Skip to main contentDr Harsh Shah · GI & Proctology Surgeon · Ahmedabad & Gandhinagar
Last updated: 18-Oct-2026
Perianal abscess treatment in Ahmedabad · Gota OPD, Gota, Ahmedabad · Apollo Hospital, Bhat, Gandhinagar
A perianal abscess is a pocket of pus beside the back passage. The treatment is to open and drain it under anaesthesia, usually the same day it is found.
Antibiotics alone do not clear an abscess. They are added only for diabetes, spreading redness, a weak immune system or a body-wide infection.
At the same operation Dr Harsh Shah examines the area for a fistula. If one is found, a soft loose thread called a seton may be placed, so the fistula can be treated safely later.
Dr Harsh Shah drains the abscess under anaesthesia, checks the whole area for a hidden pocket or a fistula, and plans the follow-up that catches a fistula early.
Dr Harsh Shah has 18 years of experience in surgery of the bowel, rectum and anus. Emergency drainage, examination under anaesthesia, seton placement and later fistula surgery are done by the same surgeon.
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
GI & Proctology Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Google rating 4.89 from 216 reviews at the Gota clinic, and 4.94 from 18 reviews at Apollo, Bhat.
| Option | Does Dr Harsh Shah use it? | Why |
|---|---|---|
| Incision and drainage under anaesthesia, the same day | Yes. This is the main treatment. | Pus under pressure must come out. Anaesthesia lets every pocket be opened fully, which is what stops it filling again. |
| Examination under anaesthesia (EUA) | Yes, at the same sitting. | It finds deeper pockets and any inner opening of a fistula, without hurting you. |
| Loose seton if a fistula is found | Yes, when the track runs through muscle or is unclear. | The thread keeps the track draining so pus cannot build up again. It protects the muscle that controls the bowels. |
| Opening a fistula at the first operation (fistulotomy) | Only for a clearly low, simple track. | It lowers the chance of a second operation, but only when very little muscle is involved. |
| Antibiotics as an add-on | Only for diabetes, spreading redness, low immunity, heart-valve or joint implants, or a body-wide infection. | They help those patients. On their own they do not empty the pus. |
| Antibiotics alone, or waiting for it to burst | No. | The pus can spread deeper, the pain worsens, and a bigger operation may be needed later. |
| Drainage under local anaesthetic in a clinic | Only for a very small abscess pointing at the skin. | Deeper abscesses cannot be drained fully this way, and poor drainage is the main reason an abscess comes back. |
Small glands inside the anal canal can get blocked and infected. The pus collects in the layers around the back passage and pushes outwards as a painful lump.
Inside the anal canal there is a ring of tiny glands. They help keep the canal moist. When one becomes blocked, germs from the bowel can infect it. Pus then forms between the muscle layers and tracks to wherever there is least resistance. Most often it comes out near the skin beside the anus. Sometimes it goes deeper into the buttock, or upwards, or around the back passage.
The usual story is a few days of throbbing pain that gets worse, a lump that is hot and tender, and pain on sitting, walking or passing stool. Some people get fever. A deep abscess may show little on the skin and cause mainly deep pain and fever. Pain that seems too strong for what can be seen is a reason for an examination under anaesthesia, not for waiting.
Piles bleed or come down; a fissure causes sharp pain with stool and a little bright blood. An abscess is a throbbing swelling, often with fever. Our pages on piles and anal fissure explain those two.
Abscesses are named by where the pus sits. The site decides whether a scan is needed and which way the pus is drained.
| Type | Where the pus sits | How it usually feels | Scan needed? | How it is drained |
|---|---|---|---|---|
| Perianal | Just under the skin at the edge of the anus. The most common type. | A tender, hot, soft lump you can see and feel. | Rarely. | A small cut on the skin close to the anus. |
| Ischioanal (ischiorectal) | Deeper, in the fatty space of the buttock beside the back passage. | A wide, hard, painful area of the buttock with fever. The lump softens late. | Sometimes. | A cut over the buttock, kept as close to the anus as possible. |
| Intersphincteric | Between the two rings of muscle that control the bowels. | Severe pain with very little to see outside. Often mistaken for a fissure. | Often an MRI. | From inside the anal canal, through the inner muscle only. |
| Horseshoe | Behind the back passage, spreading to one or both sides like a horseshoe. | Deep pain at the back, swelling on both sides. | Yes, an MRI. | A cut at the back in the middle, small cuts on each side, and usually a loose seton. |
| Supralevator | High up, above the main muscle floor of the pelvis. | Deep pelvic or rectal pain, fever, sometimes trouble passing urine. | Yes, an MRI or CT. | Through the route the pus came from: into the rectum, through the buttock, or by treating a cause in the belly. |
The route matters. Draining a high abscess the wrong way can create a long, complicated fistula that is hard to fix. That is why deep, recurrent, horseshoe and high abscesses are scanned first, and why the cut is always placed as close to the anus as possible. A cut far out on the buttock leaves a longer track if a fistula forms later.
Go to an emergency department the same day with any of these.
A neglected abscess can spread into a fast, flesh-destroying infection called Fournier’s gangrene. Diabetes and delay are the two biggest risks.
Fournier’s gangrene is a serious infection that spreads along the tissue layers of the buttock, perineum and genitals. It can threaten life. It needs urgent wide surgery to remove dead tissue, strong antibiotics through a drip, and often a second look in theatre within a day. It is uncommon, but it is seen most in people who waited, tried home remedies or chemist tablets, or had diabetes that was not known or not controlled.
So every patient has a blood sugar test. Many people first learn they have diabetes because of an abscess. High sugar is brought down with insulin around the operation. People with diabetes are drained early and seen again sooner, because their infection can spread faster and their wounds heal more slowly.
The operation takes about twenty to forty minutes under spinal or general anaesthesia. The abscess is opened, emptied and left open to heal from the inside out.
For an intersphincteric abscess, the drainage is done from inside the anal canal through the inner muscle only. For a horseshoe abscess, a cut in the middle at the back reaches the source of the pus, small cuts drain each side, and a loose seton is usually placed. For a high abscess, the scan shows where the pus came from, and the drainage follows that path.
A loose seton is a soft silicone loop through the fistula track. It keeps the track draining while the area settles, and it does not cut the muscle.
A fistula is a small tunnel from the inside of the anal canal to the skin outside. It is what is left behind when the infected gland stays connected to the abscess. If the tunnel runs through very little muscle, it can sometimes be opened at the first operation. If it runs through more muscle, if the anatomy is unclear, if it is at the front in a woman, or if there is Crohn’s disease, a loose seton is the safe choice.
The seton is tied loosely, so it is not tightened and does not slowly cut through. You may feel a little thread and see some discharge on a pad. Showers and sitz baths are fine. It is a stage, not the end of treatment. Once the infection has settled, usually after six to twelve weeks, the fistula is assessed again, often with an MRI, and the next step is planned. Our fistula-in-ano page explains fistulotomy and staged seton treatment in detail.
The infected gland often stays connected to the skin. Large studies show one in six develop a fistula, and up to one in three develop a fistula or another abscess within three years.
Draining the pus clears the pocket but not always the gland it came from. If a channel from that gland stays open, it can keep leaking or fill up again. Most fistulas show themselves within the first year. The risk is higher under the age of forty, in deeper and intersphincteric abscesses, and much higher in people with Crohn’s disease. A small number of people whose first problem is an abscess are later found to have Crohn’s disease, so bowel symptoms such as long-standing loose stools, weight loss or blood in the stool are always asked about. Blood in the stool is checked properly, with a colonoscopy in the right patients, to rule out other causes.
| When | What is checked |
|---|---|
| One to two weeks | Wound healing from the base, any pocket filling up again, the seton if one was placed, the culture report, and blood sugar. |
| Six weeks | An examination for a fistula: a small opening that keeps leaking, a lump that comes and goes, or a seton track ready for the next step. |
| If discharge continues | An MRI to map any fistula before further surgery. |
| Within the first year | Come back at once if a lump, pain or discharge returns in the same place. |
The wound is left open to heal from the bottom up. There is no painful daily packing. Warm sitz baths, a pad and soft stools are what heal it.
Many people expect a gauze to be pushed into the wound every day. Good studies have shown that daily packing hurts more and does not make healing faster or lower the chance of a fistula or a repeat abscess. So a soft dressing placed in theatre to stop oozing comes out the next day, and after that the wound is simply kept clean.
| When | What happens |
|---|---|
| Day of surgery | The throbbing pain of the abscess usually eases quickly once the pus is out. You eat and walk the same evening. Many people go home the same day or the next morning. |
| Day one | The theatre dressing is removed, often in a warm sitz bath. A pad is worn for discharge. Tablets for pain and a stool softener are started. |
| Days two to seven | Sitz bath in plain warm water for ten minutes, two or three times a day and after every stool. A gentle shower spray works too. Some blood-stained discharge is expected. The first few days are sore; pain is controlled with tablets, sitz baths and stool softeners. |
| Week two | Discharge lessens. The wound fills in from the base. First clinic review. Most people with a simple abscess are back at desk work within a few days; after a large or horseshoe drainage, one to two weeks or more. |
| Weeks three to six | The wound keeps shrinking. A small wound usually closes within a few weeks; a large cavity takes longer. The six-week visit checks for a fistula. |
Eat normally, with fruit, vegetables, dal and plenty of water. Do not strain. A stool softener for the first weeks keeps stools soft. A soft cushion helps. Take antibiotics only if they were prescribed for a reason.
Drainage is a common, safe operation, but it has risks. The main ones are a repeat abscess, a fistula, and slow healing.
| How often | Risk |
|---|---|
| Expected | Soreness for the first few days, discharge and some bleeding from the open wound, and a wound that takes weeks to close. |
| Less common | The abscess filling again if a pocket was missed or the skin sealed too early. A fistula appearing over the following months. |
| Less common | Trouble passing urine for a few hours after spinal anaesthesia, sometimes needing a tube for a short time. Bleeding that needs a stitch. Wound infection. |
| If a track is opened at the first operation | A small chance of a change in bowel control, mostly wind or slight soiling. This is why it is done only for clearly low tracks. |
| Rare but serious | Spreading infection or Fournier’s gangrene after late treatment or with diabetes. Anaesthetic, heart or chest problems in people with other illnesses. |
Dr Harsh Shah goes through each of these in person before consent.
The estimate depends on how deep the abscess is, the anaesthesia, the length of stay and whether a seton or scan is needed. A simple perianal abscess usually needs a short stay.
What moves the cost: the type of abscess (a simple perianal abscess is quicker than a horseshoe or high abscess), spinal or general anaesthesia, day care or one to two nights in hospital, an MRI, culture and tuberculosis tests on the tissue, a seton and the later fistula operation, and extra care if diabetes is uncontrolled or the infection has spread. Apollo Hospital, Bhat, works with the major insurers and cashless schemes. The office handles pre-authorisation, including for emergency admissions. Bring: any reports, a list of medicines, the insurance card and identification. You can also call +91-63555-64601 to ask what to bring.
No. Antibiotics cannot empty a pocket of pus. The abscess needs to be drained. Antibiotics are added only for diabetes, spreading redness, low immunity, heart-valve or joint implants, or a body-wide infection.
It is not safe to wait. The pus may spread deeper or around the back passage, and a burst abscess often does not drain fully, so it fills again. Drainage under anaesthesia the same day is the safer path.
No. Studies show daily packing hurts more without helping healing. A soft dressing from theatre is removed the next day, and then sitz baths, a pad and soft stools are enough.
A small wound usually closes within a few weeks. A large or horseshoe cavity takes longer. Most people return to desk work within a few days to two weeks.
Between one in six and one in three people go on to have a fistula or another abscess, most within a year. The six-week visit looks for a fistula early, when it is simplest to plan.
A loose seton is a soft silicone loop through a fistula track. It keeps the track draining and does not cut the muscle. Most people feel only a thread and some discharge on a pad.
Yes. Diabetes lets infection spread faster and slows healing. Come the same day, have your sugar checked, and expect to be drained early and reviewed more often.
Draining an abscess does not cut the muscle that controls the bowels. A low track is opened only when very little muscle is involved. Otherwise a loose seton is used to protect control.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
SF-203, 2nd Floor, Olive Greens, Gota, Ahmedabad.
Consultations, wound reviews, seton checks and the six-week fistula check.
Google: Dr Harsh Shah · 4.89 from 216 reviews
Directions to the Gota clinic · +91-63555-64601
Apollo Hospital, Bhat, Gandhinagar
Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar.
Emergency drainage under anaesthesia, examination under anaesthesia and seton placement.
Google: Dr Harsh Shah, Apollo Bhat listing · 4.94 from 18 reviews
Directions to Apollo, Bhat · WhatsApp +91-63555-64601
Patients come to Ahmedabad from across Gujarat, including Gandhinagar, Mehsana, Nadiad, Anand, Rajkot and Kutch, and from southern Rajasthan.
A hot, painful swelling near the back passage, or pain that stops you sitting? Call first, then send a photo of any scan or blood sugar report on WhatsApp, so the team knows what to expect. Fever with shivering, redness that is spreading, or not being able to pass urine needs the nearest emergency department today. Call +91-63555-64601 · Send your reports on WhatsApp
Swasth Parivar: twice a month, practical advice on recovery, diet and warning signs. No advertising. Stop any time.
Your number is used for these updates and for the clinic to reach you. It is never sold or passed on. To stop, reply STOP on WhatsApp.
