abscess
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An abscess is an encapsulated, pus-filled cavity in the tissue. It can form when the body fights a localized infection. An abscess should be identified and treated as quickly as possible so that the infection does not spread any further. Read here how an abscess develops, what symptoms it causes and how it is treated.
Abscess: Brief Overview
- Description: encapsulated accumulation of pus in the tissue
- Causes: mostly bacteria that enter the body through wounds, operations, syringes or other infection routes
- Treatment: opening of the abscess by the doctor, administration of antibiotics
- Prognosis: with rapid treatment, good chances of recovery, with non-treatment threatened blood poisoning
Abscess: description
An abscess is an encapsulated collection of pus in the tissue. The triggers are usually bacteria that invade the tissue. Then the immune system becomes active. To prevent the infection from spreading further, immune cells melt the affected tissue and encapsulate it from the surrounding healthy tissue with the help of a membrane. Pus collects inside the cavity. It is made up of dead tissue, dead immune cells and bacterial debris.
The encapsulation makes it more difficult for the infection to spread. At the same time, however, it is difficult for fresh cells of the immune system to reach the source of the inflammation. That is why an abscess has to be opened and emptied by the doctor. Otherwise, in the worst case, there is a risk of blood poisoning.
Abscess: causes
An abscess is usually caused by bacteria entering the body. Other pathogens are parasites or amoebas.
External injuries
Often a boil is the result of an external injury. In healthy people, the skin forms a natural protection against pathogens. However, in the case of deeper injuries such as cuts or animal bites, bacteria can invade the body and cause an abscess. The more contaminated the wound, the greater the risk.
Operations
Operations can also give pathogens access to the body. If there is a particularly high risk of infection, the surgeon often creates a drain. Through them, all liquids can drain off immediately. This will prevent pus from building up. Risk patients are also given an antibiotic to nip possible sources of infection in the bud.
Other tissue damage
Tissue that has already been damaged in other ways is particularly susceptible to infection. Examples of this are parts of the body that are poorly supplied with blood due to diabetes or blood clots, or tissue that grows like in cancer.
Weakened immune system
A weakened immune system also makes people susceptible to an abscess. Such an immune deficiency can be the result of an HIV infection, but also any other infection. Chemotherapy for cancer also weakens the immune system.
Common places of abscesses
An abscess can form anywhere in the body. However, certain areas are particularly often affected by boils. Because some parts of the body can easily be attacked by bacteria or other pathogens. Other abscesses form because an artificial entry point for germs is created by injuries or during an operation.
Abscess in the abdomen
Abscesses in the abdomen are often the result of injuries or surgery on the bowel. Countless bacteria live in the intestine and play an important role in digestion (intestinal flora). In a healthy intestine, the wall is impermeable to germs.
In diseases such as a ruptured appendix or injuries to the intestine, however, bacteria can penetrate the abdominal cavity. Often the peritoneum becomes inflamed. But abscesses can also form.
A collection of pus can develop, especially under the diaphragm (subphrenic abscess), under the liver (subhepatic abscess), directly on the loops of the intestine or between the rectum and bladder / vagina (Douglas abscess).
Abscesses of internal organs
Abscesses in organs such as the liver are also caused by pathogens that could get deep into an organ via the bloodstream. Organs with a high blood supply, such as the liver and spleen, are therefore particularly often affected. For example, parasites such as fox or dog tapeworms and amoebas tend to form abscesses in the liver, as this organ can easily be reached from the intestine via the blood.
Abscess on the anus
Abscesses (perianal abscess or periproctic abscess) are particularly common in the anus due to contact with the stool, which is heavily contaminated with bacteria. In addition, in addition to hair and sebum follicles, anal glands are also located directly in the anal canal and secrete secretions - good conditions for bacterial infections.
An abscess on the buttocks can also be an early sign of an inflammatory bowel disease such as Crohn's disease. Men between the ages of 30 and 50 are particularly likely to develop an abscess on the anus.
Abscess on the face
An abscess on the face often forms in severe acne. When bacteria penetrate the sebum glands and thickened sebum obstructs the exit of the sebum gland, a pimple develops. If the bacteria get deeper into the tissue, various foci of inflammation can merge and form a boil on the skin of the face.
This creates an abscess
Abscesses in the mouth
The oral cavity is also heavily populated with bacteria. Tooth and mucous membrane damage allows them to penetrate deep into the tissue, causing inflammation. When the inflammatory response encapsulates, a painful abscess forms in the lining. Depending on how deep the boil is in the tissue, one speaks of mucosal or submucosal abscesses.
Abscess on the coccyx
An abscess on the coccyx often occurs as part of a coccyx fistula (pilonidal sinus, pilonidal cyst): If a hair grows into the skin of the buttock fold, a channel to the skin surface (fistula) is formed. Bacteria can penetrate the tissue through this gate and cause inflammation with subsequent abscess formation. Overweight, middle-aged men are particularly affected.
Abscess on a hair root (boil)
An abscess in the area of a hair follicle is called a boil. These abscesses appear on hairy parts of the body, armpit, scalp and genital area. A painful, tight knot forms. If several hair follicles are affected, one speaks of carbuncle.
Abscess of the chest
In women, an abscess can also develop in the breast. For example, bacteria get into the gland ducts when breastfeeding or piercing the nipple. Then the mammary gland can become inflamed. When it is encapsulated, it develops into a boil in the chest.
Abscesses from injection
If a syringe is not adequately disinfected, bacteria can penetrate deeper tissue layers with the needle (syringe abscess). For example, a so-called gluteal abscess is caused by a needle stick in the gluteus.
Abscess: symptoms
The symptoms of an abscess can be very diverse. Since an abscess is associated with inflammation, there are general signs of inflammation:
- Redness
- swelling
- overheat
- pains
- Functional restriction of the affected area
The type of pus, its smell, and its color will vary depending on which bacterium caused the infection.
Often times, pain and fever are the only symptoms of an abdominal abscess. The inflammation can also bring the bowel function to a standstill (constipation or even bowel obstruction). If digestion stops working, the patient vomits and there is no bowel movement. Since the large intestine in particular is colonized by bacteria, further foci of infection can develop there in the abdomen.
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Abscess: "Do not open yourself!"
Three questions for
Dr. med. Uwe Kirschner,
Specialist in skin and venereal diseases -
1
Who Is Particularly Affected by Abscesses?
Dr. med. Uwe KirschnerAn abscess is not uncommon: Almost everyone develops one of these delimited, encapsulated collections of pus in the course of their life. Abscesses can appear anywhere on the skin, but also inside the body. However, those who have poorly supplied with blood, previously damaged tissue - such as diabetics - or a weakened immune system are more likely to get an abscess.
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2
When do I have to see a doctor with an abscess?
Dr. med. Uwe KirschnerSome abscesses go up on their own and should then be treated with antiseptic. Under no circumstances should you open an abscess yourself! This can be dangerous and even cause blood poisoning. It is best to see a doctor. He treats an as yet immature abscess with an ointment bandage or opens the mature abscess under sterile conditions.
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3
How can I do if I keep getting abscesses?
Dr. med. Uwe KirschnerIf abscesses recur, a doctor should check for diabetes and check your immune system. Recurring abscesses in body folds (armpits, groin, inner thighs, genital area, buttock folds, etc.) indicate a chronic disease, such as acne inversa. As this gets worse over time, you should see a specialist as early as possible.
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Dr. med. Uwe Kirschner,
Specialist in skin and venereal diseasesResident dermatologist in Mainz with a special consultation for recurring abscesses and hidradenitis suppurativa / acne inversa.
Abscess: examinations and diagnosis
If the doctor suspects an abscess, he first looks for the typical signs of inflammation. The dysfunction of the affected body part or organ may also be noticed. For example, inflammation in the brain may result in nerve failure. This can manifest itself as tingling, pain or paralysis.
Blood tests
In the case of liver abscesses, the liver function is disturbed. This shows in worsened liver values.
Other blood values can also indicate an inflammatory process. Increased levels of white blood cells and C-reactive protein (CRP for short) usually indicate inflammation in the body.
Imaging procedures
With an ultrasound machine or computed tomography (CT) scanner, the doctor can also detect a boil inside the body. It appears as a rounded structure in otherwise inconspicuous tissue. The wall of the boil appears lighter on ultrasound than the pus inside.
Abscess: treatment
Normally, the immune system discards dead body cells and pathogens. A boil is difficult for the immune cells to reach. In order for it to heal, it should be opened and emptied from the outside as quickly as possible.
Abscess surgery
As part of an abscess operation, the doctor opens an abscess as gently as possible and, in the best case, removes all of its contents. Depending on the extent and severity of the abscess, the procedure is carried out by a family doctor or a surgeon.
Sometimes the pus cannot be completely removed during abscess surgery. Then a drain is inserted. It serves as a drain for newly developing pus.
For some abscesses, it is enough to prick them open. This applies, for example, to very superficial abscesses of the skin. In the case of larger or deeper abscesses, however, the doctor must ensure that the pus cavity is completely emptied and that the abscess cavity does not close again so that the abscess can heal.
Treatment of abscesses with antibiotics
Antibiotics help fight the bacterial infection. The choice of agent depends, among other things, on the pathogen. The location of the abscess and the color and smell of the pus provide an indication of the type of germ. Based on these factors, the doctor can estimate the possible pathogens relatively well.
A bacterium can be clearly identified by analyzing sample material from the abscess, which the doctor obtains during the abscess operation. This analysis takes a few days.
Frequently used antibiotics in abscess treatment are clindamycin, penicillins, cephalosporins, doxycycline or vancomycin. In seriously ill patients, the therapy can be extended with carbapenems or linezolid.
In rare cases, abscesses are not caused by bacteria but by parasites such as amoebas. Other agents such as metronidazole or paromomycin are then used to treat abscesses.
Never open abscesses yourself!
You should never open an abscess yourself. The risk that tissue is injured and the infection spreads is too great.
With an abscess, waiting is the wrong strategy. See a doctor as soon as possible so that they can open the abscess. The longer you wait, the more severe the infection becomes.
Abscess: disease course and prognosis
It is unlikely that an abscess will heal on its own. However, if the boil is recognized early and emptied, it usually heals without consequences.
It becomes problematic when the abscess affects organs that are difficult to regenerate, such as the brain. Destroyed nerve cells are not easily replaced. Since certain brain regions specifically control individual areas of the body, depending on the location of the boil, it can lead to failures, paralysis, memory lapses or abnormal sensations.
If an abscess is left untreated, the infection can spread to the entire body - life-threatening sepsis ("blood poisoning") develops.
The prognosis for an abscess also depends on the overall condition of the patient. The weaker the patient and their immune system, the more difficult it will be to fight the boil.
Bacteria, on the other hand, have a hard time in people with a strong immune system. So a good body defense is the best protection against abscesses.
Additional information:
Guidelines:
- S3 guideline "Odontogenic Infections" of the German Society for Oral and Maxillofacial Surgery and the German Society for Dentistry, Oral and Maxillofacial Medicine
- S3 guideline "Anal abscess" of the German Society for General and Visceral Surgery e.V.
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