Definition and Causes:

Paraproctitis is inflammation and suppuration of the fatty tissues around the rectum. It ranks second in prevalence among gastrointestinal diseases (after hemorrhoids) and first in emergency surgical care.
The disease is infectious, mostly occurring due to the penetration of pathogenic microorganisms from the mucous membrane of the large intestine into the area around the rectum. Major symptoms include pain, burning sensation in the anal area, and elevated body temperature.
Diagnosis of paraproctitis requires necessary examination by a gastroenterologist. Without immediate medical treatment, the disease may become chronic, leading to the formation of fistulas in the inflamed area, which may eventually develop into septicemia.

Types of Paraproctitis:
Paraproctitis can be divided into two main types: acute and chronic.

  • Acute paraproctitis presents with clear clinical features. Depending on the location of inflammation, acute paraproctitis can be:
    1. Subcutaneous (subcutaneous) – extending into the fatty tissue beneath the skin of the anus.
    2. Perianal (perianal fistula) – inflammation in the perianal fistula pit.
    3. Pelvic (pelvic cavity) – inflammation within the small pelvic cavity.
    4. Intramuscular – inflammation concentrated in the tissues and muscles surrounding the anal sphincter.
  • Chronic paraproctitis has a prolonged course. It often occurs when acute paraproctitis is improperly treated (or left untreated), usually in the area of Morgagni crypts, extending to the tissues surrounding the large intestine.

Symptoms of Paraproctitis:
In the initial stages, the disease may exhibit mild symptoms such as slight elevation of body temperature, itching in the anal area, often resembling symptoms of anal fissures, hemorrhoids, or other gastrointestinal diseases.
Later stages present with:

  • Fever above 38°C, accompanied by chills.
  • Severe pain in the anal region.
  • General deterioration of health.
    Acute subcutaneous paraproctitis shows distinct symptoms such as redness and swelling in the tissues around the anus, along with severe pain upon touching the inflamed area. Other types of paraproctitis show varying symptoms depending on the location of inflammation, including additional bowel function disturbances, false urges, constipation, among others.
    In cases of chronic progression, fistulas develop, opening near the anus or closer to the buttocks. Pain diminishes, and openings begin to discharge foul-smelling purulent secretions. Without treatment, these fistulas may heal and reoccur. Self-healing of chronic paraproctitis is not possible.

Causes of Paraproctitis:

It is an infectious disease caused by microorganisms invading the soft tissues near the rectum. Bacterial proliferation triggers inflammation, mostly caused by streptococci, staphylococci, and Escherichia coli.
Bacteria are usually unable to penetrate human soft tissues due to the presence of barriers. However, when the skin and mucous membranes are compromised, harmful microflora penetrates through mucus and reaches the fatty tissues.
Several factors contribute to this condition:

  • Anal fissures.
  • Constipation.
  • Diarrhea.
  • Rectal inflammation (proctitis).
  • Digestive function disorder (damage to intestinal tissues due to poorly digested solid food particles).
  • Hemorrhoids.
    These factors impair tissue integrity, allowing pathogenic factors to penetrate soft tissues almost unhindered, resulting in ulcer formation.

Diagnosis of Paraproctitis:
Initial diagnosis is based on patient complaints (including discomfort and pain in the rectal and anal areas) along with data from a colon specialist’s examination and rectal digital examination.
Laboratory diagnostic methods include comprehensive blood and biochemical analysis, glucose testing, and complete urine analysis. If purulent discharge is present, a small sample is sent for bacteriological examination to identify the causative organism and assess its antibiotic sensitivity.
Confirmatory diagnostic procedures include:

  • Ultrasonography of the perirectal area.
  • Rectoscopy (anoscopy) to examine the rectal mucosa.
  • Rectomanoscopy and colonoscopy (assessment of the large intestine condition).
  • Fistulography (radiographic imaging of fistula tract using contrast medium).
  • Computed tomography and magnetic resonance imaging.
    Based on the results of these tests, a colon specialist evaluates the stage and characteristics of disease progression, determining the appropriate treatment approach.

Surgical Treatment of Paraproctitis:
The only rapid treatment method for paraproctitis is surgical intervention. During surgery, the surgeon opens the abscess, drains the pus, and irrigates the cavities using special antiseptic solutions. Simultaneously, drainage of the abscess is performed.
In chronic paraproctitis, surgeons perform complex procedures, excising the fistulas and reconstructing the anatomical integrity of the organs in the small pelvic area.
Surgeries can be performed under general anesthesia or local anesthesia (depending on the complexity of the surgical procedures).

Traditional Treatment:

After surgery, a course of medications is prescribed for the patient. Special ointments are applied to the formed wounds to prevent pus accumulation and accelerate tissue healing. Additionally, the patient must undergo a course of antibiotic therapy.


  • Clinical Recommendations for the Diagnosis and Treatment of Adult Patients with Acute Paraproctitis. Moscow, 2013.