What are the signs and symptoms of anorectal abscess?

Updated: Jul 24, 2020
  • Author: Andre Hebra, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Almost all perirectal abscesses are associated with perirectal pain that is indolent in nature. Patients with a perianal abscess typically complain of dull perianal discomfort and pruritus. The pain often is exacerbated by movement and increased perineal pressure from sitting or defecation. Those with an ischiorectal abscess often present with systemic fevers, chills, and severe perirectal pain and fullness consistent with the more advanced nature of this process. External signs are minimal and may include erythema, induration, or fluctuance.

As many as 50% of patients with perirectal abscesses may present with swelling around the rectum, and as many as one quarter may present with rectal or perirectal drainage that may be bloody, purulent, or mucoid. [2, 4] These patients may also present with constipation, most likely due to pain on defecation, but the absence of constipation or even diarrhea does not rule out the diagnosis. Most of them report no history of fever or chills.

In many cases, these patients delay presentation to a physician, or they have already presented to a physician and have been given alternative diagnoses. [2, 4] Furthermore, complaints of abdominal pain are rare in these patients.

In addition to these symptoms, various case reports in the literature describe patients with perirectal abscesses who present with penile discharge, hip pain, or an ingested foreign body. [16, 17, 18]

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