Objective To explore the clinical effect of transrectal ultrasound-guided puncture and cathetering drainage in the treatment of high-position perianal abscess. Methods Eighty patients with high-position perianal abscess, who admitted to Shuguang Hospital of Shanghai University of Traditional Chinese Medicine from Jan. of 2015 to 2018, were randomized into interventional therapy group and surgical treatment group, with 40 cases in each group. The patients in the interventional therapy group were treated with cathetering drainage guided by transrectal ultrasound, and the patients in the surgical treatment group were treated with traditional incision drainage. The clinical effect was evaluated in the two groups, and the pain, fever and exudation scores, white blood cell count, C-reactive protein level, maximal section area of abscess cavity, and wound healing time were compared between the two groups before operation and on 3 days and 7 days after operation. Results The total effective rates of the interventional therapy and surgical treatment groups were 87.5% (35/40) and 80% (32/40), respectively, and the difference was significant (χ²=1.385, P=0.709). On 3 days and 7 days after operation, the pain score, exudation score, white blood cell count, C-reactive protein level and maximum section area of the abscess cavity were significantly lower in the interventional therapy group than those in the the surgical treatment group (all P<0.01). The patients with retrorectal abscess or high intersphincteric abscess in the interventional therapy group had shorter wound healing time versus the patients in the surgical treatment group (both P<0.01). Conclusion Compared with traditional incision drainage, cathetering drainage guided by transrectal ultrasound can reduce pain and decrease exudation of the patients with high-position perianal abscess to effectively control infection.