A Buttock Abscess is a collection of pus (akin to a large pimple) in the region of the buttocks and anus. The abscess can be superficial on the surface of the skin or deep within the buttock fat.
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There are four different types of buttock abscess with different causes and treatment options.
This is an abscess located on the skin surface just adjacent to the anus. Most perianal abscesses are superficial. The patient will be able to feel a very tender lump in the region which may have pus discharging from it.
A perianal abscess arises from infected anal glands within the anal canal and the infection subsequently tracks to the skin surface to form a collection of pus.
This is a deep abscess that usually arises within the fat tissue of the buttocks. The majority of ischiorectal abscesses will not have a swelling on the skin.
The patient will usually experience a deep-seated pain within the buttock. This is usually associated with a high fever with no discharge of pus. The deep-seated nature of an ischiorectal abscess makes an initial diagnosis more difficult. A consult with a General Surgeon may be needed to clinch the diagnosis.
An ischiorectal abscess also arises from infected anal glands, similar to a perianal abscess. In the case of an ischiorectal abscess, the infection tracks further from the anus to end up in the deep fatty tissues of the buttocks.
A superficial skin abscess can arise anywhere on the buttocks and is not restricted to the region around the anus. The patient will be able to feel a tender skin lump that is often red and may have pus discharging from it.
The superficial skin abscess arises from the skin surface and is usually due to a break in the skin allowing bacteria to infiltrate. Breaks in the skin can arise from shaving or abrasions from clothing chafing against the skin. In diabetics, these abscesses can arise spontaneously with no obvious skin damage.
A pilonidal abscess occurs exclusively at the region of the natal and buttock clefts. The natal cleft is the ‘valley’ between the buttocks overlying the ‘tail bone’ of the spine and the buttock cleft is the corresponding ‘valley’ between the fleshy parts of the buttocks.
The patient will experience a tender and red skin lump on either side of the cleft region, and this corresponds to an abscess. Some patients may, however, experience a pimple-sized nodule with occasional discharge of small amounts of pus for weeks on end.
The pilonidal abscess has a unique underlying cause. Most pilonidal abscesses occur in individuals with heavy hair growth at the buttock and cleft regions. The pilonidal abscess starts with ingrown hairs at the depth of the ‘valley’ of the clefts that eventually form tiny hair pits. The hair pits can be identified during a specialist consult as it manifests as small pinpoint holes in the clefts. The infection then spreads from these pits to both sides of the clefts to form an abscess.
All buttock abscesses need urgent treatment to allow the pus to be drained completely.
This is accomplished through a minor surgery under general anaesthesia. The surgeon makes an incision/cut on the abscess to allow the pus to drain out with subsequent packing of the open wound with a special dressing material. In severe cases, the surgeon will need to remove part of the unhealthy and dead skin overlying the abscess and this will result in a bigger wound.
It is vital for the wound to be left open and not stitched up. Stitching up the wound will re-create the abscess cavity and allow pus to re-accumulate. The wound needs to be allowed to heal from the bottom up and this healing process will take at least 2 weeks.
Due to the different underlying causes of the different types of abscesses, we can expect different sequelae and different treatment options.
The superficial skin abscesses usually heal with no further recurrences, except for diabetics with poorly controlled sugar levels who may have recurring abscesses.
The perianal and ischiorectal abscesses arise from infected anal glands with subsequent tracking of the infection to distant areas. In up to 37% of patients with either of these conditions, the track may remain patent/open instead of closing up. As a result, there is a small communication/tract between the anal canal and the buttock skin, resulting in regular but small amounts of discharging pus from the skin and occasionally repeated development of abscesses.
The development of the tract is known as an Anal Fistula. The treatment option will be for obliteration/destruction of the fistula and surgical techniques include Fistulotomy, Seton placement, VAAFT (Video-Assisted Anal Fistula Treatment) or a LIFT (Ligation of Inter-sphincteric Fistula Tract) procedure. The exact treatment will need to be tailored to each patient and a detailed consultation with a colorectal surgeon is essential.
The initial operation to drain the pus from the abscess is the first step in the treatment of pilonidal disease. As mentioned above, the root of the problem lies in the hair pits located in the natal and buttock clefts. Removal of the hair pits is essential in ensuring a long-term cure.
The surgical techniques available include Fistulotomy with marsupialization of skin edges, Karydakis flap procedure, Bascom procedure or a rhomboid or buttock rotation flap procedure.
Buttock abscesses should be treated urgently due to the pain and discharge it brings to the individual. Most buttock abscesses heal with no subsequent sequelae. Treatment options are available for sequelae that do develop.