What are the discharge instructions for a patient after incision and drainage (I&D) of an abscess?

Discharge Instructions After Incision and Drainage of Abscess

For uncomplicated abscesses after adequate drainage, antibiotics are not necessary, wound packing is optional and may cause unnecessary pain, and patients should monitor for signs of recurrence while allowing the wound to heal by secondary intention. 1

Wound Care

• Keep the wound clean and dry initially, then begin warm water soaks or sitz baths 24-48 hours after the procedure to promote drainage and healing 1
• Change the outer dressing daily or when it becomes soaked with drainage; use absorbent dressings to cover the area 2
• Allow the wound to heal from the inside out (secondary intention) - do not allow the skin edges to close prematurely 1
• If packing was placed, it will typically be removed within 24 hours, as evidence shows packing does not improve healing time and causes additional pain 1, 2, 3

Pain Management

• Take over-the-counter pain medications (acetaminophen or ibuprofen) as needed for discomfort 1
• Pain should progressively improve over the first week; increasing pain may indicate recurrence or inadequate drainage 1

Antibiotic Use

Antibiotics are NOT routinely needed after adequate drainage unless you have specific high-risk features 1:

Take prescribed antibiotics ONLY if you have:

• Fever >38.5°C (101.3°F) 1
• Heart rate >110 beats/minute 1
• Surrounding skin redness extending >5 cm beyond the wound edges 1
• Diabetes, immunosuppression, or other immune system problems 1, 4
• Signs of systemic infection or sepsis 1

If antibiotics were prescribed, complete the full 7-day course even if you feel better 4, 3

Warning Signs - Return Immediately If You Develop:

• Fever >38.5°C (101.3°F) 1
• Rapidly spreading redness around the wound 1
• Increasing pain, swelling, or pus after initial improvement 1
• Red streaks extending from the wound 1
• Foul-smelling drainage or tissue that appears black or dead 1
• Inability to control bowel movements (for perianal abscesses only) 1
• Signs of severe infection: confusion, severe weakness, rapid breathing, or feeling very ill 1

Follow-Up Care

• Schedule a follow-up visit in 7-14 days to ensure proper healing 2, 3
• Routine imaging is NOT needed after drainage unless the abscess recurs or fails to heal 1
• Recurrence occurs in up to 15-44% of cases, particularly with inadequate initial drainage 1

Additional imaging or evaluation IS needed if: 1

• The abscess recurs at the same location
• The wound fails to heal after several weeks
• You develop a persistent draining opening (possible fistula)
• You have inflammatory bowel disease or it is suspected

Activity and Work

• Avoid strenuous activity for 48-72 hours to prevent bleeding or wound disruption 1
• Return to normal activities as tolerated once pain improves 4
• Most patients can return to work within 2-3 days for non-physical jobs 5

Expected Healing Time

• Complete healing typically occurs in 2-4 weeks depending on abscess size 2
• Median healing time is approximately 21-24 days for perianal abscesses 2
• Larger or deeper abscesses may take longer to heal completely 1

Important Caveats

The high recurrence rate (up to 44%) emphasizes that adequate initial drainage is critical - if you notice the abscess reforming, seek care promptly rather than waiting 1. For anorectal abscesses specifically, up to one-third may have an underlying fistula tract that increases recurrence risk 1.