenital to have an abscess at such a young age?
This disease is not congenital because in the mother, the fetus is sterile and the first fetal stool is also sterile, so no infection will arise. Only within 24 hours after feeding on breast milk, the intestine will start to grow bacteria and there is a possibility of infection, so perianal abscesses in infants and children are all acquired infections and develop. Usually it is an anal sinus infection caused by diarrhea.
Q: Perianal abscesses are caused by infections. We all know that patients with diabetes are prone to infections when their blood sugar is not well controlled, so are diabetic patients prone to perianal abscesses?
The presenter is right, there is statistical evidence that the prevalence of concurrent infection in diabetic patients is more than 32.5%, because high blood sugar is conducive to the reproduction of bacteria, and the bactericidal ability of white blood cells in the patient’s body is lower than normal people, immunity is low, the chance of infection is greater than that of ordinary people, and once a diabetic patient is infected with a perianal abscess, its scope and severity are greater than that of ordinary people, the disease progresses rapidly, if not timely If not treated in time and the infection spreads, it will easily produce some serious complications, such as necrotizing fasciitis, sepsis, etc., and the condition will be critical.
Q: So what should we do if a diabetic patient has a perianal abscess?
This situation, too, is relatively common because diabetes is now a high incidence, but people do not pay enough attention to it, and many patients do not know they have diabetes, but are hospitalized for perianal abscess and only find out they have diabetes when they do preoperative examination. It should be more fortunate for patients to find out that they have diabetes at this time, so preoperative checkups are very important. Many patients do not understand preoperative blood draws, and they all think that I am having a surgery, why do I need to draw so much blood? The main purpose of blood sampling is to rule out contraindications to surgery, and when blood glucose is very high, it is risky to do radical surgery. So our principle of treatment for this situation is to treat the surface in an emergency, and to treat the root cause in a slow manner. We can first do an incision and drainage to release the pus to prevent further development of the disease and relieve the patient’s pain, and then use insulin to rapidly lower the blood sugar until the blood sugar is appropriate, generally controlled below 8mmol/l, before doing the radical surgery. After the operation, we should strictly control blood sugar and control blood sugar to prevent the occurrence of infection.
Q: What are the risks of surgery in patients with very high blood sugar?
The postoperative wounds of such patients are difficult to heal, or even do not heal, and the stressful effect of surgery will lead to higher blood sugar, which greatly increases the possibility of postoperative infection. Even if the blood sugar is controlled to a reasonable range, the patient’s wounds will be about 10 days slower than normal. So we must eat reasonably and beware of diabetes.
Q: We usually think it hurts to have hemorrhoids, but now that we’ve heard from Dr. Ding that it also hurts to have a perianal abscess, how should we distinguish between these two diseases?
The symptoms of hemorrhoids are mainly blood in the stool and the prolapse of the swelling in the anus after the stool. The pain of perianal abscess is mainly constant burning and throbbing pain, there will be this burning sensation and hard lumps can be felt around. The pain sensation of the two diseases is still different, but for us ordinary people may not be very easy to distinguish, so once the pain in the anus is unbearable, you should still go to the clinic to check. It is important to find out what the disease is.
Q: If I have a perianal abscess, will it go away with some anti-inflammatory injection?
Do not blindly give anti-inflammatory injections, as antibiotics will not only fail to control the inflammation, but also make the abscess spread deeper and make surgery difficult. There is also the possibility of forming local hard nodes, which cannot dissipate for a long time and will sooner or later turn into pus, because the root cause of this disease is in the anus, which will be contaminated by a secretion of mucus once you defecate, unlike a wound on our arms and legs, which can be kept clean, and a perianal abscess is always in an infected environment, so this disease can never be cured by antibiotics. In addition, many patients who have been given antibiotics have their pus cultured, and many of them are multi-drug resistant bacteria, which means that the bacteria are not sensitive to many antibiotics, making it difficult for us to treat them. China is a big antibiotic country, the abuse of antibiotics is very serious, we can use 160,000 tons of antibiotics a year in China, accounting for about half of the world, now our hospitals have strict control of antibiotics, if this continues, in a few years, we may have to face a situation of no drugs available.
Q: What should we do if we have a perianal abscess?
Once you have a perianal abscess, please visit an outpatient anorectal clinic immediately, as surgery is the best way to go. Many people mistake a perianal abscess for a hemorrhoid, which causes delayed treatment and mistreatment, giving a low perianal abscess a chance to develop into a high abscess, expanding the scope of infection, leading to longer treatment time and increasing the patient’s pain, so surgery should still be performed as soon as possible.
Q: I heard from a friend that changing medication while hospitalized is not pleasant, what is the purpose of changing medication?
Some people are afraid of pain and trouble to change medication, which is very detrimental to the patient’s recovery. If the medication is not changed properly, there is a risk of non-healing, pseudo-healing, infection, recurrence, etc. Changing medication after surgery can play a role in cleaning the wound and preventing infection, and at the same time, it can make the wound drainage smooth and avoid the collection of exuded pus, which can cause infection. Topical medications that promote wound healing can be used during the dressing change to speed up the growth of the wound. Daily dressing changes also ensure that the wound grows from the base and prevent pseudo-healing.
Q: What do I need to pay attention to in terms of diet for perianal abscess surgery?
First of all, eat a diet with less residue, such as noodles and thin rice, the day before the surgery, and fast for 6 hours before the surgery. After 6 hours, we can eat a small amount of food, but we should not eat food containing more fat. From the first day after surgery, you can eat normally, except for spicy food, according to the patient’s daily eating habits. In order to keep the bowel movement smooth, patients can eat some fresh fruits and vegetables, such as bananas, spinach, fish soup and other easy-to-digest foods with low fat content, but not full meals and not too greasy. And encourage patients to have bowel movement on time. You can eat some coarse fiber food, which is good for softening stool, such as mushrooms, green vegetables, cabbage ah, etc.; the main food should be mainly coarse grains to enhance the laxative effect, such as corn porridge, millet porridge, and other coarse foods. Eating 2-3 small spoons of honey daily can assist in bowel movements.
Q: I heard that having surgery can cause fecal incontinence, is this true?
This is a question often asked by patients in outpatient clinics, and it is also a common misconception. I will explain to you that the muscle that controls defecation, which we call the rectal ring of the anal canal, is composed of part of the external sphincter, the internal sphincter, the anal raphe, and the joint longitudinal muscle. For high abscesses, the abscess cavity is above the sphincter muscle and incorrect surgery can damage the patient’s sphincter muscle, so many hospitals take two surgical approaches. The surgery we are doing now is called incision and hanging, which can help the elasticity of the rubber band, so that the patient’s sphincter function can be well protected by repairing while incising. Hanging thread therapy was first used in the Ming Dynasty.
Without surgery, an anal fistula will be formed, and long-term inflammatory stimulation will cause sphincter fibrosis, or sclerosis of the sphincter, and in some patients we give him a finger diagnosis, and the sphincter is like wood, with reduced elasticity, affecting the function of the anus. So this disease should still be operated as soon as possible.
Q: Is it painful to have this surgery?
It is not possible to have this surgery without pain, but the pain is certainly much lighter than when the disease develops. Our surgical method is to slowly cut open the patient’s abscess cavity, which is equivalent to a kind of minimally invasive, and the pain of the surgery has been reduced to a minimum. After the operation, we give the patient a local injection of long-acting pain-relieving drugs, together with some oral pain-relieving drugs, which can significantly reduce the patient’s pain. If you are really afraid of pain, you can use a pain pump. Therefore, the pain is generally tolerable and can be controlled by many means.
Q: What if you have a perianal abscess and don’t have time to be hospitalized for surgery?
If you have a perianal abscess, if you have a radical surgery, you usually have to be hospitalized for about 1-2 weeks. If you don’t have time, you can do a temporary drainage operation to release the pus, which will significantly reduce the pain and more importantly, prevent the disease from developing further. Wait until you have time, or when you have a recurrence, then come back for surgery.
Q: How should we prevent perianal abscess in our daily life?
We can take the following preventive measures, first of all, actively exercise, enhance physical fitness, avoid sedentary, nowadays people can say that the amount of activity is less and less, basically traffic ah are driving in a car, also prefer to surf the Internet ah play computer games, sedentary will lead to poor local blood circulation in the anus to increase the chances of infection, you can take a walk ah jogging ah and other relatively gentle and non-vigorous exercise to promote the anal part of the The second is to keep the anus clean. The second is to keep the anus clean, pay attention to personal hygiene, daily after the stool can be warm salt water bath, do not sit for a long time in a humid place. The third is to regulate the diet to prevent constipation and diarrhea, try not to drink alcohol, eat less spicy and stimulating food, eat a light diet, and develop the habit of regular bowel movements. Actively prevent and treat other anal diseases.