Mr Sanjay Purkayastha
BSc MBBS MD FRCS
Laparoscopic, General and Bariatric Surgeon
Private Medical Care:
General & gastroenterological surgery
Bariatric / weight loss surgery
Emergency abdominal conditions / surgery
An abscess is a painful collection of pus, usually caused by a bacterial infection.
An abscess can develop anywhere in the body however skin abscesses tend to be more common in the:
hands and feet
Most abscesses are caused by a bacterial infection.
Bacteria can get into your skin and cause an abscess if you have a minor skin wound, such as a small cut or graze, or if a sebaceous gland (oil gland) or sweat gland in your skin becomes blocked.
When bacteria enter your body, your immune system sends infection-fighting white blood cells to the affected area.
As the white blood cells attack the bacteria, some nearby tissue dies, creating a hole which then fills with pus to form an abscess. The pus contains a mixture of dead tissue, white blood cells and bacteria.
It may be possible to reduce your risk of skin abscesses through good hygiene, a healthy lifestyle and looking after your skin.
The symptoms of an abscess can vary. A skin abscess often appears as a swollen, pus-filled lump under the surface of the skin.
Signs of a skin abscess can include:
a smooth swelling under your skin that can feel hard or firm
pain and tenderness in the affected area
warmth and redness in the affected area
a visible build-up of white or yellow pus under the skin in the affected area
a high temperature (fever)
In addition to the specific causes mentioned above, things that increase the likelihood of an abscess developing can include:
having a weakened immune system – this could be due to a medical condition such as HIV, or a treatment such as chemotherapy
having diabetes mellitus
having an underlying inflammatory condition, such as hidradenitis suppurativa, panniculitis, acute pancreatitis and inflammatory bowel disease (IBD)
being a carrier of staphylococcal bacteria
However, many abscesses develop in people who are otherwise generally healthy.
If you have a skin abscess, your doctor will examine the affected area, ask how long you've had the abscess, whether you've injured that area and whether you have any other symptoms.
If your symptoms are typical of an abscess, this is normally enough for your doctor to make a confident diagnosis, although you may have further tests including:
a blood test to look for signs of infection
a urine test to test for glucose, which is a sign of diabetes. People with diabetes have an increased risk of developing skin abscesses
In cases where the abscess is situated close to the anus (perianal abscesses) there can be a connection between the collection of pus and the rectum. This is known as a fistula and such cases need to be managed differently.
Some small skin abscesses may drain naturally and get better without the need for treatment. Applying heat in the form of a warm compress, such as a warm flannel, may help reduce any swelling and speed up healing. However, the flannel should be thoroughly washed afterwards and not used by other people, to avoid spreading the infection.
For larger or persistent skin abscesses, your GP may prescribe a course of antibiotics to help clear the infection and prevent it from spreading.
A course of antibiotics will usually start before a specific type of bacteria has been identified, so "broad-spectrum" antibiotics will initially be given. These are designed to work against a wide range of known infectious bacteria and will usually cure most common infections. Once a specific bacterium has been identified from a pus sample, a more "focused" antibiotic can be used.
Sometimes, especially with recurrent infections, you may need to wash off all the bacteria from your body to prevent re-infection (decolonisation). This can be done using antiseptic soap for most of your body and an antibiotic cream for the inside of your nose.
However, often antibiotics alone may not be enough to clear a skin abscess, and the pus will need to be drained to clear the infection. If a skin abscess is not drained, it may continue to grow and fill with pus until it bursts, which can be very painful and can cause the infection to spread or recur.
Incision and drainage is usually done under general anaesthesia. This means you will be asleep during your operation.
If you're having general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do so by signing a consent form.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.
If the abscess is situated close to the anus a fistula must first be ruled out prior to the incision and drainage. The surgeon will perform an examination of the rectal passage while the patient is asleep (examination under anaesthesia or EUA). This will involve the insertion of a rigid plastic tube with an attached eye-piece into the rectal passage (rigid sigmoidoscopy). This allows the surgeon to inspect the rectal walls and to look for any fistulae. If the abscess is not located near the anus, this step would not be performed.
During the procedure, the surgeon will make a cut (incision) in the abscess, to allow the pus to drain out. They may also take a sample of pus for testing. This allows the specific bacteria causing the abscess to be identified, which can help determine the best way of treating it.
Once all of the pus has been removed, the surgeon will clean the hole that is left by the abscess using sterile saline (a salt solution).
An antiseptic dressing (gauze wick) will be placed inside the wound to keep it open. The abscess will be left open but covered with a wound dressing, so if any more pus is produced it can drain away easily.
The procedure will leave a small scar.
You may need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
As most incision and drainages are performed as a day-case, you will usually be able to go home when you feel ready but you will need to arrange for someone to drive you home. Try to have a friend or relative with you for the first 24 hours after your surgery.
Before you go home your nurse will give you some advice about caring for your healing wounds.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.
Most patients are well enough to go home on the same day and this is actively encouraged as an uncomplicated procedure often means that recovery is more comfortable at home. In rare circumstances patients may have to stay overnight for pain control or due to the procedure being complicated.
You may also experience some short-term constipation. You can help reduce this by not taking codeine painkillers, eating plenty of fibre and by staying well hydrated, although your GP can prescribe medication if the problem is particularly troublesome.
Before leaving hospital, you will be advised about caring for your wound and what activities you should avoid. In most cases, you can return to normal activities within a week. As the wound is not stitched closed it will take several weeks to heal completely. During this time the packing inserted during the operation must be changed every day or every few days. This will be done by the the Nurse practitioner at your registered GP surgery.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Your surgeon may give you painkillers when you're discharged from hospital.
As with every procedure, there are some risks associated with incision and drainage. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Complications are when problems occur during or after the procedure. The possible complications of any procedure include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Other possible complications may include:
wound infection (although antibiotics may be given before, during or after the operation to minimise the risk of serious infections)
bleeding or a bruise forming under the skin causing a firm swelling (haematoma) – this will usually get better on its own but you should see your GP if you are concerned
scarring – there will be some scarring where the incisions was made
recurrence of the abscess – the abscess may return, either in the same spot or elsewhere on the body
numbness over the affected area- as nerves supplying the affected area of skin may be damaged during the procedure, a small patch of numbness may result
recurrence- there is a chance that an abscess may return again in the future, either in the same place or elsewhere on the body