Understanding perianal sepsis: Causes, symptoms, and treatment

In the realm of medical terminology, perianal sepsis and anal sepsis are often interchangeable terms, both referring to an infectious condition located in the vicinity of the anus. This condition, while relatively common, can lead to significant discomfort and complications if left untreated. In his latest online article, Mr Petr J Hanek delves deeper into what perianal sepsis entails, including its causes, symptoms, diagnosis, potential complications, and treatment options.

Causes:

Perianal sepsis typically arises from the infection of glands near the anal canal, positioned just above the anal sphincter, which are responsible for producing mucus. This infection can occur when these glands become blocked, leading to the accumulation of pus. While the exact cause may vary, factors such as poor hygiene, pre-existing conditions like Crohn's disease or ulcerative colitis, and compromised immune function can increase the risk of developing perianal sepsis.

Symptoms:

The symptoms of perianal sepsis can vary in intensity and presentation. Common signs include sudden perianal pain, redness, swelling, and the formation of a boil or abscess near the anal canal. Patients may also experience systemic symptoms such as chills, fatigue, fever, and a general feeling of being unwell. In chronic cases, continuous discharge of pus or blood may occur. However, some individuals may not experience noticeable symptoms despite the presence of the infection.

Diagnosis:

Diagnosing perianal sepsis often involves a physical examination to assess visible symptoms such as redness and swelling. However, due to the intense pain associated with the condition, rectal examinations can be challenging. Increasingly, imaging techniques such as MRI scans and endoanal ultrasound are utilised for their accuracy in identifying the size, location, and nature of any collections near the anal passage.

Complications:

If left untreated, perianal sepsis can lead to severe complications. In rare cases, the infection can progress to generalised sepsis, a potentially life-threatening condition. Chronic infections may also cause structural changes in the affected tissues, increasing the risk of developing pre-cancerous or cancerous conditions over time. Additionally, repeated episodes of sepsis or surgical interventions can compromise the function of the anal sphincter, leading to irreversible consequences.

Prevention:

Preventing perianal sepsis primarily involves maintaining good hygiene practices, supporting a healthy immune system, and adopting a balanced diet rich in fibre and fluids. While there are no foolproof measures to prevent the condition entirely, individuals with conditions like Crohn's disease or ulcerative colitis should remain vigilant, as they are at increased risk. Regular medical check-ups and prompt treatment of any concerning symptoms can help mitigate the risk of complications.

Treatment:

Treatment of perianal sepsis often involves surgical intervention. One common approach is the insertion of a seton, a non-absorbable material that helps drain the pus and facilitate healing. This is followed by procedures aimed at closing off the internal opening of the fistula, such as advancement flap surgery or laser treatment. While these interventions can provide relief and promote healing, none guarantee a 100% success rate, highlighting the ongoing challenges in managing this condition effectively.

Mr Petr J Hanek is an esteemed consultant surgeon. You can schedule an appointment with Mr Hanek on his Top Doctors profile.