Perianal Abscess and Urinary Retention

Clinical Recognition

• The World Society of Emergency Surgery guidelines state that occasionally patients with anorectal abscesses will present with urinary retention, which is a recognized but uncommon complication that should prompt immediate evaluation and treatment 1, 2, 3

Mechanism and Anatomical Considerations

• Deeper abscesses, particularly intersphincteric and supralevator types, are more likely to cause urinary retention due to their proximity to pelvic structures, and may present with pain referred to the perineum, low back, and buttocks, or with symptoms mimicking intra-abdominal conditions 1, 2, 3

Clinical Evaluation

• Pain on digital rectal examination is characteristic of deeper abscesses, particularly intersphincteric and supralevator types, where DRE reveals a tender, indurated area above the anorectal ring 4

Management Implications

• The presence of urinary retention as a complication of perianal abscess indicates a more severe presentation requiring emergency drainage, which is also indicated for patients with sepsis, severe sepsis, septic shock, immunosuppression, diabetes mellitus, or diffuse cellulitis 5