A buttock abscess is a pus-filled lesion in your buttock that can cause pain and discomfort. Buttock abscesses can appear anywhere on the skin of the buttocks. This can be on the fleshy part of the buttocks or at the natal cleft (buttock crack region) or it can be close to the anus, for which it is known as a Perianal abscess. Seeking medical attention is crucial in the removal and treatment of the abscess.
What are buttock abscesses?
Pilonidal abscesses can originate from pilonidal cysts on the natal cleft.
Buttock abscesses are inflamed and infected lesions filled with pus in the buttock region. The abscess can grow anywhere on the buttock where an infection occurs.
Types of buttock abscess
Common abscesses that are found in the buttocks include [1]:
Perianal abscess – Perianal abscesses are found just under the skin around the anus, and are typically caused by infected anal glands within the anal canal. You may be able to feel a tender lump just beneath the skin, there may also be some pus discharging from the lesion.
Ischiorectal abscess – Ischiorectal abscesses are located deeper in the fat and fibrous tissues in the buttocks, you may not typically see or feel the abscess from the skin. Ischiorectal abscesses can cause deep-seated pain, and may be accompanied by systemic symptoms such as high fever. Similar to perianal abscesses, ischiorectal abscesses are typically caused by infected anal glands, but instead of tracking outwards towards the skin, they track deeper into the fatty tissues of the buttocks.
Supralevator abscess – Supralevator abscesses are rare buttock abscesses which are found in the supralevator space, just between the pelvic floor and the levator ani muscles [2]. These rare buttock abscesses can arise from cryptoglandular anal disease, or from an abdominal infection [3]. In some cases, supralevator abscesses can cause potential difficulty with urination.
Intersphincteric abscess – Intersphincteric abscesses are located between the internal and external anal sphincters, without penetrating the surrounding tissues. The abscess can be caused by anal gland infections, which tracks into the intersphincteric space [3]. With intersphincteric abscesses, some may experience pain while passing motion.
Superficial skin abscess – Superficial skin abscesses are abscesses located just beneath the skin, which is not restricted to the rectal or anal region. The cause of the infection can vary, including from cuts or wounds on the skin, or from ruptured or infected skin cysts.
Pilonidal abscess – A pilonidal abscess is a specific type of abscess located on the natal or buttock clefts. The natal cleft is the groove between the buttocks, above the tailbone, you might know this region as the “butt crack”. Pilonidal abscesses have a unique underlying cause, typically starting as pilonidal cysts, hair between the skin of the natal cleft is trapped under or inside the skin. This forms a pilonidal cyst, which is a sac filled with the trapped hair and skin debris. The cyst can become infected with bacteria and develop into an abscess.
Anorectal abscesses can be located on the superficial areas near the anus, or deep within the fatty tissues and sphincters.
What are the signs and symptoms of buttock abscess?
Buttock abscesses may show varying symptoms depending on where the abscess is located. Typical symptoms of buttock abscesses include:
A painful, tender lump on the buttocks
Pain or discomfort felt deep in the buttocks
Redness and swelling, typically seen in superficial, perianal, or pilonidal abscesses
Pus discharge or bleeding from the skin lesion, or from the anus
Fever
Pain and discomfort with urination or defecation
What causes buttock abscess?
Buttock abscesses are caused by bacterial infection of the skin. When bacteria enters the body, the body’s immune system reacts to the infection by sending inflammatory signals to the infection site. As a result, white blood cells aggregate to the infected to kill off bacteria. Through this process, the pus forms, which contains living and dead white blood cells, bacteria, tissue debris, and fluid from nearby blood vessels.
In buttock abscesses the infections can be caused by [1]:
Abdominal surgery injuries
Inflammatory diseases
Infection from gastrointestinal tract
Neoplastic growth
Bowel injuries
Cyst rupture
Skin injuries, friction, or ingrown hair
Do all buttock abscesses need treatment?
Most buttock abscesses require treatment — especially if the abscess is painful, growing or accompanied by a fever. The treatment approach largely depends on your condition’s severity:
Small, superficial abscesses — May drain on their own and heal with a warm compress and prescribed antibiotics.
Larger, deeper abscesses — May require an incision to drain the pus and wound packing to promote healing.
If left untreated, an abscess can worsen or spread. This can, eventually, lead to more serious complications such as sepsis or chronic sinus formation.
How are buttock abscess treated?
Regardless of the type of buttock abscess, urgent medical treatment is necessary to treat and drain the abscess. Typically, your doctor may prescribe some antibiotics to fight the bacterial infection. Drainage is typically done on large or unresolving abscesses. A drainage procedure often involves the following:
Anaesthesia – Surgery is performed under general anaesthesia. Local anaesthesia is usually inadequate to allow a complete surgery to be performed.
Incision – The surgeon will make a cut on the abscess to remove its contents. The size of the incision depends on the size of the abscess.
Drainage – The surgeon will then drain out the pus from the abscess. In some cases, the surgeon may also remove part of the surrounding tissues which are damaged or dead in a process called debridement.
Wound packing – In some cases, a wound packing may be applied to absorb the drainage. Your doctor may instruct you to change the wound packing throughout your recovery process. The incision wound is often left open to allow for complete drainage of the abscess. Stitching the wound close may recreate the abscess cavity, leading to pus accumulation. The wound will heal from the inside out, which averagely takes 4 weeks.
In certain conditions such as Pilonidal sinus/disease and Anal fistulas, the surgery is performed in stages to ensure complete eradication of the underlying cause.
What happens if buttock abscesses are not treated?
Buttock abscesses are a cause for medical concern and should not be ignored. Complications involved with untreated abscesses include:
Spread of infection – Untreated infections can spread to other nearby tissues, or even cause sepsis.
Recurrent abscess – Improper drainage can lead to recurrent abscesses. Diabetic or hyperglycaemic patients are also at higher risk of recurrent infections and abscesses.
Fistula – A fistula is an abnormal connection between two body surfaces, such as the rectum or anus and the external skin, a fistula can form as a result of repeated infections. Surgical intervention is required to treat a fistula.
Summary
Infections leading to buttock abscesses can cause serious discomfort and pain. Fortunately, the condition is treatable. Seeking medical attention for a buttock abscess may feel embarrassing, but it is a necessary step to relieve yourself of pain and potential complications from the abscess. Schedule a consultation with our doctor today for a thorough diagnosis and personalised treatment plan.
Frequently Asked Questions
Can buttock abscesses go away on their own?
Minor abscesses may go away on their own. But most abscess, especially larger or deeper ones require medical attention for proper drainage and treatment. It is also not recommended to drain the abscess on your own.
When do I need to see a doctor?
If you notice signs and symptoms of a buttock abscess, seeking immediate medical attention is highly recommended to treat the abscess early. Delayed treatment may result in sequelae that can further complicate the drainage procedure or further spread the infection. Visit your healthcare provider if you notice:
Fever and chills
A painful tender lump on your buttock
Pain while defecating
Pus or blood from your faeces, or coming out from the anus
Can I pop the abscess on my own?
Popping an abscess on your own can expose you to complications such as spread of the infection to nearby tissues, incomplete drainage, and scar formation. For abscess draining procedures, it is highly recommended to visit a healthcare provider.
How long does recovery from an abscess removal take?
Recovery from an abscess drainage procedure may depend on the size of the abscess, or where it is located. Typically, you can expect the wound to heal in 2 weeks. The wound needs to heal from the inside out, hence deeper and larger wounds may take longer. During this time, it is important to keep the area clean and follow post-operative care instructions from your doctor.
Sanyal S, Khan F, Ramachandra P. Successful management of a recurrent supralevator abscess: a case report. Case Rep Surg. 2012;2012:871639. doi: 10.1155/2012/871639. Epub 2012 May 7. PMID: 22649747; PMCID: PMC3357932.
Tupe CL, Pham TV. Anorectal Complaints in the Emergency Department. Emerg Med Clin North Am. 2016 May;34(2):251-70. doi: 10.1016/j.emc.2015.12.013. Epub 2016 Mar 23. PMID: 27133243.
