A perianal abscess is an infection with a collection of pus near the anus or rectum. It often causes severe, increasing, throbbing pain, a tender lump, swelling, redness and sometimes fever or weakness. This is not a typical “haemorrhoid” that can be observed for weeks — if an abscess is suspected, urgent medical assessment is needed.
This article explains which symptoms may suggest an abscess, how it may differ from perianal thrombosis and haemorrhoids, and why treatment usually involves incision and drainage. If you have severe anal pain, a rapidly growing lump, fever or increasing swelling, book an urgent proctology consultation in Gdańsk.
Author: Dr Kamil Smok, surgeon and proctologist | Medical review: Justyna Szul, MD, proctologist | Status: Draft — medical review required | Publication date: 29.06.2026 | Last updated: 29.06.2026
What is a perianal abscess?
A perianal abscess is a limited collection of pus caused by infection near the anus or rectum. It often begins with an infection of the glands located in the anal canal. When the drainage of secretions becomes blocked, bacteria may multiply in the tissues and the body forms a collection of pus.
In practice, the patient most often feels increasing pain and notices a painful thickening or lump near the anus. Over time, redness, swelling, warmth in the area and, in more significant inflammation, fever and weakness may appear.
A perianal abscess requires medical assessment because in many cases the main treatment is incision and drainage, meaning opening the abscess and allowing the pus to drain. Simply waiting, using ointments or taking antibiotics without draining the abscess usually does not solve the problem.
Symptoms of a perianal abscess — what should you look for?
Symptoms of an abscess usually worsen faster and are more intense than in typical haemorrhoids. Patients often describe the pain as throbbing, pulsating, deep or “bursting”. The pain may make sitting, walking, sleeping and bowel movements difficult.
Symptoms that may suggest a perianal abscess include:
- severe, increasing pain in or around the anus,
- throbbing or pulsating pain,
- a tender lump near the anus that may enlarge,
- swelling, redness or warmth of the skin,
- pain that worsens when sitting, walking or passing stool,
- fever, chills or general weakness,
- discharge of pus or foul-smelling fluid if the abscess opens on its own,
- deep rectal pain, even without a large visible skin lesion.
Important: absence of fever does not rule out an abscess. In some patients, the main symptom is simply severe, increasing pain and a painful lump.
“For the patient, a perianal abscess often looks like a sudden, very painful lump near the anus. This is not a situation where it is worth trying haemorrhoid ointments for weeks — proctological or surgical assessment is needed.”
— Dr Kamil Smok, surgeon and proctologist
Abscess, perianal thrombosis or haemorrhoids — how may they differ?
A perianal abscess may be confused with perianal thrombosis, haemorrhoids or simply “a lump near the anus”. Differentiation is not always possible without examination. The table below is for orientation only and does not replace consultation.
| Feature | Perianal abscess | Perianal thrombosis | Haemorrhoids |
|---|---|---|---|
| Pain | often severe, increasing, throbbing | often sudden, severe, localised | often discomfort, itching or burning; severe pain is not typical for internal haemorrhoids alone |
| Lump | painful, tender, may enlarge | sudden painful lump at the anal margin | possible prolapse, moisture or itching |
| Fever | may occur, especially with a larger infection | usually not | usually not |
| Management | urgent assessment; often incision and drainage | medical assessment; treatment depends on duration and pain severity | diagnostics and treatment selection: conservative, office-based or procedural |
Read also: perianal thrombosis — symptoms and treatment and a lump near the anus — what can it mean?
When is a perianal abscess urgent?
Suspected perianal abscess requires prompt medical assessment. The stronger the pain, fever and swelling, the more urgent the consultation. Waiting may lead to the infection enlarging, pain worsening and complications developing.
Seek urgent medical care if you have:
- severe or rapidly increasing anal pain,
- a painful lump near the anus that is enlarging,
- fever, chills or feeling generally unwell,
- redness and swelling of the skin around the anus,
- discharge of pus or foul-smelling fluid,
- pain that makes sitting, walking or sleeping difficult,
- diabetes, immunosuppression or a chronic condition that increases the risk of a more severe infection.
With very severe symptoms, high fever, rapid deterioration of general condition, urinary problems, extensive swelling or suspected deep abscess, urgent hospital care may be needed.
Why is waiting not recommended?
An abscess is a collection of infected material. If the pus is not drained, pressure in the tissues may increase, pain may worsen and the infection may spread further. Sometimes an abscess opens on its own and begins to drain, but this does not always mean complete healing.
Lack of appropriate treatment may increase the risk of:
- worsening pain and swelling,
- spread of infection into surrounding tissues,
- abscess recurrence,
- formation of an anal fistula,
- need for more extensive treatment, especially with deep or large abscesses.
An anal fistula is a tract that may develop after infection and connect the inside of the anus or rectum with the skin near the anus. Not every patient develops a fistula after an abscess, but it is a known possible consequence, which is why follow-up matters.
Treatment of a perianal abscess — what does it involve?
The basic treatment of an acute perianal abscess is usually incision and drainage, meaning opening the abscess and draining the pus. The goal is to decompress the infected collection, reduce tissue tension and limit the spread of infection.
Treatment may include:
- surgical or proctological assessment,
- incision of the abscess,
- evacuation of pus,
- leaving a path for further drainage,
- wound care recommendations,
- follow-up after the procedure,
- antibiotics only in selected situations, such as systemic symptoms, cellulitis, immunosuppression, diabetes or extensive infection — the decision is made by the doctor.
An antibiotic alone, without drainage, is usually not sufficient treatment for an abscess because the medication may not effectively reach a closed collection of pus. However, there are situations where antibiotics are needed as an addition to treatment — this decision should be made by a doctor.
What does abscess incision look like?
The course of treatment depends on the location, size and depth of the abscess, as well as the patient’s condition. A small, superficial abscess may be treated on an outpatient basis. A deeper, extensive, recurrent or unusually located abscess may require hospital treatment or anaesthesia other than local anaesthesia.
A typical approach may include:
- Medical history and examination — the doctor assesses pain, the lump, fever, comorbidities and complication risk.
- Assessment of abscess location — sometimes external examination is enough, sometimes a gentle proctological examination is needed, and deeper lesions may require imaging.
- Anaesthesia — selection depends on the clinical situation and extent of the abscess.
- Incision and drainage — the doctor opens the abscess, drains the pus and reduces tissue tension.
- Post-procedure recommendations — the patient receives information on hygiene, dressings, follow-up and alarm symptoms.
Do not puncture or squeeze a painful lump near the anus on your own. This may worsen the infection, make treatment more difficult and increase the risk of complications.
Does pain go away immediately after abscess drainage?
In many patients, drainage of the abscess brings clear pain relief because pressure in the infected tissue decreases. However, it should not be promised that pain will disappear immediately in every patient. After the procedure, tenderness, burning, drainage or wound-related discomfort may persist.
The speed of improvement depends on:
- the size of the abscess,
- depth and location of the infection,
- duration of symptoms before treatment,
- comorbidities,
- quality of drainage,
- following post-procedure recommendations.
Recovery after abscess incision
After abscess incision, the wound usually remains open so that fluid can continue to drain. Discharge, blood or pus may appear for some time. Healing time depends on abscess size, location and the patient’s general health.
After the procedure, the doctor may recommend:
- wound follow-up,
- regular hygiene of the anal area,
- dressings or absorbent pads if the wound drains,
- pain medication selected for the patient,
- keeping stools soft and avoiding strong straining,
- antibiotics only when indicated,
- follow-up for possible fistula if symptoms persist or recur.
Contact a doctor if, after the procedure, you develop increasing bleeding, worsening pain, fever, chills, difficulty urinating, rapidly spreading redness or deterioration of general condition.
Abscess and anal fistula
An abscess and an anal fistula are related. An abscess is an acute infection with a collection of pus. A fistula is an abnormal tract that may remain after infection and connect the inside of the anus or rectum with the skin near the anus.
Symptoms that may suggest a fistula after an abscess include:
- recurrent drainage from a small opening near the anus,
- repeated abscesses in a similar location,
- periodic pain and swelling followed by fluid discharge,
- soiling of underwear with discharge,
- chronic irritation of the skin around the anus.
If symptoms return after abscess treatment or the wound drains for a long time, proctological follow-up is needed.
Diagnostics — is anoscopy always needed?
The diagnosis of an abscess is based on medical examination. In many superficial abscesses, the doctor may recognise the problem based on medical history and inspection of the anal area. Digital rectal examination or anoscopy may be helpful, but with very severe pain they may sometimes be limited or postponed until the patient can tolerate them.
Diagnostics may include:
- medical history regarding pain, fever and how quickly symptoms progressed,
- inspection of the anal area,
- palpation, if possible,
- digital rectal examination or anoscopy, if indicated and tolerated,
- imaging if a deep, atypical, recurrent or extensive abscess is suspected,
- assessment for comorbidities such as diabetes, inflammatory bowel disease or immunosuppression.
Not every anal pain requires immediate anoscopy, but every severe, increasing pain with a lump or fever requires medical assessment.
Who can you see at Wyspa Medycyny Przyjaznej?
At Wyspa Medycyny Przyjaznej in Gdańsk, proctology consultations are provided by doctors dealing with diagnosis and treatment of anal and rectal diseases. If a perianal abscess is suspected, prompt qualification is important because some patients require urgent incision and drainage or referral for treatment in an appropriate setting.
- Sara Godyńska, MD, proctologist,
- Justyna Szul, MD, proctologist,
- Dr Kamil Smok, surgeon and proctologist.
Booking:
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Frequently asked questions
Can a perianal abscess go away on its own?
Sometimes an abscess may open on its own and start draining, but this does not always mean complete healing. If an abscess is suspected, medical assessment is needed because incision and drainage are often necessary.
Is an antibiotic enough for a perianal abscess?
An antibiotic alone is usually not enough if a closed collection of pus has formed. Antibiotics may be needed in selected patients, for example with fever, cellulitis, immunosuppression, diabetes or extensive infection, but the decision is made by the doctor.
How can you tell an abscess from haemorrhoids?
An abscess more often causes severe, increasing, throbbing pain, a tender lump, swelling, redness and sometimes fever. Haemorrhoids more often cause bleeding, itching, burning or prolapse. The final diagnosis requires examination.
Does abscess incision hurt?
The procedure is performed under appropriately selected anaesthesia, depending on the location and extent of the abscess. After drainage, many patients feel reduced tension and pain, but the wound may remain tender for some time.
Can a fistula form after an abscess?
Yes, an anal fistula is a possible consequence of an abscess. It does not occur in every patient, but recurrent drainage, repeated abscesses or a wound that does not heal for a long time require proctological follow-up.
When should I see a doctor urgently?
Urgent assessment is needed for severe increasing anal pain, a painful enlarging lump, fever, chills, pus discharge, extensive swelling, rapid deterioration of general condition or difficulty urinating.
Severe, throbbing pain and a growing lump near the anus?
Do not wait for weeks and do not treat it like typical haemorrhoids. A perianal abscess often requires urgent assessment and drainage.
Book an urgent proctology consultation →Summary
A perianal abscess is an infection with a collection of pus near the anus or rectum. It most often causes severe, increasing, throbbing pain, a painful lump, swelling, redness and sometimes fever or weakness.
It is a condition that requires prompt medical assessment. In many cases, the basis of treatment is incision and drainage of the abscess. An antibiotic alone is usually not enough, although in selected patients it may be needed as an addition to treatment.
Not every lump near the anus is a haemorrhoid. If pain is rapidly increasing, the lump is enlarging or fever appears, do not wait — proctological or surgical consultation is needed.
Read also
Sources and medical context:
- American Society of Colon and Rectal Surgeons — Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula, 2022
- Guideline Central / ASCRS — Anorectal Abscess guideline summary
- Cleveland Clinic — Perianal Abscess: Symptoms, Causes & Treatment
- NHS — Anal fistula
- Guy’s and St Thomas’ NHS Foundation Trust — Perianal abscess surgery
- Wyspa Medycyny Przyjaznej — proctology consultation in Gdańsk
This article is for informational purposes only and does not replace medical consultation. Severe increasing anal pain, fever, chills, purulent discharge, a rapidly enlarging lump, heavy bleeding, difficulty urinating or rapid deterioration of general condition require urgent individual medical assessment.