With constipation, a hard bowel movement can erode the lining in the anal canal, resulting in infections of small glands in the anal lining. This results in swelling and formation of pus that increases to a significant size. Eventually, the pus finds its way through or around the sphincter muscles of the anus and out through the skin around the anus or internally.

The following factors can increase the likelihood of developing a fistula:

• straining to have a bowel movement when you are constipated
• waiting too long to have a bowel movement
• having less fibre in diet
• insufficient water intake
• low immunity states: diabetes, steroid intake, other diseases.

Symptoms of perianal abscess include:

• pain and swelling near the anal region
• pus discharge after an episode of intense pain
• fever
• a swelling noted around the anus
• sometimes a sensation of “internal pain” or itchiness in the region may indicate the presence of perianal abscess

Your health care provider will examine your rectum and anus. It may be a little painful if there is a swelling/ recent pain/pus discharge. Proctoscopy (examination with a small instrument) may be performed using a local anaesthetic ointment, to better assess the anal region. An MRI of the perianal region may be performed, to identify the size, extent and connections of the abscess.

Surgery is the only definitive treatment for perianal abscess. In some cases, if the abscess has already burst and there is no significant pus collection left within, your healthcare provider may consider giving you a simple trial of antibiotics without surgery. However, it is not advisable to wait by yourself for the abscess to burst, as that has a very high risk of fistula formation and slower recovery, due to inner pus collections that may be left untreated.

The newer techniques with smaller incision allows for quick healing of the wound and recovery in 2-3 weeks. The chances of fistula are less with laser ablation, and the risk of incontinence is negligible.

Eat more high-fibre foods, which will help prevent constipation. Good sources of fibre include fresh fruit; raw or cooked vegetables, especially asparagus, cabbage, carrots, corn, and broccoli; and whole-grain cereals with bran, such as shredded wheat or bran flakes.

Drink plenty of water. This helps to soften stools so they are easier to pass.

Sitting in lukewarm water 2 or 3 times a day for 15 minutes cleans the anal area and may relieve discomfort. Also, you might try putting a cloth-covered ice pack on the anus for 10 minutes, 4 times a day.

Antibiotics are needed if there is active pus discharge, to reduce the infection. They are also used during and after the surgery, so as to control any infection. Local anaesthetic and disinfectant creams along with a stool softener and an oral painkiller are also prescribed.

In most cases the symptoms go away in a few days after surgery. The wounds in more severe cases should get better in a couple of weeks. A wound check and clean up may be required after 3-4 days of surgery, especially in large abscesses.

Always tell your health care provider when you have anal pus discharge, pain or fever. Although a few drops of blood/ fluid is expected after fistula surgery.

Follow these guidelines to help prevent fistulas and to relieve their discomfort:

• Do not strain during bowel movements. This only increases the force of injury.
• Follow your high-fibre diet and drink plenty of water. If necessary, take a stool softener. Softer stools make it easier to empty the bowels and reduce pressure on the veins.
• Don't overuse laxatives. Diarrhea can be as damaging to the anus as constipation.
• Ask your health care provider what nonprescription product you should buy to relieve pain and itching. Also, ask about any side effects of any medications prescribed for you.
• Exercise regularly to help prevent constipation.