What is an abscess?

An abscess is a collection of infected fluid (called pus) that forms under the skin. Abscesses are caused by a bacterial infection. Abscesses can be found anywhere in the body. They most commonly present in the armpits (axilla), the groin, in between the buttocks (pilonidal abscess) or around the back passage (perianal abscess).

What does an abscess look and feel like?

An abscess usually presents as a painful lump. The skin overlying the lump may be red, hot and swollen. Sometimes the abscess can burst and smelly fluid (pus) may leak out of the swelling.

Why do I have an abscess?

Abscesses are very common. They form as a response to bacterial infections. Anyone can develop an abscess but there are certain factors that increase the risk of developing an abscess, such as smoking, diabetes, and certain skin conditions.

What investigations will I have?

Most abscesses are diagnosed by a doctor or nurse examining you. Rarely, we may arrange a scan if we are unsure if you have an abscess.

Can abscesses cause complications?

Most abscess will increase in size and then burst. The infection often gets better after the abscess has burst. Rarely, the abscess can cause infection in the skin or body which may lead to more serious complications such as sepsis.

What is the treatment for abscesses?

Most abscesses can be managed with a small procedure called an incision and drainage. Some small abscesses can be treated with a course of antibiotics.

What does an incision and drainage procedure involve?

A cut is made in the skin over the abscess and the pus inside the abscess is washed out. The abscess cavity is then packed with a dressing.

Will I need a general anaesthetic?

We can drain abscesses under local anaesthetic (you are awake) or under general anaesthetic (being put to sleep). This will depend on the size of the abscess, where it is on your body and any health conditions that you may have. A doctor or nurse will discuss each option with you.

What does a local anaesthetic involve?

This means draining the abscess whilst you are awake. The anaesthetic drug is injected into the skin surrounding the abscess. This causes some discomfort and a stinging sensation that lasts for a few seconds. Your skin will then feel numb: you will be able to feel pressure but not sharp pain.

We try to perform an incision and drainage under local anaesthetic whenever it is possible.

Advantages of having your procedure under local anaesthetic are that your procedure can happen straight away and you will be able to go home straight after your procedure.

What does a general anaesthetic involve?

This involves being put to sleep in an operating theatre. We recommend this if the abscess is large or if the abscess is near your back passage (anus).

There are a number of factors to consider if you have a general anaesthetic.

• You have to stop eating food 6 hours before surgery. You have to stop drinking 2 hours before surgery.
• The procedure takes place on our emergency operating list – this means we cannot guarantee what time your procedure will take place. Sometimes you may have to wait several hours in hospital for your procedure.
• We often cannot perform an incision and drainage under general anaesthetic on the same day you present to hospital. We frequently ask patients to come back the next day for their operation.
• You will need to spend several hours in hospital recovering from the anaesthetic.
• If your procedure is performed in the evening or late at night you may have to spend a night in hospital.

What are the risks of an incision and drainage?

There are very few risks involved. Patients can expect to experience the following:

• You might notice that there is some blood on your dressing after surgery. This is quite normal. More significant bleeding can usually be managed by applying pressure. Rarely you may have to go back to theatre if the bleeding persists.
• It is quite normal to experience some bruising where your wounds are. Often this does not appear until you have gone home from hospital.
• Delayed healing. It usually takes weeks for the abscess cavity to heal completely. Sometimes this may take longer. Your risk of this happening is higher if you are a smoker.
• Rarely, an abscess can come back in the same place. If this happens you may need another procedure to drain the abscess.

What should I expect immediately after my operation?

Most people will go home after surgery. If you have nobody to stay with you on your first post-operative night, if you are in poor health or are otherwise frail, may have to stay in hospital overnight after your operation.

Will I have pain after my operation?

Most people will have some discomfort after their incision and drainage. If you have pain, you should take regular paracetamol and ibuprofen (if you can take them) for the first few days after your discharge. The hospital may give some stronger pain relief to take at home. You should take all painkillers as directed on the packet.

Will I still need antibiotics?

The incision and drainage procedure gets rid of the infection. It is unusual to need any more antibiotics after your incision and drainage procedure.

What should I do with my wound?

Your wound will have been packed with a dressing following your incision and drainage. This dressing will need to be removed after 24 to 48 hours. This will be done by the practice nurse at your local GP surgery. The wound may not require any further dressings or it may need dressings to be replaced on a regular basis until the wound heals.

If you have poor mobility, district nurses may be able to visit you at home and perform the dressing changes.

If you are discharged from the hospital during a weekend, the nursing staff on the Surgical Assessment Unit will give you instructions on how to get your dressings changed.

How long will the wound take to heal?

This depends on the size, the site of the abscess. Most abscesses wounds are expected to heal within a few weeks (depending on the size).

Will I be given a hospital review appointment after my operation?

Most people will make a straightforward recovery. We do not routinely see patients after an incision and drainage of an abscess.

If you keep developing multiple abscesses or an abscess in the same place we may arrange further tests or refer you to another specialist.

When can I start driving again?

Once you can comfortably use all the controls in the car and turn round in your seat to safely reverse the car. You must be able to perform an emergency stop. It is always best to check with your insurance company to see if they have any specific rules. This is particularly important for professional drivers, e.g., taxi drivers, HGV drivers.

When can I go back to work?

This depends on how unwell you were, the nature of your job and the site and size of the abscess. Most people should be able to return to work quickly. Please ask us for a fit note (Statement of Fitness for Work).

Symptoms requiring you to seek medical attention

If you experience any of the following within the first week after your incision and drainage, you should contact the Surgical Assessment Unit (see below for contact details):

• Severe pain
• Bleeding: if your dressings become soaked in blood, and the bleeding does not stop after applying firm pressure for 20 minutes, you should contact the hospital
• Increased discharge and swelling: this might mean that the abscess need further treatment.

Who can I contact if I feel something isn’t right after my abscess operation?

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Please contact the patient advice and liaison service (PALS)

Frimley Park Hospital 0300 613 6530

fhft.palsfrimleypark@nhs.net

Heatherwood Hospital and Wexham Park Hospital 0300 615 3365

fhft.palswexhampark@nhs.net