An Overview of Anal or Rectal Abscess

Why You Should Never Ignore the Pain

Table of Contents
View All
Table of Contents

An anorectal abscess (also referred to as an anal abscess, rectal abscess, perianal abscess, or perirectal abscess depending on its location) is a pus-filled cavity that forms within the furrows of the anal canal (called the anal sinuses).

Anorectal abscesses are most often caused by the accumulation of common bacteria ​in vulnerable or compromised tissues. As your body tries to control the infection, white blood cells killed in the battle and other bodily fluids start to collect in the tissue, forming a pocket of pus.

Abscesses can form near or within the anus or develop much higher up in the rectum itself. While an abscess can form spontaneously for no apparent reason, it is commonly associated with gastrointestinal disease, bowel irregularities, immune suppression, and even certain medications.

Verywell / Laura Porter

Anorectal Abscess Symptoms

Anorectal abscesses are usually first recognized because of dull, throbbing pain in the anus or rectum, often accompanied by sharp pain when defecating.

Perianal abscesses ("peri-" meaning around) are the most common type and can usually be identified visually as they occur in the upper layers of tissue. When touched, the lump will usually be tender, red, and warm.

By contrast, perirectal abscesses tend to form deeper tissues and are often more felt than seen. Of the two types, a perirectal infection tends to be more serious.

As the pus starts to consolidate and form a palpable mass, other symptoms of an anorectal abscess appear, including:

  • Fever
  • Fatigue
  • Constipation
  • Rectal discharge and bleeding
  • Feeling like you need to go to the bathroom when you don’t
  • Increasing and often constant pain, worsening with movement or while sitting

If you experience any of these symptoms, it is important to see a healthcare provider and have a thorough examination.

If left untreated, an abscess can lead to the development of an anal fistula, an abnormal tunneling connection between the skin around the anus and the rectal or anal canal through which stool and pus may drain. This may require intensive surgery and a prolonged period of recovery.

If you develop a high fever (over 100.4 degrees), shaking chills, persistent vomiting, the inability to have a bowel movement, or extreme anal or rectal pain (with or without a bowel movement), go to the emergency room without delay. These may indicate a systemic infection that has spread from the site of the abscess into the bloodstream.

Without proper treatment, systemic infection of this sort can lead to sepsis, toxic shock, and even death.


An anorectal abscess can develop in isolation, often due to the overgrowth of bacteria common in the digestive tract, such as Escherichia coli (E. coli).

However, in recent years, there has been an increasing number of cases associated with methicillin-resistant Staphylococcus aureus (MRSA), a difficult-to-treat bacterial strain that can be passed through skin-to-skin contact.

While anyone, young or old, can get an anorectal abscess, there are a number of conditions that can increase your risk. They include:

  • Inflammatory bowel diseases (IBD) like Crohn's disease and ulcerative colitis
  • HIV and other forms of immune suppression
  • Diabetes
  • Anal sex
  • Chronic or severe constipation or diarrhea
  • Steroid drug use, including prednisone
  • Chemotherapy
  • Sexually transmitted infections of the anus or rectum
  • Hidradenitis suppurativa, a rare skin condition


Most anorectal abscesses are diagnosed based on your medical history and a physical exam. If an abscess is internalized within the anal canal, your healthcare provider may want to perform an endoscopy, using a flexible, lighted endoscope to get a better look inside.

Less commonly, imaging tests such as a computed tomography (CT) scan or a transrectal ultrasound (TRUS) may be used if the abscess is especially deep.

During the physical exam, your healthcare provider will want to ascertain whether the mass is an abscess or hemorrhoid. The two conditions can usually be differentiated by the presentation of symptoms.

With an abscess, the pain will worsen over time and fail to respond to standard hemorrhoid treatment. There may also be generalized symptoms of infection that you would not commonly experience with hemorrhoids, such as fever and nighttime chills.

Other tests may be ordered if IBD, HIV, or diabetes is suspected, including blood tests and colonoscopy.


Anorectal abscesses rarely go away on their own or resolve solely with antibiotic therapy. In most cases, the healthcare provider would need to drain the abscess, a relatively simple in-office procedure that involves a local numbing agent, a scalpel, and a pair of forceps.

If the abscess is especially deep or situated high in the rectum, the procedure needs to be performed in a hospital under general anesthesia. The surgery generally takes around 30 minutes. Some of the extracted pus may be sent to the lab to identify the causal bacterium.

Once the procedure is done, antibiotics are prescribed for around a week to help treat the infection and prevent any further spread. You may also be advised to use a sitz bath, a shallow basin used to soak and clean the anal area.

Tylenol (acetaminophen) is sometimes prescribed to help relieve the pain. During recovery, stool softeners may be needed to reduce abrasion and allow the drained abscess to better heal.

After a bowel movement, dab softly with toilet paper and rinse with a squirt bottle filled with warm water. Wash lightly with soap but avoid alcohol or hydrogen peroxide, which can slow healing. If needed, pad the wound with gauze or a maxi pad.

You can also ask your healthcare provider about the short-term use of over-the-counter topical creams and gels, which may help soothe anal tissues.

The drainage of an abscess will provide almost immediate relief. While there may some pain after the procedure, it will usually be mild by comparison. However, if you experience excessive rectal bleeding, fever, chills, or vomiting after returning home from the procedure, call your healthcare provider immediately.

Frequently Asked Questions

  • Why does a perianal abscess come back?

    If you have recurrent abscesses around the anus, you may have an anal fistula. This is an abnormal tunnel that develops between the inside of the anal canal and an outside opening in the skin. Your healthcare provider will need to surgically drain the fistula and will prescribe antibiotics to clean up the infection and prevent recurrence.

  • Are hemorrhoids the same thing as anal abscesses?

    No. Both are painful disorders that develop around the rectum. However, anal abscesses are infections while hemorrhoids are protruding, swollen veins. Hemorrhoids can become infected, but they're not the same type of infection as abscesses. Hemorrhoids often recur, but abscesses usually will not return once they’re treated. 

  • Can I drain a boil myself?

    No. What looks like a small boil, or abscess, could be a much deeper and extensive infection. Applying heat may help the boil open on its own, which will cause it to drain. However, it’s best to have a healthcare provider drain the abscess in an office procedure that can ensure the area is kept sterile. Your healthcare provider will also usually prescribe antibiotics and may test the pus to identify the type of infection.

20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gossman W, Waheed A, Emmanuel B, Tuma F. Perianal Abscess. Treasure Island, FL: StatPearls Publishing.

  2. Johnston SL. Clinical immunology review series: an approach to the patient with recurrent superficial abscessesClin Exp Immunol. 2008;152(3):397-405. doi:10.1111/j.1365-2249.2008.03640.x

  3. Chang J, Mclemore E, Tejirian T. Anal Health Care BasicsPerm J. 2016;20(4):15-222. doi:10.7812/TPP/15-222

  4. Kovalcik PJ, Peniston RL, Cross GH. Anorectal abscess. Surg Gynecol Obstet. 1979;149(6):884-886.

  5. Lohsiriwat V. Anorectal emergenciesWorld J Gastroenterol. 2016;22(26):5867-5878. doi:10.3748/wjg.v22.i26.5867

  6. Whiteford MH. Perianal abscess/fistula diseaseClin Colon Rectal Surg. 2007;20(2):102-109. doi:10.1055/s-2007-977488

  7. Owen HA, Buchanan GN, Schizas A, Cohen R, Williams AB. Quality of life with anal fistulaAnn R Coll Surg Engl. 2016;98(5):334-338. doi:10.1308/rcsann.2016.0136

  8. Mitra A, Yadav A, Mehta N, Varma V, Kumaran V, Nundy S. Complicated Perianal SepsisIndian J Surg. 2015;77(Suppl 3):769-773. doi:10.1007/s12262-013-0997-y

  9. Raygada JL, Levine DP. Methicillin-Resistant Staphylococcus aureus: A Growing Risk in the Hospital and in the CommunityAm Health Drug Benefits. 2009;2(2):86-95.

  10. De Zoeten EF, Pasternak BA, Mattei P, Kramer RE, Kader HA. Diagnosis and treatment of perianal Crohn disease: NASPGHAN clinical report and consensus statement. J Pediatr Gastroenterol Nutr. 2013;57(3):401-412. doi:10.1097/MPG.0b013e3182a025ee

  11. Van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, Van Deventer SJ, Dekker E. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006;101(2):343-350. doi:10.1111/j.1572-0241.2006.00390.x

  12. Adamo K, Sandblom G, Brännström F, Strigård K. Prevalence and recurrence rate of perianal abscess--a population-based study, Sweden 1997-2009. Int J Colorectal Dis. 2016;31(3):669-673. doi:10.1007/s00384-015-2500-7

  13. Turner EJ, Raza SA. Long-term steroids and an extensive diverticular abscessBMJ Case Rep. 2012;2012:bcr1020114926. doi:10.1136/bcr.10.2011.4926

  14. Asgeirsson T, Nunoo R, Luchtefeld MA. Hidradenitis Suppurativa and Pruritus AniClin Colon Rectal Surg. 2011;24(1):71-80. doi:10.1055/s-0031-1272826

  15. Nguyen VX, Le Nguyen VT, Nguyen CC. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providersInt J Gen Med. 2010;3:345-357. doi:10.2147/IJGM.S14555

  16. Kim MJ. Transrectal ultrasonography of anorectal diseases: advantages and disadvantagesUltrasonography. 2015;34(1):19-31. doi:10.14366/usg.14051

  17. Abcarian H. Anorectal infection: abscess-fistulaClin Colon Rectal Surg. 2011;24(1):14-21. doi:10.1055/s-0031-1272819

  18. American Society of Colon & Rectal Surgeons. Abscess and fistula.

  19. Harvard Health Publishing. Anal disorders.

  20. University of Michigan Health. Boils.

Additional Reading

By Jerry Kennard
 Jerry Kennard, PhD, is a psychologist and associate fellow of the British Psychological Society.