Local Treatment of Anal Sacculitis in Dogs

Anal sacculitis (ie, inflammation or infection of anal sacs without compromise of the wall or abscessation of the sac) is common in dogs.¹  

This retrospective study evaluated intralesional treatment of canine anal sacculitis (n = 33), as well as risk factors for development. Diagnosis was based on clinical signs (eg, licking and dragging perianal region) and supported by the presence of abnormally colored discharge, increased inflammatory cell count, or increased bacterial counts in the discharge. Prior to presentation, 18 dogs received ≥1 course of systemic antibiotics, and 8 dogs were treated with anal sac flushing or infusion. Disease was bilateral in 26 cases. 

Treatment consisted of manual expression, insertion of a shortened and lubricated 3.5-French urinary catheter into the anal sac duct, and flushing with a 6-mL syringe filled with sterile saline until the sac was clean. A steroid/antibiotic/antifungal otic solution was administered through the catheter until the sac was full. Treatment was repeated approximately every 2 weeks until anal sac contents normalized. 

Average number of treatments was 2.9 (range, 1-6). The clinician considered 24 dogs resolved. Four dogs were considered resolved by their owners alone (resolution was not clinically confirmed). Five dogs did not complete the recommended treatment course. Three dogs that completed the treatment course relapsed and responded well to an additional round of treatment.  

Although obesity and poor stool quality have been implicated in development of anal sacculitis,^2,3 definitive conclusions about the relationship between obesity and anal sacculitis could not be made, and only 7 dogs had poor stool quality at the time of presentation. Atopic dermatitis was the most common comorbidity. 

Key pearls to put into practice:

Clinical signs, gross findings, and microscopic findings should be used to diagnose anal sacculitis. Management of comorbidities (eg, allergy, soft stool, obesity) may reduce recurrence.⁴ 

Local treatment with otic preparations (typically, 0.75-1.25 mL) promotes judicious use of systemic antibiotics, which is critical in allergic patients with significant antibiotic exposure from bacterial pyoderma.^5,6

The first anal sac infusion typically causes discomfort; moderate sedation is thus recommended. This author typically administers injectable butorphanol and dexmedetomidine for the first treatment and butorphanol alone for subsequent treatments. A 20- or 22-gauge intravenous catheter (without the needle) can be used for infusion instead of a urinary catheter.

Licking, chewing, and/or dragging of the perianal region is not always caused by anal sac disease. If anal sacs are empty or clinical signs do not resolve after anal sac expression, ectoparasites and allergy should be considered. One study found ≈50% of patients with perianal pruritus not resolved by anal sac expression had either environmental allergies or cutaneous adverse food reaction.⁷