Initially, the patient notices a dull, aching, or throbbing pain that becomes worse immediately before defecation, is lessened after defecation, but persists between bowel movements. The pain is increased by the increased pressure in the rectum that occurs just before defecation.
As the abscess spreads, increases in size, and comes nearer the surface, the associated pain becomes more intense. Pain will be aggravated by straining, coughing, or sneezing. As the abscess progresses, pain and tenderness interfere with walking or sitting.
The patient appears markedly uncomfortable and may be febrile. A tender mass may be present, or there may be a tender, erythematous area with or without fluctuance. On rectal examination, a tender mass or induration is detected. Leukocytosis may be present.
Although clinical evaluation of abscesses is usually sufficient, if pain is out of proportion to physical findings or if the extent of the abscess is uncertain, ultrasonography can be helpful.3
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