Understanding perianal sepsis: Causes, symptoms, and treatment

Written by: Mr Petr J Hanek
Edited by: Kate Forristal

In the realm of medical terminology, perianal sepsis and anal sepsis are often interchangeable terms, both referring to an infectious condition located in the vicinity of the anus. This condition, while relatively common, can lead to significant discomfort and complications if left untreated. In his latest online article, Mr Petr J Hanek delves deeper into what perianal sepsis entails, including its causes, symptoms, diagnosis, potential complications, and treatment options.


Perianal sepsis typically arises from the infection of glands near the anal canal, positioned just above the anal sphincter, which are responsible for producing mucus. This infection can occur when these glands become blocked, leading to the accumulation of pus. While the exact cause may vary, factors such as poor hygiene, pre-existing conditions like Crohn's disease or ulcerative colitis, and compromised immune function can increase the risk of developing perianal sepsis.



The symptoms of perianal sepsis can vary in intensity and presentation. Common signs include sudden perianal pain, redness, swelling, and the formation of a boil or abscess near the anal canal. Patients may also experience systemic symptoms such as chills, fatigue, fever, and a general feeling of being unwell. In chronic cases, continuous discharge of pus or blood may occur. However, some individuals may not experience noticeable symptoms despite the presence of the infection.



Diagnosing perianal sepsis often involves a physical examination to assess visible symptoms such as redness and swelling. However, due to the intense pain associated with the condition, rectal examinations can be challenging. Increasingly, imaging techniques such as MRI scans and endoanal ultrasound are utilised for their accuracy in identifying the size, location, and nature of any collections near the anal passage.



If left untreated, perianal sepsis can lead to severe complications. In rare cases, the infection can progress to generalised sepsis, a potentially life-threatening condition. Chronic infections may also cause structural changes in the affected tissues, increasing the risk of developing pre-cancerous or cancerous conditions over time. Additionally, repeated episodes of sepsis or surgical interventions can compromise the function of the anal sphincter, leading to irreversible consequences.



Preventing perianal sepsis primarily involves maintaining good hygiene practices, supporting a healthy immune system, and adopting a balanced diet rich in fibre and fluids. While there are no foolproof measures to prevent the condition entirely, individuals with conditions like Crohn's disease or ulcerative colitis should remain vigilant, as they are at increased risk. Regular medical check-ups and prompt treatment of any concerning symptoms can help mitigate the risk of complications.



Treatment of perianal sepsis often involves surgical intervention. One common approach is the insertion of a seton, a non-absorbable material that helps drain the pus and facilitate healing. This is followed by procedures aimed at closing off the internal opening of the fistula, such as advancement flap surgery or laser treatment. While these interventions can provide relief and promote healing, none guarantee a 100% success rate, highlighting the ongoing challenges in managing this condition effectively.


Mr Petr J Hanek is an esteemed consultant surgeon. You can schedule an appointment with Mr Hanek on his Top Doctors profile.

By Mr Petr J Hanek

Mr Petr J Hanek is a renowned consultant general, colorectal, and proctology surgeon based in London and Orpington. He has been a surgeon for over 33 years, having performed over 1500 operations throughout his professional trajectory. Mr Hanek’s main areas of expertise include:
• Repairs for inguinal, umbilical, incisional hernia (using mesh or without)
• Management of recurrent/chronic perianal sepsis
• Treatment for haemorrhoids, fissures, and rectal prolapse.

Mr Hanek first qualified from Charles’ University in Prague, Czech Republic in 1990 and undertook his postgraduate training in DGH. After completing compulsory military training, he was appointed at University Hospital Prague – Na Bulovce, where Mr Hanek accomplished general surgery training including abdominal surgery in 1998.

Mr Hanek later took up a substantive consultant colorectal surgeon position at University Hospital Prague – Motol. Here, Mr Hanek led a colorectal team that treated 130 patients a year, mainly providing surgical treatment for bowel cancer. In the busy high-profile university hospital practice, Mr Hanek also acquired proficiency in inguinal hernia repair, incisional hernia repair, chronic perianal sepsis management, haemorrhoids, fissures, fistulae, and rectal prolapse.

In 2004, Mr Hanek relocated to the UK, and was soon appointed as substantive general/colorectal surgeon at Dartford and Gravesham, providing treatment for colorectal cancer, as well as general surgery and proctology (rectum and anus).

Mr Hanek keeps abreast of any developments in his field by attending annual meetings of the Association of Coloproctology, the European Abdominal Wall Reconstruction Symposium, and UK and international meetings relevant to his professional interests.

On a personal level, Mr Hanek is the 3rd generation of surgeons in his family. His grandfather and father dedicated their lives to surgical practice before passing away from bowel cancer, and recently having become a skin cancer patient himself, Mr Hanek always does his utmost best to follow his family credo – "treating every patient as if they were his own mother."

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