Q: My Maltese had a blocked right anal gland sac for some time, which resulted in a hole near the anus that became infected. Several rounds of antibiotics didn’t help and he has now developed a perianal fistula. There are now three large holes in his anal area, and even his left anal gland is infected. Our vet has discouraged surgery and has put my dog on cyclosporin for a month. Will the condition be likely to improve and when can surgery be done to remove the root cause?

A: It sounds like your Maltese has anal furunculosis. The root cause of this chronic condition is your pet’s immune system, which cannot be fixed with surgery. Anal sacs sit between the internal and external anal sphincter at the four and eight o’clock position. They fill with a noxious fluid that is secreted when a dog defecates.

Sometimes anal sacs get infected because the neck of the gland gets blocked and the glands cannot empty. The next stage after blockage is that the sacs become infected and burst to the outside. Usually once this happens, all that’s needed is a short course of antibiotics and life returns to normal. However, in some cases the recovery can be prolonged.

In your dog’s case, it may or may not be that the original infection played a role in him developing anal furunculosis—it can occur separately. The cause of anal furunculosis is thought to be a combination of the animal’s immune system overreacting to digested food and/or bacteria in the perianal area, and faeces getting stuck in the perianal area. It’s a disease that is seen almost exclusively in German Shepherds, but other breeds can be affected.

The disease can be really dramatic, and one lay term used to describe it is “lacey anus” as the anus is seen to be hanging in a net of ulcerated perianal skin. Cyclosporin by itself can be curative, or it might need to be given on and off as the disease waxes and wanes. Sometimes it’s used to correct the condition to the point that surgery is carried out. However, surgery alone won’t resolve the issue and does carry the risk of permanent faecal incontinence.

Another thing that may well help is to make sure the perianal area is kept clean with baby wipes. Be warned though, that even with all the care, attention, drugs and
surgical treatments, that these cases can be refractory; it may get better for a while but never resolve.