Diagnosis & Information/Condition Information

Perianal HS: 5 Symptoms, Causes, and Treatment

Medically reviewed by Nahla Maher, M.D.

Written by Carrie Madormo, RN, MPH

Updated on October 13, 2026

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Key Takeaways

Perianal hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes painful lumps, abscesses, and scarring in the skin between the buttocks and around the anus, affecting everyday activities like sitting, walking, and using the bathroom.
Perianal HS develops when hair follicles become blocked, triggering inflammation that can lead to deep nodules, draining abscesses, sinus tracts, and even fistulas. The exact cause is unknown, but genetics, hormones, and immunity all play a role, and the condition is not caused by poor hygiene or contagious in any way.
If you are experiencing symptoms of perianal HS, talking with a doctor as soon as possible is important, since early treatment can help prevent long-term complications, and a healthcare provider can help you explore options that may include medications, surgical procedures, or lifestyle adjustments to help manage discomfort.

View all takeaways

Perianal hidradenitis suppurativa (HS) causes painful nodules and abscesses between the buttocks and around the anus. These symptoms can significantly affect your quality of life, even making basic functions difficult. “The pain of walking or sitting was too much,” wrote one member of myHSteam about their perianal symptoms.

HS symptoms in this region may lead to infections, scarring, and other complications. While HS is more common in women, perianal symptoms are more common in men. Overall, HS affects the area around the anus or the genital region in 18.8 percent of people with the condition.

In this article, we’ll cover the symptoms and causes of perianal HS. We’ll also review treatment options for perianal HS and what to ask your doctor.

🗳️ Which symptoms of perianal HS have you experienced?

Painful boils

Draining abscesses

Sinus tracts and/or fistulas

More than one of these

What Is Perianal HS?

HS, also known as acne inversa, is a chronic inflammatory skin condition that causes painful lumps in areas where skin rubs together, often near apocrine sweat glands. These glands are connected to hair follicles. HS commonly affects the armpits, inner thighs, and groin. It can also affect the skin between the buttocks and around the anus (the perianal region).

“The pain of walking or sitting was too much.”

— A myHSteam member

Many people live with HS for years before being diagnosed. You may feel hesitant to talk about your perianal HS symptoms. Because untreated perianal HS can lead to serious complications, don’t wait to reach out to your doctor.

What Are the Symptoms of Perianal HS?

Perianal HS affects the skin between the buttocks and around the anus. Symptoms can range from mild to severe. Doctors use the Hurley staging system to classify HS from stage 1 to stage 3, with stage 3 being the most severe.

Here are the potential symptoms of perianal HS:

Painful Lumps

Perianal HS causes nodules that usually look like pimples, cysts, or boils. They can feel like deep lumps in the skin that are tender to the touch.

You may notice that HS nodules go away on their own, but it’s very common for new lumps to develop in the same area.

Draining Abscesses

As perianal HS progresses, the nodules can grow and join together. When this happens, the nodules swell up with fluid, leading to abscesses. This can be very painful.

When the abscesses break open, blood and pus can drain out. This fluid may have an unpleasant odor.

Scarring

Perianal HS nodules can damage the skin, leading to permanent scars.

Sinus Tracts

As the abscesses break open and heal repeatedly, deep tunnels called sinus tracts develop under the skin.

Fistulas

Perianal HS can cause tunnels under the skin that may resemble anal fistulas. An anal fistula is an abnormal tunnel that connects the anal canal to the skin near the anus. Symptoms of an anal fistula may include pain, swelling, and drainage of pus or blood.

Some people may develop a fever or have difficulty controlling their bowel movements because of an anal fistula.

Inflamed nodules, draining abscesses, sinus tracts, and thick scarring around the anus and buttocks on dark brown skin, consistent with perianal hidradenitis suppurativa. — Perianal hidradenitis suppurativa can cause painful lumps, abscesses, tunnels under the skin, and scarring around the anus and buttocks. (CC BY-NC-ND 4.0 / Mônica Mourthé de Alvim Andrade et al.)

What Does Perianal HS Feel Like?

Perianal HS symptoms can vary from person to person. At their worst, they can interfere with basic functions of everyday life. One myHSteam member with perianal HS wrote, “It was hard for me to sit down at work.”

“I have open wounds on my buttocks, anus, and groin that are constantly weeping, so I have to wear dressings on them,” said another member. “I want to be more active, but I’m in constant pain.”

“I have open wounds on my buttocks, anus, and groin that are constantly weeping, so I have to wear dressings on them.”

— A myHSteam member

Another member shared that they had lost progress on managing their perianal HS: “I’ve gone totally backwards to the awful leaking smells and lesions everywhere, including my anus area. It makes normal things like having a bowel movement really tough.”

Perianal HS can also cause problems with intimacy and sexual health. One myHSteam member wrote, “My groin and anal HS make me feel distant from my wife.”

What Causes Perianal HS?

Perianal HS is an autoinflammatory syndrome. The exact cause is unknown, but researchers believe that genetics, immunity, hormones, and other factors affect your risk. Perianal HS isn’t contagious, and it’s not caused by a lack of hygiene.

Perianal HS develops when hair follicles around the anus become clogged with keratin (a protein found in the skin). Blocked follicles may rupture, triggering an inflammatory response that causes deep, painful nodules. Bacteria may also contribute to the inflammation.

Risk Factors for Perianal HS

In general, risk factors for HS include smoking, obesity, and having a close family member with HS.

According to DermNet, an online resource for skin health information, perianal HS is more common in men than women.

Researchers have found that people with Crohn’s disease have a higher risk of developing HS than others. Crohn’s disease is a type of inflammatory bowel disease that causes inflammation of the digestive tract.

How Is Perianal HS Treated?

Treating perianal HS depends on how severe the symptoms are. Early diagnosis and treatment are important to prevent long-term problems.

Treatment may involve applying medication to the affected area (topical treatment) or using medication that works throughout the body (systemic treatment). In some cases, surgery may be recommended.

Medications

Some topical HS treatments used on other parts of the body should not be used on the sensitive perianal region. Always follow directions on how to use each medication. If a medication was prescribed for HS on another part of the body, ask before applying it to the perianal area.

Medications that may be recommended include:

Antibiotics — Antibiotics, including clindamycin, may be used in various ways to treat HS.
Anti-inflammatory medications — Your doctor may inject corticosteroids, such as triamcinolone, into the nodules to reduce pain and inflammation.
Biologics — Biologics approved to treat moderate to severe HS include adalimumab (Humira and other brands), bimekizumab-bkzx (Bimzelx), and secukinumab (Cosentyx).
Hormone therapy — If your HS flares seem to be related to hormonal changes, your doctor may recommend hormonal birth control, spironolactone, cyproterone acetate, or finasteride.
Retinoids — Isotretinoin may be considered for some people with lesions that look like acne.

Surgery

Some studies suggest that surgical removal and reconstruction may provide the best outcomes for extensive cases of perianal HS.

Surgery in the perianal region can be more difficult than in other parts of the body because the surgeon must also consider how to maintain control of the bowels. Some dermatologists may recommend incision and drainage to temporarily relieve pain caused by an abscess. However, many abscesses return after this procedure.

Deroofing is a surgical procedure that involves removing the skin covering a sinus tract and leaving it open to heal on its own. Wide surgical excision can provide long-term control of perianal HS, but it may require skin grafts and a longer healing time.

How To Manage Perianal HS at Home

Making a few lifestyle changes may help you feel more comfortable:

Use a bidet after a bowel movement to avoid irritating your skin with toilet paper.
Avoid scrubbing your delicate perianal skin in the shower.
Wear loose, breathable underwear to avoid irritating your skin.
If you smoke, ask your doctor for help quitting. If you have excess weight, ask whether weight management might improve your symptoms.

Members of myHSteam often share ideas for how to find relief. One member wrote, “Sitz baths can provide some pain relief.”

Read more about bathroom cleanliness and comfort with HS. ❯

Perianal HS and Cancer Risk

Squamous cell carcinoma is a type of skin cancer that can develop as a rare complication of chronic HS, especially perianal HS. Tell your doctor about any sore that doesn’t heal or any area of skin that changes or grows. Your doctor may want to biopsy it.

Read more about HS and cancer risk. ❯

Is It Perianal HS or Crohn’s Disease?

Perianal HS symptoms may resemble those of perianal Crohn’s disease. Since Crohn’s disease may occur with HS, it’s important to be aware of possible Crohn’s symptoms. If you have diarrhea, blood in the stool, mouth sores, or abdominal pain and cramping, ask your dermatologist for a referral to a gastroenterologist.

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