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Anal Sac Diseases 53

Anal Sac Diseases Client Education
Sheet
VetBooks.ir Acute General Treatment Diseases and Disorders

• Anal sac mass
BASIC INFORMATION
• Others possible with anal sac neoplasia • Anal sac impaction: expression of anal sac
Definition contents is often sufficient to alleviate clinical
Diseases of the anal sacs, the most Etiology and Pathophysiology signs, although recurrence is not unusual.
clinically important of which are impaction, The underlying cause of impaction and Sedation and lavage of anal sacs with saline
inflammatory/infectious, or neoplastic (primar- inflammatory/infectious anal sac disease is may be needed in some animals to soften
ily adenocarcinoma). Information on neoplastic unknown. Some speculated causes include secretions for easier expression.
anal sac disease can be found on (p. 29). retention of anal sac secretions or abnormal • Anal sacculitis: typical approach to treatment
composition of secretions leading to bacterial is expression of anal sac followed by infusion
Synonyms colonization and inflammation or impaction. of antibiotic/glucocorticoid-containing oint-
Anal sacculitis, anal sac impaction, anal sac Experimental models that occlude the anal sac ments (otic or ophthalmic products) through
abscess, adenocarcinoma of the apocrine glands duct or establish infection have not consistently the anal sac duct into the anal sac. Lavage of
of the anal sac reproduced features of the clinical disease. anal sacs, perhaps with ceruminolytic agents,
may be helpful in severe cases.
Epidemiology • Anal sac abscess: therapy as described for
SPECIES, AGE, SEX DIAGNOSIS anal sacculitis and also systemically admin-
Dogs are affected with anal sac disease more Diagnostic Overview istered antimicrobials, typically those with
often than cats. There is no sex predisposition The diagnosis of anal sac disease is based primarily a gram-positive spectrum such as beta-lactams
to inflammatory anal sac disease. on clinical signs and physical examination find- (e.g., cephalosporins, amoxicillin-clavulanic
ings of anal sac distention, pain or discomfort, acid), or clindamycin. Drainage (lance and
GENETICS, BREED PREDISPOSITION or a mass during examination of the anal sacs. lavage) may be needed in some. Antibiotics
Small-breed dogs that typically weigh < 15 kg often continued for 2-3 weeks to the point
may be at increased risk for impaction. Miniature Differential Diagnosis of no further signs of infection.
and toy poodles, Chihuahuas, American cocker • Other causes of tenesmus or hematochezia
spaniels, and English springer spaniels have ○ Acute or chronic colitis Chronic Treatment
been singled out as at-risk breeds. Increased ○ Rectal masses Patients with recurrent anal sac impaction or
risk of infection in Siamese cats has been ○ Perianal fistula infection may be candidates for anal sacculec-
suggested. • Other causes of perianal pruritus and tomy or anal sac marsupialization to achieve
inflammation long-term resolution of disease.
RISK FACTORS ○ Allergic skin disease
Obesity; diarrhea or chronic soft stools ○ Food allergy Nutrition/Diet
(impaction); seborrheic disorders (impaction); ○ Flea allergy dermatitis Some clinicians advocate adding fiber to the
routine expression of anal sacs in normal dogs ○ Parasitic skin disease diet or changing diets in patients with soft/
has been suggested to pose a risk of inadver- ○ Perianal pyoderma loose stools to produce a stool quality that
tent anal sac trauma and recurrent anal sac ○ Tail fold or perivulvar dermatitis promotes emptying of anal sacs during defeca-
disease. tion, but the role of diet in management of
Initial Database anal sac disease has not been explored.
Clinical Presentation Results of a CBC, biochemical profile, and
DISEASE FORMS/SUBTYPES urinalysis are nonspecific. In severe cases, there Possible Complications
Clinical features may reflect those of the can be an inflammatory leukogram. Potential complications of anal sac surgery
primary anal sac disease or distant/systemic include fecal incontinence or fistulas if the anal
consequences of anal sac neoplasia (p. 29). Advanced or Confirmatory Testing sac is incompletely resected.
• There are no specific cytologic features that
HISTORY, CHIEF COMPLAINT suggest the diagnosis. Clinically normal Recommended Monitoring
Most affected animals present with one or more dogs can have intracellular and extracellular Clinical signs; serial microscopic examination
of the following: bacteria and leukocytes in anal sac secre- of anal sac secretions to document decreasing
• Scooting tions. In conjunction with clinical signs, intracellular bacterial numbers and erythrocytes
• Licking or chewing at perianal region large numbers of intracellular bacteria and may be considered, but is not routinely done.
• Reluctance to sit or lift tail erythrocytes seen on cytologic examination
• Tenesmus or painful defecation of anal sac contents support a diagnosis of PROGNOSIS & OUTCOME
• Fresh blood on stool anal sac infection.
• Others possible with anal sac neoplasia • Skin scrapes, diet trials, or other skin-specific The prognosis for most patients with anal sac
approaches may be needed in patients with disease is good to excellent with treatment.
PHYSICAL EXAM FINDINGS clinical signs that persist after treatment of Persistence of clinical signs can provoke
Physical examination abnormalities are typically anal sac disease or that have obvious features investigation into other causes of colonic or
limited to the perianal region: of dermatoses. perianal skin disease.
• Anal sac distention
• Pain during rectal examination TREATMENT PEARLS & CONSIDERATIONS
• Bloody anal sac contents
• Loss of hair, redness, perianal swelling and Treatment Overview Comments
pain in tissues overlying anal sac (abscess) Treatment is largely directed at expressing anal Rectal examinations should be performed
• Draining tract (abscess) sac contents (impaction) and treating infection as a part of routine physical examinations
• Fever (abscess) (sacculitis or abscess). on dogs for early detection of anal sac masses.

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