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

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 ³,⁴.

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 ³,⁴,⁵. This is crucial to consider whether surgical drainage is needed ⁴.
• Pain Management: Offer simple analgesia such as paracetamol for pain relief ¹,³,⁴,⁵. Advise against opioid analgesics as they can cause constipation and exacerbate symptoms ¹,³. Nonsteroidal anti-inflammatory drugs (NSAIDs) should also be avoided where possible, as they may aggravate conditions or increase the risk of complications ⁴,⁵. Sitting in a shallow, warm bath several times a day may help relieve pain ¹. For extreme pain on defecation, a short course of topical lidocaine 5% ointment can be considered for use before passing a stool ¹.
• 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 ¹,³. Advise on the importance of correct anal hygiene, ensuring the anal region is kept clean and dry to aid healing and avoid complications ¹,³. Advise against 'stool withholding' and undue straining during bowel movements ¹,³.