At a glance
A perianal abscess is a painful collection of pus that forms in the tissue near the anus. It is usually caused by an infected gland just inside the anal canal. It is one of the most common conditions treated by colorectal surgeons.
Perianal abscesses are not something to manage at home. They typically need medical drainage. The sooner an abscess is treated, the lower the risk of complications.
This page covers what people commonly experience, what to expect from treatment, the connection to fistulas, and when to seek urgent care.
Common patterns people report
- Rapidly increasing pain near the anus over hours to days
- A noticeable, tender lump or swelling near the anus
- Pain that worsens with sitting, walking, or bowel movements
- Redness and warmth in the skin over the swollen area
- Fever, chills, or feeling generally unwell
- Difficulty finding any comfortable position
- The abscess sometimes draining on its own, with temporary relief followed by recurrence
People often describe the pain as severe and unlike anything they have experienced in that area before. It tends to get worse, not better, without treatment.
Why abscesses need drainage
Antibiotics alone rarely resolve a perianal abscess. The collection of pus needs a way out. Medical drainage — either in a clinic, emergency department, or operating theatre — is the standard treatment.
Drainage may involve:
- A local anaesthetic and a small incision to release the pus (often done in an emergency department or clinic)
- A procedure under general anaesthesia for larger or deeper abscesses
- Packing the wound afterwards in some cases to help it heal from the inside out
The relief after drainage is often significant and relatively rapid, though there is still a recovery period.
What to expect at the hospital or clinic
- You will likely be examined and may have the area numbed with local anaesthetic
- The doctor will make a small cut to drain the pus
- The wound is usually left open to continue draining and to heal gradually
- You may receive instructions for wound care, pain relief, and follow-up
- Some people are discharged the same day. Others may need a short stay if the abscess is large or if there are signs of spreading infection
The connection to fistulas
Around half of perianal abscesses are reported to lead to a fistula — an abnormal tunnel between the anal canal and the skin. This is not something you have caused or can prevent. It happens because the original infection created a path that does not fully close.
If you notice ongoing drainage from the area weeks after your abscess was treated, this may indicate a fistula has formed. Let your doctor know.
What tends to help
- Seeking medical care promptly — early drainage reduces the risk of the infection spreading or becoming more complex.
- Following wound care instructions — keeping the area clean after drainage supports healing.
- Sitz baths — warm water soaks can help with comfort and cleaning the wound area after drainage.
- Pain relief as directed by your doctor — staying on top of pain management in the days after drainage.
- Attending follow-up appointments — your doctor will want to check healing and watch for signs of a fistula.
What tends to make things worse
- Waiting and hoping the abscess will resolve on its own
- Attempting to squeeze or lance the abscess yourself
- Ignoring a fever alongside anal swelling and pain
- Skipping follow-up after drainage
- Not completing any prescribed course of antibiotics if given
Talking to your doctor
If you think you may have a perianal abscess, it helps to communicate:
- How quickly the pain and swelling developed
- Whether you have a fever or feel unwell
- Whether you have had an abscess in this area before
- Any drainage you have noticed
- Other health conditions, particularly Crohn’s disease or diabetes
- Medications you take, especially anything that affects your immune system
A perianal abscess with fever and rapidly increasing swelling is urgent. Do not wait for a routine appointment. Seek same-day medical care.
If you experience severe pain, heavy bleeding, fever, or symptoms that concern you, seek medical care.