Red, swollen and painful lumps in the anal area

Introduction Swelling pain in the anal area is the main symptom of abscess around the rectum. At the time of examination, local anal swelling, tenderness and painful lumps were observed. The general manifestation of the disease is that the patient first feels pain or tingling in the anus, and can lick a hard block, tenderness, followed by increased pain, increased painful mass, and chills and fever. Abscesses can form locally after 3 to 5 days. The low abscess has local symptoms and mild systemic symptoms; the high abscess has severe systemic symptoms and mild local symptoms. Abscess can spontaneously discharge pus into the anorectal rectum, relieve pain after drainage, and the systemic symptoms improve or disappear. After the formation of anal fistula, the abscess can recur.

Cause

(1) Causes of the disease

About 99% of perianal abscesses are associated with anal gland infection and suppuration. The normal anal gland is mostly located between the internal and external sphincters of the anus, and the opening is located in the anal crypt. When feces and bacteria enter the anal gland through the opening, it can cause anal sinusitis and inflammation of the anal gland. These inflammations can spread to the perianal rectum to form an perianal abscess. The gaps around the anorectal rectum are usually filled with adipose tissue and lymphoid tissue, and the tissue is loose. Abscesses often occur in these gaps during infection. Other causes include injuries, foreign bodies, proctitis, and skin diseases. However, it should be pointed out that some lesions do not originate from the anal gland. For example, some anorectal abscesses can be directly derived from anal fissure, thrombotic external malleolus rupture, prolapsed thrombotic sputum, internal hemorrhoids or rectal prolapse drug injection. Can be derived from perianal skin infections, sepsis, blood disorders or direct trauma, a small number of cases can also be derived from tuberculosis, ulcerative colitis or Crohn's disease.

(two) pathogenesis

1. Pathological anorectal infection can be divided into three stages:

1 anal gland infection stage.

2 anorectal abscess around the rectum stage.

3 anal fistula formation stage.

After the anal gland infection, an abscess is formed between the internal and external sphincters, and then spreads along the combined fibers to various aspects, and various types of abscesses occur. Down the perianal subcutaneous formation of perianal subcutaneous abscess; inward to anal canal subcutaneous tissue to form abscess or ulceration; outward through the external sphincter to the ischial rectal fossa to form the ischial rectal abscess, sometimes continue upward through the levator ani muscle formation Abscess in the pelvic rectal space. The abscess can form a horseshoe-shaped abscess around the anal canal and the lower part of the rectum from one side to the other.

2. Classification

(1) Classification by infectious pathogen:

1 non-specific perianal abscess: caused by mixed infection of Escherichia coli, anaerobic bacteria and the like.

2 specific infection: clinically rare, mainly tuberculous abscess.

(2) Classification by abscess:

1 levator ani muscle abscess (low abscess): including perianal subcutaneous abscess, ischial rectal abscess, low horseshoe abscess.

2 levator levator abscess (high abscess): including pelvic rectal abscess, rectal posterior abscess and high horseshoe abscess.

(3) According to the final outcome of abscess classification: Eisenhammer (1978) divided the anorectal abscess into two categories: fistula abscess and non-tubular abscess.

1 non-tubular abscess: Anyone who has nothing to do with the anal sinus and anal gland, and ultimately does not leave anal fistula, are non-tubular abscesses.

2 fistula abscess: that is, the transanal sinus, anal gland infection, and finally left anal fistula.

an examination

Related inspection

Anal finger examination anal inspection

The general manifestation of the disease is that the patient first feels pain or tingling in the anus, and can lick a hard block, tenderness, followed by increased pain, increased painful mass, and chills and fever. Abscesses can form locally after 3 to 5 days. The low abscess has local symptoms and mild systemic symptoms; the high abscess has severe systemic symptoms and mild local symptoms. Abscess can spontaneously discharge pus into the anorectal rectum, relieve pain after drainage, and the systemic symptoms improve or disappear. After the formation of anal fistula, the abscess can recur.

Because of the different parts of the abscess, its symptoms and signs also have their own characteristics:

1. Perianal subcutaneous abscess accounts for 40% to 45% of the anorectal abscess, located in the subcutaneous tissue of the anus and lower anal canal, separated by the fascia and the ischial rectal space. It occurs mostly on the back side of the anus. Swelling pain in the anal area is the main symptom of this disease. Local redness, tenderness and painful lumps can be seen during the examination. There is a sense of fluctuation after suppuration. If you wear it yourself, you can see the broken mouth and pus. The diagnosis of this disease is easier, such as the formation of an abscess, can be confirmed by puncture.

2. The ischial rectal abscess accounts for 15% to 25% of the perianal abscess and is located in the rectal fossa. The sciatic rectal space is wedge-shaped, between the levator ani muscle and the ischial bone, the bottom is the skin between the anus and the ischial tuberosity, and the tip is in the membrane junction of the myofascial fascia and the levator ani muscle. At the beginning of inflammation, the anus is often uncomfortable or slightly painful, followed by systemic symptoms such as headache, elevated body temperature, rapid pulse, chills, etc., while local pain is aggravated, restlessness, and pain during defecation. Have difficulty urinating, and then urgency. When the body is examined, it can be seen that the anus is swollen, the skin is purple and hard, and the doctor can have a full bulge and tenderness in the rectum. Early sciatic rectal puncture is the simplest and most effective way to find abscess.

3. The pelvic rectal abscess accounts for about 2.5% to 9% of the perianal abscess. The pelvic and rectal space is located in the pelvic cavity, the lower part is the levator ani muscle, the upper part is the pelvic peritoneum, and the lower part is the rectum and the lateral ligament. The male in front is the bladder and prostate, and the female is the uterus and broad ligament. After the occurrence of abscess, the main symptoms are systemic poisoning, and the local manifestation of the anus is not obvious. The diagnosis can be swollen and tender under the levator ani muscle. Due to the deep infection location, early diagnosis is not easy, so patients with systemic infection symptoms, and even septic shock can not consider the disease may be considered, B-ultrasound or CT examination can help diagnose.

4. Horseshoe-shaped abscess Horseshoe-shaped abscess is an abscess that spreads behind the anus and anal canal, and most of them are in the posterior, caused by infection of the posterior anal gland or one side of the abscess spread to the opposite side, which can be divided into high horseshoe abscess and Low horseshoe abscess. In addition to the symptoms of systemic infection, the local manifestations are swelling and tenderness in the posterior anal canal, and the pus in the later stage.

(1) Clinical symptoms. Perianal persistent severe pain, increased pressure when coughing or coughing; may have generalized fatigue, fever and other infections.

(2) Signs. The skin around the anus has obvious erythema, with induration and tenderness, can be fluctuating, is an perianal abscess; rectal examination, the tender side of the affected side is the ischial rectal abscess; the upper side of the upper rectum has tenderness and bulging Pelvic rectal abscess; rectal examination has tenderness, swelling and fluctuation in the posterior wall of the rectum, and is a rectal abscess. High intermuscular abscess, no abnormal appearance of the perianal, rectal examination in the upper or lower end of the anal canal and smooth surface, oval, tidy edge, hard, tender pain, or fluctuations in the high intermuscular abscess.

(3) The anus can sometimes see the opening in the microscopic examination. If it is pressurized around, it can also be seen that the pus flows out from the opening.

Differential diagnosis

Anal pain: is a clinical manifestation of a variety of anorectal diseases. Pain of different nature reflects different disease characteristics.

Anal papillary hypertrophy: due to the anal nipple on both sides of the anal sinus, the anal sinus first affects the anal nipple after inflammation, causing anal milk inflammation, swelling and hypertrophy.

Rectal anal pain and discomfort: Anorectal pain is the most common symptom of anorectal disease. Due to the relationship between anatomy and physiology, the pain of anorectal disease occurs in the lower abdomen, perineum, anal margin and lower rectum.

Anal abscess: also known as anal canal abscess intestinal bacteria caused by anal crypt (anal canal rectal junction sinus fossa tissue) inflammatory infection along the lymphatic invasion of the rectal anal canal tissue formation abscess.

The general manifestation of the disease is that the patient first feels pain or tingling in the anus, and can lick a hard block, tenderness, followed by increased pain, increased painful mass, and chills and fever. Abscesses can form locally after 3 to 5 days. The low abscess has local symptoms and mild systemic symptoms; the high abscess has severe systemic symptoms and mild local symptoms. Abscess can spontaneously discharge pus into the anorectal rectum, relieve pain after drainage, and the systemic symptoms improve or disappear. After the formation of anal fistula, the abscess can recur.

Because of the different parts of the abscess, its symptoms and signs also have their own characteristics:

1. Perianal subcutaneous abscess accounts for 40% to 45% of the anorectal abscess, located in the subcutaneous tissue of the anus and lower anal canal, separated by the fascia and the ischial rectal space. It occurs mostly on the back side of the anus. Swelling pain in the anal area is the main symptom of this disease. Local redness, tenderness and painful lumps can be seen during the examination. There is a sense of fluctuation after suppuration. If you wear it yourself, you can see the broken mouth and pus. The diagnosis of this disease is easier, such as the formation of an abscess, can be confirmed by puncture.

2. The ischial rectal abscess accounts for 15% to 25% of the perianal abscess and is located in the rectal fossa. The sciatic rectal space is wedge-shaped, between the levator ani muscle and the ischial bone, the bottom is the skin between the anus and the ischial tuberosity, and the tip is in the membrane junction of the myofascial fascia and the levator ani muscle. At the beginning of inflammation, the anus is often uncomfortable or slightly painful, followed by systemic symptoms such as headache, elevated body temperature, rapid pulse, chills, etc., while local pain is aggravated, restlessness, and pain during defecation. Have difficulty urinating, and then urgency. When the body is examined, it can be seen that the anus is swollen, the skin is purple and hard, and the doctor can have a full bulge and tenderness in the rectum. Early sciatic rectal puncture is the simplest and most effective way to find abscess.

3. The pelvic rectal abscess accounts for about 2.5% to 9% of the perianal abscess. The pelvic and rectal space is located in the pelvic cavity, the lower part is the levator ani muscle, the upper part is the pelvic peritoneum, and the lower part is the rectum and the lateral ligament. The male in front is the bladder and prostate, and the female is the uterus and broad ligament. After the occurrence of abscess, the main symptoms are systemic poisoning, and the local manifestation of the anus is not obvious. The diagnosis can be swollen and tender under the levator ani muscle. Due to the deep infection location, early diagnosis is not easy, so patients with systemic infection symptoms, and even septic shock can not consider the disease may be considered, B-ultrasound or CT examination can help diagnose.

4. Horseshoe-shaped abscess Horseshoe-shaped abscess is an abscess that spreads behind the anus and anal canal, and most of them are in the posterior, caused by infection of the posterior anal gland or one side of the abscess spread to the opposite side, which can be divided into high horseshoe abscess and Low horseshoe abscess. In addition to the symptoms of systemic infection, the local manifestations are swelling and tenderness in the posterior anal canal, and the pus in the later stage.

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