How should I manage a patient with a suspected anorectal abscess in primary care before referral to secondary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For a patient with a suspected anorectal abscess in primary care, the primary management involves urgent referral to secondary care due to the risk of serious complications like perianal sepsis ,.

Key actions before referral include:

  • Urgent Referral: Arrange urgent hospital admission or referral to colorectal surgery if perianal sepsis or a fistula is suspected, or if there is peri-rectal fullness on digital rectal examination ,,. This is crucial to consider whether surgical drainage is needed .
  • Pain Management: Offer simple analgesia such as paracetamol for pain relief ,,,. Advise against opioid analgesics as they can cause constipation and exacerbate symptoms ,. Nonsteroidal anti-inflammatory drugs (NSAIDs) should also be avoided where possible, as they may aggravate conditions or increase the risk of complications ,. Sitting in a shallow, warm bath several times a day may help relieve pain . For extreme pain on defecation, a short course of topical lidocaine 5% ointment can be considered for use before passing a stool .
  • Stool Consistency and Hygiene: Advise the patient to ensure stools are soft and easy to pass by maintaining adequate dietary fibre intake (gradually increased) and sufficient fluid intake ,. Advise on the importance of correct anal hygiene, ensuring the anal region is kept clean and dry to aid healing and avoid complications ,. Advise against 'stool withholding' and undue straining during bowel movements ,.

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