Understanding the Differences Between Perianal Abscess and Hemorrhoids

Understanding Perianal Abscess and Hemorrhoids

Both perianal abscess and hemorrhoids can cause pain, discomfort, and bleeding in the anal area, but they are two distinct conditions. While hemorrhoids involve swollen veins inside or just outside the anus, an abscess refers to a collection of pus that has built up within tissues. Knowing the differences between these two problems can help you seek the right treatment.

What is a Perianal Abscess?

A perianal abscess is a collection of pus that has formed within the soft tissues surrounding the anus. It results from an infection, often starting when bacteria enters the skin through a small tear or cut. This leads to inflammation and the formation of a walled-off pocket of pus.

Perianal abscesses typically occur just outside the anus, but they can also develop deeper in the pelvis. Common locations include under the skin near the anal opening, between the vagina and rectum in women, and in glands just inside the anus.

Abscesses are often quite painful, since the buildup of pus puts pressure on surrounding sensitive tissues. Other symptoms may include:

• A tender, red lump or swelling near the anus
• Anal discharge, bleeding, and itching
• Pain with bowel movements, urination, coughing/sneezing
• Fever and chills in some cases

Causes and Risk Factors

Perianal abscesses can occur in anyone, but certain factors raise your risk:

• Blocked anal glands - These small glands around the anus can become blocked and infected.
• Ingrown hairs - Hairs that curve back and re-enter the skin can become infected.
• Anal fissures - Cracks or tears in the skin lining the anus are vulnerable to bacteria.
• Crohn's disease - This inflammatory bowel disease increases infection risk.
• HIV - Immune system impairment makes abscess more likely.
• Diabetes - High blood sugar allows infections to develop.
• Prior abscess - You may be prone to repeat abscesses.

Diagnosing a Perianal Abscess

A doctor can often diagnose a perianal abscess through a physical exam of the anal area. They will look for swelling, redness, tenderness, and possible drainage around the anus.

Other tests that may help confirm an abscess include:

• Digital rectal exam - The doctor inserts a gloved finger into the anus to feel for abnormalities.
• Anoscopy - A small tube with a light is inserted to view the anal canal and lower rectum.
• MRI or CT scan - Provides detailed images to locate abscesses.
• Needle aspiration - Inserting a needle into the swelling to draw out fluid confirms pus buildup.

Perianal Abscess Treatment

Treatment typically involves draining the abscess of pus, either in a doctor's office or through surgery. This provides relief of symptoms and prevents the infection from spreading or recurring.

Drainage procedures may include:

• Incision and drainage - A small cut is made to open and drain the abscess.
• Unroofing - A larger opening allows debris to drain out over time.
• Seton placement - A soft thread is left in a fistula (tunnel) to keep it open so pus can exit.

Antibiotics are often prescribed after drainage to clear any remaining infection. Sitting in a warm tub several times a day, pain medicine, and stool softeners can provide comfort during healing.

If abscesses recur, further treatment may be needed such as injecting fibrin glue into fistulas or surgery to seal tracts. Hyperbaric oxygen therapy is also sometimes used to improve healing.

Understanding Hemorrhoids

Hemorrhoids refer to swollen veins that have developed just inside or right outside the anal opening. Also known as piles, they often result from increased pressure in the lower rectum. The veins there fill with blood, stretch, and expand, forming cushions or clumps.

Internal hemorrhoids develop within the rectum, while external hemorrhoids arise under the skin around the anus. A thrombosed hemorrhoid contains a blood clot, causing severe swelling.

Symptoms of hemorrhoids may include:

• Bright red blood on toilet paper, stool, or in the toilet bowl
• Anal itching, pain, irritation
• Tender lumps or swelling around the anus
• Leakage of feces
• A feeling that the bowels haven't emptied completely

Pain is usually worse with external hemorrhoids and during bowel movements. Bleeding may occur with straining, irritation, or a hard stool.

What Causes Hemorrhoids?

There are a number of contributing factors that can lead to hemorrhoids, including:

• Chronic constipation and straining
• Sitting for long periods on the toilet
• Diarrhea
• Pregnancy and childbirth
• Obesity
• A low fiber diet
• Heavy lifting

As pressure increases in the veins of the anorectal area, it can cause the veins to bulge and expand. Those most at risk are adults ages 45 to 65. Hemorrhoids also often develop during pregnancy.

Diagnosing Hemorrhoids

Doctors can often diagnose external hemorrhoids through a simple examination of the anus. Tests may be needed to rule out other causes of bleeding, itching, and discomfort.

Procedures used to confirm hemorrhoids include:

• Visual exam - The anus is inspected for signs of swelling, lumps, irritation, and bleeding.
• Anoscopy - Allows the doctor to see inside the anal canal with a narrow, lighted tube.
• Digital exam - Inserting a gloved, lubricated finger into the rectum to feel for abnormalities.
• Colonoscopy - A viewing tube is inserted into the rectum to see the entire colon.

Internal hemorrhoids are graded based on their degree of prolapse outside the anus:

• Grade 1 - Swelling inside the anus that does not protrude
• Grade 2 - Prolapse with straining that retracts spontaneously
• Grade 3 - Prolapse with straining that must be pushed back in
• Grade 4 - Prolapse that cannot be pushed back in

Treating and Preventing Hemorrhoids

Mild symptoms can often be relieved with over-the-counter topical creams, ointments, suppositories, or pads. These may contain witch hazel, hydrocortisone, or lidocaine for pain relief.

Other home treatments include:

• Sitz baths - Soaking in warm water can relieve swelling and discomfort.
• Ice packs - Reduce swelling and numb pain when applied to the area.
• Over-the-counter pain relievers - Ibuprofen, naproxen or acetaminophen can help relieve discomfort.
• Stool softeners - Make bowel movements easier to pass.
• High fiber diet - Softens stool and prevents constipation.

For larger hemorrhoids or severe symptoms, a doctor may recommend:

• Rubber band ligation - Rubber bands applied to internal hemorrhoids cut off circulation, causing them to shrivel.
• Sclerotherapy - Injecting a chemical solution causes scar tissue that shrinks the hemorrhoid.
• Infrared coagulation - Burning the hemorrhoid causes it to shrink.
• Hemorrhoidectomy - Surgical removal of severe internal or external hemorrhoids.

Preventing constipation and avoiding straining with bowel movements can help keep hemorrhoid symptoms from flaring. Medications to treat conditions that contribute to hemorrhoids, such as high blood pressure, may also help.

Key Differences Between Perianal Abscess and Hemorrhoids

Understanding the distinct features and causes of perianal abscesses versus hemorrhoids is important for getting the right treatment. Here are some of the main differences:

• A perianal abscess results from an infection, while hemorrhoids stem from swollen, dilated veins.
• Abscesses cause buildup of pus, but hemorrhoids do not involve pus.
• Hemorrhoid symptoms are usually less severe compared to an abscess.
• Abscesses may require incision and drainage, while hemorrhoids typically do not.
• Hemorrhoids arise from increased pressure in the lower rectum; abscesses don't necessarily relate to pressure.
• Abscesses can reoccur if a fistula (tunnel) develops; hemorrhoids may reoccur with continued constipation/straining.

Both conditions can initially be evaluated through a medical history and physical exam. However, hemorrhoids alone usually do not require testing beyond a visual inspection. Imaging or needle aspiration may be needed to confirm an abscess.

While small hemorrhoids can often be treated with over-the-counter remedies, a perianal abscess requires drainage or antibiotics prescribed by a doctor. Hemorrhoids can usually be prevented through diet, hydration, and hygiene, while abscesses may recur even with treatment.

Seeking prompt medical attention for symptoms is important, as an untreated abscess can worsen and spread infection throughout the body. Understanding the typical features of both hemorrhoids and abscesses allows for an accurate diagnosis.

When to See a Doctor

It's important to consult a doctor for any persistent rectal bleeding, pain, swelling, irritation, or bumps around the anus. While hemorrhoids are commonly self-treated, a doctor should assess symptoms to rule out a perianal abscess or other conditions.

See a doctor right away if you have severe pain, rectal bleeding, drainage, or fever along with anal symptoms. Bleeding can signify an abscess, but also potentially more serious gastrointestinal conditions like colorectal cancer or inflammatory bowel disease.

A doctor can perform an exam and any necessary testing to determine if hemorrhoids, abscess, fissures, warts, or another issue is causing your discomfort. Based on the diagnosis, they will recommend the proper treatment.

Prompt medical care provides relief of symptoms and helps prevent complications. Even if symptoms seem minor at first, don't neglect anal discomfort, bleeding, or other abnormalities. See a doctor to identify the cause and appropriate remedies.

The Takeaway

Rectal symptoms like pain, swelling, and bleeding can happen due to different anorectal problems. Perianal abscesses and hemorrhoids share some similar signs, but have distinct underlying causes.

Hemorrhoids arise from dilated blood vessels, while abscesses relate to a skin infection. Though hemorrhoids can often be self-treated, abscesses require drainage and antibiotics prescribed by a doctor.

Don't assume discomfort or bleeding is due to hemorrhoids alone. See a doctor for an accurate diagnosis if you have any persisting anal symptoms. Proper treatment can provide relief from hemorrhoids or abscesses and help prevent complications.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.