Thanks for the clarification.  I've never had symptoms like this.  Keep in
mind that the symptoms can very widely from person to person.  My sympyoms
have been limited to pain at the penis tip, in the rectum if I sit for long
periods of time, and sometimes ED.  My symptoms also wax an wane.  Spicey
foods and alcohol tend to cause flair ups.

I suspect "mo" is the latest screen name for a guy formerly known as "Fatty
Mawson", a troll who has posted his antacid remedies here for years.

It's the most active forum that I've found on the internet for discussing
this problem.

Looking for something established medicine has not yet discovered.
"They" did not find anything, because "they" did not look.
If one had an anorectal problem like a fistula, impacted or ruptured
anal gland, or a fungal abscess, it would seem logical to expect to
see some evidence of it in anorectal secretions.

Fungi are present in the intestiona tract, and they are necessary for
digestion.  A search of the internet will find little information
on the subject. So even if the test were done and fungi was found,
how would the lab know if it was abnormal?  Red or amber would
be blood or clotting factor and I believe would indicate a problem.

The current diagnostic procedure for this type of problem from

eMedicine World Medical Library

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Perianal Abscess
Last Updated: January 3, 2003    
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Synonyms and related keywords: anal abscess, perianal abscess, anorectal
abscess, ischiorectal abscess, perianal fistula, digital rectal examination,
DRE

     AUTHOR INFORMATION     Section 1 of 11    Click here to go to the
next section in this topic
Author Information Introduction Indications Relevant Anatomy And
Contraindications Workup Treatment Complications Outcome And Prognosis Future
And Controversies Pictures Bibliography

Author: Andre Hebra, MD, Clinical Associate Professor of Surgery, Department
of Surgery, University of South Florida, All Children's Hospital

Coauthor(s): Patrick B Thomas, MD, Staff Physician, Department of Surgery,
Medical University of South Carolina; Michael DeWolfe, BS, BA, Medical
University of South Carolina

Andre Hebra, MD, is a member of the following medical societies: Alpha Omega
Alpha, American Academy of Pediatrics, American College of Surgeons, American
Medical Association, American Pediatric Surgical Association, Association for
Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical
Association, Southeastern Surgical Congress, and Southern Medical Association

Editor(s): Marc D Basson, MD, PhD, Chief of Surgery, John D Dingell VA Medical
Center, Professor of Surgery, Department of Surgery, Wayne State University
School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor,
Pharmacy, eMedicine; Amy L Friedman, MD, Chief of Liver Transplantation
Services, Assistant Professor, Department of Surgery, Division of Organ
Transplantation and Immunology, Yale-New Haven Hospital, Yale University
School of Medicine; Paolo Zamboni, MD, Chair of Surgical Methodology,
Assistant Professor, Department of Surgical, Anesthesiological, and
Radiological Sciences, University of Ferrara Medical Center, Ferrara, Italy;
and John Geibel, MD, DSc, Director, Professor, Department of Surgery and
Cellular Molecular Physiology, Yale-New Haven Hospital, Yale University School
of Medicine
     INTRODUCTION     Section 2 of 11   Click here to go to the previous
section in this topic Click here to go to the top of this page Click here to
go to the next section in this topic
Author Information Introduction Indications Relevant Anatomy And
Contraindications Workup Treatment Complications Outcome And Prognosis Future
And Controversies Pictures Bibliography

Perianal abscess represents an infection of the soft tissues surrounding the
anal canal, with formation of a discrete abscess cavity. The severity and
depth of the abscess are quite variable, and the abscess cavity frequently is
associated with formation of a fistulous tract. For that reason, both perianal
abscess and perianal fistula are discussed in this article.

Problem: Anorectal abscesses originate from infection arising in the
cryptoglandular epithelium lining the anal canal. The internal anal sphincter
is believed to serve normally as a barrier to infection passing from the gut
lumen to the deep perirectal tissues. This barrier can be breached through the
crypts of Morgagni, which can penetrate through the internal sphincter into
the intersphincteric space. Once infection gains access to the
intersphincteric space, it has easy access to the adjacent perirectal spaces.
Extension of the infection can involve the intersphincteric space,
ischiorectal space, or even the supralevator space. In some instances, the
abscess remains contained within the intersphincteric space. The variety of
anatomic sequelae of the primary infection is translated into variable
clinical presentations.

Frequency: The peak incidence of anorectal abscesses is in the third to fourth
decades of life. Men are affected more frequently than women, with a
male-to-female predominance of 2:1 to 3:1. Approximately 30% of patients with
anorectal abscesses report a previous history of similar abscesses that either
resolved spontaneously or required surgical intervention. A higher incidence
of abscess formation appears to correspond with the spring and summer seasons.
While demographics point to a clear disparity in the occurrence of anal
abscesses with respect to age and sex, no obvious pattern exists among various
countries or regions of the world. Although suggested, a direct relationship
between bowel habits, frequent diarrhea, and poor personal hygiene and the
formation of anorectal abscesses remains unproved.

The occurrence of perianal abscesses in infants also is quite common. The
exact mechanism is poorly understood but does not appear to be related to
constipation. Fortunately, in infants this condition is quite benign and
rarely requires any operative intervention other than simple drainage.

Etiology: Perirectal abscesses and fistulas represent anorectal disorders
arising predominately from the obstruction of anal crypts. Infection of the
now static glandular secretions results in suppuration and abscess formation
within the anal gland. The abscess typically forms initially within the
intersphincteric space and then spreads along adjacent potential spaces.

Pathophysiology: Perirectal abscesses and fistulas represent anorectal
disorders that arise predominately from the obstruction of anal crypts. Normal
anatomy demonstrates anywhere from 4-10 anal glands drained by respective
crypts at the level of the dentate line. Anal glands normally function to
lubricate the anal canal. Obstruction of anal crypts results in stasis of
glandular secretions and, when subsequently infected, suppuration and abscess
formation within the anal gland results. The abscess typically forms in the
intersphincteric space and can spread along various potential spaces. Common
organisms implicated in abscess formation include Escherichia coli,
Enterococcus species, and Bacteroides species; however, no specific bacterium
has been identified as a unique cause of abscesses. Less common causes of
anorectal abscess that must be considered in the differential diagnosis
include tuberculosis, cancer, Crohn disease, trauma, leukemia, and lymphoma.

Clinical: The classic locations of anorectal abscesses listed in order of
decreasing frequency are as follows: perianal 60%, ischiorectal 20%,
intersphincteric 5%, supralevator 4%, and submucosal 1% (see Image 1).
Clinical presentation correlates with the anatomical location of the abscess.

Patients with perianal abscesses typically complain of dull perianal
discomfort and pruritus. Their perianal pain often is exacerbated by movement
and increased perineal pressure from sitting or defecation. Physical
examination demonstrates a small, erythematous, well-defined, fluctuant,
subcutaneous mass near the anal orifice.

Patients with ischiorectal abscesses often present with systemic fevers,
chills, and severe perirectal pain and fullness consistent with the more
advanced nature of this process. External signs are minimal and may include
erythema, induration, or fluctuance. On digital rectal examination (DRE), a
fluctuant indurated mass may be encountered. Optimal physical assessment of an
ischiorectal abscess may require anesthesia to alleviate patient discomfort
that would otherwise limit the extent of the examination.

Patients with intersphincteric abscesses present with rectal pain and exhibit
localized tenderness on DRE. Physical examination may fail to identify an
intersphincteric abscess. Though rare, supralevator abscesses present a
similar diagnostic challenge. As a result, clinical suspicion of an
intersphincteric or supralevator abscess may require confirmation by CT scan,
MRI, or anal ultrasonography. The latter is limited to confirming the presence
of an intersphincteric abscess.

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