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Anorectal Abscess

Anorectal Abscess is a topic covered in the 5-Minute Clinical Consult.

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  • Localized induration, inflammation, and infection of the cryptoglandular tissues of the anal canal
  • 80% are perianal; the remainder are intrasphincteric or supralevator.
  • On clinical continuum with anorectal fistula, chronic or recurrent infection predisposes to fistula formation.
  • System(s) affected: gastrointestinal, skin/exocrine
  • Synonym: perianal abscess; perirectal abscess

Geriatric Considerations
A high pelvirectal abscess may cause minimal symptoms (lower abdominal pain and fever).

Pediatric Considerations
Common in 1st year of life


  • Predominant age: all ages (most common in 3rd and 4th decades and during infancy)
  • Predominant sex: male > female (2 to 3:1)


Etiology and Pathophysiology

  • Bacterial invasion of the anal glands found in the intersphincteric space, which may begin with an abrasion or tear in lining of anal canal, rectum, or perianal skin
  • The internal anal sphincter serves as a barrier to infection between gut lumen and perianal tissues.
  • Four types: Perianal (perirectal) is the most common (60%). Ischiorectal is the next most common followed by intersphincteric and supralevator (1)[C].
  • Organisms (usually mixed aerobic; anaerobic)
    • Escherichia coli
    • Streptococci
    • Staphylococci (especially methicillin-resistant)
    • Bacteroides fragilis
    • Pseudomonas aeruginosa

Risk Factors

  • Inciting trauma
    • Injections for internal hemorrhoids
    • Enema tip abrasions
    • Puncture wounds from eggshells or fish bones
    • Foreign objects
    • Prolapsed hemorrhoid
  • Inflammatory bowel disease
  • Chronic granulomatous disease (especially Crohn disease)
  • Immunodeficiency disorders
  • Hematologic malignancies (5–8% have anorectal abscess at some time)
  • Diabetes mellitus
  • Chronic medical immunosuppression
  • Morbid obesity

General Prevention

  • Avoid constipation.
  • Avoid rectal thermometers, enemas, or suppositories whenever possible in immunocompromised patients.

Commonly Associated Conditions

  • Crohn disease
  • Other inflammatory disease (e.g., appendicitis, salpingitis, diverticulitis)
  • Consider perianal hidradenitis suppurativa or HIV disease in patients with recurring perianal or ischiorectal abscesses.
  • Consider anal fistula in patients with recurrent perianal abscesses in same location.

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Stephens, Mark B., et al., editors. "Anorectal Abscess." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816032/all/Anorectal_Abscess.
Anorectal Abscess. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816032/all/Anorectal_Abscess. Accessed July 23, 2019.
Anorectal Abscess. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816032/all/Anorectal_Abscess
Anorectal Abscess [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 July 23]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816032/all/Anorectal_Abscess.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Anorectal Abscess ID - 816032 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816032/all/Anorectal_Abscess PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -