Perianal abscess drainage (incision and drainage of a perianal (anorectal) abscess)
A usually urgent procedure to drain a perianal abscess — a painful collection of pus near the back passage — by making a small cut to release the pus and relieve the infection.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A perianal abscess is a painful collection of pus near the back passage that usually needs draining, not just antibiotics.
- Draining it relieves the pain quickly; the wound is usually left open to keep draining as it heals.
- Some people develop a fistula (a tunnel between the bowel and skin) afterwards, which can need further treatment.
- This is usually an urgent problem — seek prompt medical care rather than waiting for routine private appointments.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Quickly relieves the severe pain of an abscess once the pus is released
Drainage cannot be avoided for a true abscess — antibiotics alone rarely clear a collection of pus, so delaying drainage is the main risk.
The throbbing pain usually eases once the abscess is drained. Take painkillers, bathe the area as advised, and expect some discharge from the wound.
Clear written instructions on bathing, dressings and pain relief.
The throbbing pain usually eases once the abscess is drained. Take painkillers, bathe the area as advised, and...
Many people return to non-physical work within a few days to a week. Avoid heavy lifting. The wound continues to...
The open wound heals gradually from the bottom up. Keep stools soft so opening your bowels is comfortable and the...
A draining seton may be left for weeks while infection settles, before any definitive fistula treatment. You can...
What is perianal abscess drainage?
A perianal abscess is a painful, pus-filled collection in the tissues around the back passage. Most start when a small gland just inside the anus becomes blocked and infected. It causes throbbing pain, swelling and redness near the anus, and you may feel feverish and generally unwell.
An abscess usually needs draining rather than just antibiotics, because antibiotics alone often cannot clear a walled-off collection of pus. A small cut is made over the abscess to release the pus, and the wound is usually left open to keep draining as it heals. This relieves the pain quickly.
Draining the abscess treats the infection but does not always end the story. In some people a fistula — a small tunnel between the bowel and the skin — is found at the time or develops afterwards, which can need further treatment. Recurrent or unusual abscesses are also a reason to look for an underlying cause, such as Crohn's disease.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Simple incision and drainage
A small cut is made over the abscess to release the pus, the cavity is cleaned, and the wound is left open to drain and heal from the bottom up. This is the standard...
Examination under anaesthetic
While you are asleep, the surgeon examines the back passage to find the abscess and check whether a fistula is present, before draining it. This helps plan any further...
Drainage with seton (if a fistula is found)
If a fistula tunnel is found at the same time, the surgeon may place a soft thread (seton) through it to keep it draining, with definitive fistula treatment planned later...
Drainage of a deeper (ischiorectal or higher) abscess
Abscesses that sit deeper in the tissues around the rectum may need a larger procedure and occasionally a short hospital stay, but the principle of releasing the pus is the...
Preparing for your procedure
- This is often urgent — go to your GP, an urgent care service or A&E if you have severe pain, swelling and fever near the back passage.
- You will usually be admitted for the same-day or next-available operating list rather than a routine appointment.
- Follow fasting instructions once a procedure is planned, as it is usually done under general anaesthetic.
- Tell the team about all medicines, including blood thinners, and about diabetes, which raises the risk of serious infection.
- Mention any bowel condition, especially Crohn's disease, and any previous abscesses or fistulas.
- Arrange a lift home and someone to help for the first day or two after a general anaesthetic.
- Expect to manage an open, draining wound at home and to need dressings.
What happens
Drainage is usually done under general anaesthetic as a day case. The surgeon first examines the back passage, sometimes checking for a fistula at the same time.
A small cut is made over the abscess to let the pus out. The cavity is cleaned, and the wound is usually left open — sometimes with a light dressing or pack — so it keeps draining rather than sealing over and reforming. If a fistula is found, a soft draining thread (seton) may be placed.
The pain usually eases soon after the pus is released. You wake up in recovery and, once comfortable and able to pass urine, most people go home the same day with advice on bathing, dressings and pain relief.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Drainage cannot be avoided for a true abscess — antibiotics alone rarely clear a collection of pus, so delaying drainage is the main risk.
- A small, early or already-draining collection may occasionally be managed without a formal operation, on specialist advice.
- Routine cutting of any fistula found at the same time is not always appropriate, as it can risk continence; many surgeons place a seton and plan later.
- People with severe spreading infection may need urgent hospital care and possibly more than a simple drainage.
Delay or rearrange if…
- In practice, an abscess should not be delayed — but a procedure may be deferred only briefly to stabilise someone who is very unwell or to manage blood thinners.
- If you have diabetes or a weakened immune system, you should be seen urgently rather than wait, as infection can spread fast.
- If symptoms are mild and the diagnosis is uncertain, urgent assessment (not delay) is the right step.
- Definitive fistula surgery is usually delayed until the acute infection has settled.
Alternatives to discuss
- There is no good alternative to draining a true abscess; antibiotics are an addition, not a substitute.
- Antibiotics alone may be considered only for very early cellulitis without a drainable collection, on specialist advice.
- Dealing with any fistula later (staged), rather than at the same time, to protect bowel control.
- Specialist colorectal review for recurrent abscesses to find and treat an underlying cause.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Quickly relieves the severe pain of an abscess once the pus is released
- Treats the infection more reliably than antibiotics alone
- Reduces the risk of the infection spreading
- Allows the surgeon to check for a fistula at the same time
- Lets the wound heal from the bottom up so the abscess is less likely to reform immediately
Risks & complications
- Pain and discomfort, especially when sitting or opening your bowels, easing over days
- An open wound that discharges and needs bathing and dressings
- Bleeding or oozing from the wound while it heals
- Time off work while the wound settles
- A fistula developing afterwards, which can need further treatment
- The abscess coming back
- Wound infection or slow healing
- Needing a repeat drainage procedure
- Spreading or severe infection, particularly in people with diabetes or weakened immunity
- Bleeding needing further treatment
- Effect on bowel control if drainage involves nearby muscle
- Problems related to the anaesthetic
The most important thing to know is that draining the abscess may not be the end: a notable proportion of people go on to have a fistula, which can need further surgery. People with diabetes or a weakened immune system can develop more serious, spreading infection and need prompt attention. Tell your surgeon about any bowel condition, and ask what the plan is if a fistula is found or the abscess comes back.
Published figures to discuss
The main quantifiable risk after drainage is going on to develop a fistula or having the abscess recur. Reported rates vary widely with the type of abscess, whether a fistula was already present, patient factors such as diabetes, and length of follow-up, so figures should be treated as broad guides rather than precise predictions.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Fistula after drainage | Up to roughly a third of people in published series | A perianal abscess and a fistula are often part of the same process; rates vary with abscess type and follow-up. | Guide sourcesClinical context |
| Recurrence of abscess | A notable minority, higher when a fistula is present | Recurrent disease should prompt a search for an underlying cause such as Crohn's disease. | Guide sourcesClinical context |
| Incontinence from aggressive cutting near the sphincter | Uncommon but serious | Drainage prioritises sepsis control; definitive fistula surgery is often delayed until anatomy is clear. | Guide sourcesClinical context |
| Delayed healing or ongoing discharge | Common for days to weeks | Persistent discharge, recurrent swelling or pain may indicate a fistula or missed deeper abscess. | Secondary anal fistula formation after drainage of perianal sepsis: risk factors — PMCpmc.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
The severe pain usually settles quickly once the pus is drained. Most people go home the same day and are back to light activity within a few days, while the open wound heals over the following days to weeks with regular bathing and dressings.
- Rapid relief of the worst pain once the abscess is drained
- Ongoing discharge and oozing from an open wound for a while
- Soreness when sitting or opening your bowels that eases over days
- A wound that heals gradually rather than overnight
Aftercare
- Bathe or gently shower the area daily and after opening your bowels to keep it clean.
- Change dressings as shown; some wounds need a nurse to help.
- Take painkillers as needed, including before bowel movements if they are painful.
- Keep stools soft with fluids, fibre and laxatives if advised.
- Avoid heavy lifting and strenuous activity in the first week.
- Watch for persistent discharge after the wound should have healed, which can signal a fistula.
- Know who to contact urgently if pain, swelling or fever returns.
- Painkillers at home and a plan to take them before bowel movements
- Dressings and a way to bathe or shower the area
- Soft-stool plan (fluids, fibre, laxatives if advised)
- Loose, comfortable clothing
- Someone to help for the first day after a general anaesthetic
- Time off work arranged
- Clinic or out-of-hours number saved in case the abscess returns
Scars and how they heal
The wound is usually left open to drain and heal from the bottom up, leaving a small scar near the anus. There is not usually a neat stitch line. If a seton has been placed for a fistula, there will be a small thread visible at the skin until it is dealt with.
⚠ Get urgent help if…
- Pain, swelling or redness returning or spreading after initial improvement
- Fever, chills or feeling generally unwell
- Spreading redness or severe pain out of proportion (urgent — can signal serious infection)
- Heavy or persistent bleeding
- Being unable to pass urine
- Persistent discharge of pus after the wound should have healed (possible fistula)
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
Draining the abscess reliably relieves the pain and treats the immediate infection, and most people recover well. The wound then heals over days to weeks.
The main thing the procedure cannot guarantee is that the problem is fully over. A proportion of people develop a fistula afterwards, and some abscesses recur. Persistent discharge, or a return of pain and swelling, should be reassessed rather than ignored. Recurrent or unusual abscesses are a reason to look for an underlying cause such as Crohn's disease.
For many people a single drainage cures the problem. However, abscesses can recur, and a significant minority develop a fistula that needs further treatment, sometimes weeks or months later. Recurrent disease should prompt a search for an underlying cause and specialist colorectal review.
Related tests, treatments or support
If a fistula is found at the time the abscess is drained, the surgeon may place a draining seton then and plan definitive fistula surgery later. Drainage is sometimes combined with an examination under anaesthetic to map the anatomy. Antibiotics may be added in selected people (for example with diabetes or spreading infection), but they do not replace draining the pus.
Follow-up & long-term care
You may be reviewed to check the wound is healing and to look for signs of a fistula. There may not be a routine appointment after simple drainage, but you should be able to contact the team and be seen again if pain or discharge persists or the abscess returns.
- Keep the area clean and keep stools soft while the wound heals.
- Watch for and report persistent discharge, which can signal a fistula.
- Seek prompt care if pain, swelling or fever returns rather than waiting.
- If you have diabetes or Crohn's disease, keep these well controlled to reduce recurrence.
Repeat, follow-on and what comes next
- A proportion of people need definitive fistula surgery weeks or months after drainage.
- A recurrent abscess may need repeat drainage and then a fistula procedure.
- Persistent discharge after the wound should have healed should be reassessed for a fistula.
- Recurrent or unusual abscesses warrant investigation for an underlying bowel condition.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear written instructions on bathing, dressings and pain relief.
- A named, urgent contact route if pain, swelling or fever returns.
- Advice to watch for persistent discharge that could signal a fistula.
- Follow-up to check healing, with reassessment of any non-healing wound.
- Joined-up care with a colorectal specialist for recurrent disease or suspected Crohn's disease.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The surgeon's fee and whether an examination under anaesthetic is included.
- Anaesthetic fee (usually general) and theatre or facility charges.
- Whether it is straightforward or a deeper, more extensive abscess needing more time or a stay.
- Whether a seton is placed because a fistula is found.
- Dressings and any nurse-led wound care afterwards.
- Follow-up appointments and any further treatment for a fistula.
- Urgency, as this is often an emergency rather than a planned procedure.
- The surgeon's fee and whether examination under anaesthetic is included
- Anaesthetic and theatre or facility fees
- Dressings and any nurse-led wound care
- Follow-up appointments
- What is included if a fistula is found and needs a seton or later surgery
- Cancellation policy
- What happens, and what it costs, if the abscess recurs or a complication occurs
On the NHS? Perianal abscess drainage is usually carried out urgently on the NHS; because it is often an emergency, it is not something to wait for routine private care.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Implying that draining the abscess is definitely the end of the problem, without mentioning fistula risk.
- Cutting a fistula found at the same time without explaining the risk to continence.
- Not flagging that people with diabetes or weakened immunity need urgent attention.
- No clear plan or contact route if the abscess returns or discharge persists.
- Relying on antibiotics and delaying necessary drainage.
Marketing red flags
- Offering antibiotics as a way to avoid draining a clear abscess.
- Promising a one-off cure without mentioning the chance of a fistula or recurrence.
- Not arranging prompt drainage for an acutely painful, infected swelling.
- Not advising urgent care for people with diabetes or spreading infection.
Choosing a specialist safely
- Check the surgeon is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the surgeon who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Did you check for a fistula while draining the abscess, and was one found?
- Will the wound be left open, and how do I look after it?
- What is the chance I develop a fistula or the abscess comes back?
- Could there be an underlying cause such as Crohn's disease?
- What should I watch for, and who do I contact urgently if symptoms return?
- Do I need antibiotics as well, and why or why not?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can't antibiotics treat the abscess instead of surgery?
Will the pain go away quickly?
Why is the wound left open?
Will I get a fistula?
Is this urgent?
Is it treated on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Guy's and St Thomas' NHS — Perianal abscess surgery NHS — Anal fistula (background on abscess and fistula link) Incision and drainage of perianal abscess with or without treatment of fistula — PubMed Secondary anal fistula formation after drainage of perianal sepsis: risk factors — PMC
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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