Perianal abscess – assessment and referral

Symptoms – when to seek help

• Sudden throbbing pain near the anus, worse on sitting or defecation.
• Visible red, warm, tender swelling at the anal opening.
• Fever, chills or general malaise.
• Pus or blood from the anus.

Where does treatment take place?

The setting and the anaesthesia depend on the abscess. A superficial, well-defined abscess can often be drained under local anaesthesia, whereas a deep, extensive or complicated abscess needs drainage in an operating theatre, where a possible fistula can be addressed at the same time. It is not true that every abscess requires general anaesthesia. We assess what applies in your case and refer you on when treatment cannot be done as an outpatient (ASCRS anorectal abscess and fistula 2022).

Our assessment at Kirurgen.dk

Assessment rests on a clinical examination by a specialist. Imaging with endoanal ultrasound or MRI is not routine for every abscess, but can be relevant in complex, deep or recurrent disease, when Crohn's disease is suspected, or when the anatomy is unclear. The aim is to get you to the right place quickly.

Referral – where do we send you?

We typically refer to an acute surgical department in the Capital Region of Denmark:

• Herlev Hospital – Department of Surgery.
• Hvidovre Hospital – Gastro Unit.
• Bispebjerg Hospital – Department of Surgery.
• Hillerød (Nordsjællands Hospital) – Department of Surgery.
• Private hospital of your choice, if you have health insurance.

After drainage

A proportion of patients later develop an anal fistula because the connection between the anal gland and skin does not heal. The reported proportion varies between series. We are happy to provide follow-up assessment at our clinic afterwards.

Urgent assessment – what to do

A perianal abscess needs acute or same-day assessment. Contact your GP the same day, use the out-of-hours medical helpline (1813 in the Capital Region of Denmark), or go to an emergency department. With fever, rapidly increasing swelling, severe pain or feeling generally unwell, seek acute care immediately and call 112 if you are seriously affected. We are not an alternative to acute assessment, but we can offer clinical triage and follow-up after acute treatment.