Abscesses During Pregnancy

Vilma Ruddock
Pregnant woman with her doctor

Pregnant and non-pregnant women are prone to the same types of abscesses. When they occur during pregnancy, the main concern is the risk for spread of bacteria through your body, which could cause severe complications for you and your baby. If you are concerned about an abscess, consult your doctor to discuss treatment options that are safe for your baby.

Pregnancy and Abscesses

According to Principles of Medical Therapy in Pregnancy, during pregnancy you are at risk for getting the same kind of bacterial infections that can lead to abcesses as you are outside of pregnancy. Risk factors for developing an abscess are also the same, and there appears to be no difference in how your immune system fights it.

The Abscess

An abscess is a collection of pus encased in tender or painful, swollen, inflamed, and reddened tissue. The pus, a liquefied collection of the infecting organisms, white and other inflammatory cells, and dead tissue, can come to a point and drain.

The abscess usually starts as a small local infection, which then progresses and spreads wider and deeper into surrounding tissues. The infecting organisms are most often the bacteria common to the particular site of infection.

Management

Abscesses during pregnancy should be treated to prevent the infection from spreading and getting into your blood (sepsis), harming you and your baby. A localized abscess might drain and heal spontaneously, but your doctor usually has to drain larger ones through an incision and remove any dead tissue. Antibiotics and pain medicines are added if needed.

Common Sites of Infection

Common sites of infection and abscesses include areas of your skin, near your vagina, and in your anus and rectum. Abscesses in any of these locations are easier to diagnose and treat than the less common abscesses that can occur in your abdomen or pelvis.

Skin Abscesses

The skin is the most common site of abscesses before and during pregnancy, and skin abscesses are more common in women with a history of diabetes or skin abscesses. The skin bacteria, Staphylococcus aureus (staph) is a common cause, but other organisms may be the culprits, depending on the skin location.

To prevent infection and abscesses, keep your skin clean and dry and treat any abrasions or sores quickly before they progress.

Infected Hair Follicle or Sebaceous Gland

Skin Abscess

A common type of skin abscess begins either as an infected blocked hair follicle (folliculitis) or sweat gland (infected sebaceous cyst), or an infected open area on the skin surface. An abscess forms when the infection spreads into the skin's dermis and subcutaneous tissues.

The most common sites for these skin infections include the armpits, the groin, the buttocks, and the labia, though they can occur on other parts of the body, including the face and scalp. Lymph nodes that drain the site of infection may be swollen. For example, an abscess on your labia might cause swollen nodes in your groin.

Hidradenitis Suppurativa

Hidradenitis suppurativa is a more complex collection of chronic skin abscesses. The condition can be painful and persistent in spite of treatment. It may be present before pregnancy and flare because of the hormonal changes in pregnancy.

The infection starts in blocked sweat glands, which then spreads into deeper layers of skin. Usually there are multiple, small, draining, painful abscesses and sinus tracts in the location, more commonly in the armpit, groin, and skin around the labia and anal areas.

Pilonidal Abscess

A pilonidal abscess occurs under skin near the anus. It develops when bacteria infects a sinus tract or a pilonidal cyst at the end of the tailbone near the anus. Symptoms include pain, especially on sitting, and drainage of pus from the abscess. These abscesses tend to recur. If they do, you may need surgery to close the sinus tract.

General Symptoms of Skin Abscesses

Symptoms of a skin abscess include a hard or soft, reddened, warm, tender, or painful mass at the site of infection, which may or may not be draining. The abscess may be surrounded by a red or darkened area of skin (cellulitis). The degree of pain of an abscess depends on the extent of the infection.

Treatment of Skin Abscesses

Small skin abscesses may open and drain by themselves, or occasionally the infection reabsorbs and heals. Avoid squeezing or picking an abscess, which might cause the infection to spread.

Home remedies can reduce pain and discomfort and help the abscess come to a point and drain. They may include:

  • Gently applying a warm washcloth to the abscess for 15 to 20 minutes, three or four times a day
  • Soaking the area in a warm Sitz bath for 15 to 20 minutes two to three times a day. Avoid squeezing or picking the abscess, which might cause it to get worse.

Avoid applying any medicines to the abscess, including topical antibiotics, without checking with your doctor.

When to Consult Your Doctor

Consult your doctor for other treatment options that might be allowed during pregnancy if:

  • The abscess is larger than half an inch
  • There is red streak that travels away from the abscess, which could mean it has spread to blood or lymphatic vessels
  • The abscess is not resolving or is getting bigger or more painful with home remedies
  • You develop a fever, chills, sweats, fatigue, or feel weak, lightheaded, which might spread of infection into your blood

Doctor prescribed treatment options may include:

  • Pain medicine by mouth, if needed
  • Possible incision and drainage to speed healing
  • Possible antibiotics if the abscess is large, or there other symptoms such as fever

Bartholin's Gland Abscess

The Bartholin's glands lie in the tissues near the posterior part of the opening to the vagina. Some women are prone to a Bartholin's abscess when the mouth of a gland gets blocked, and bacteria in the area infect the gland.

According to the American Family Physician, multiple bacteria are usually involved in the infection. If you have a history of sexually transmitted infections, such as gonorrhea and chlamydia, you are at greater risk for a Bartholin's abscess.

Symptoms

Symptoms of a Bartholin's abscess include a painful lump, which may be draining pus under vulvar skin near the vaginal entrance. Large, tense abscesses can be extremely painful, and you might have difficulty sitting, walking, or having intercourse. Other symptoms might include fever and chills.

Treatment

Like other abscesses, a Bartholin's gland abscess may open and drain spontaneously without treatment. Warm sitz baths for 15 to 20 minutes two or three times a day may give symptomatic relief and help the abscess resolve. Drainage typically brings quick relief of this painful abscess.

See your doctor if you have a large, painful abscess, or if a small abscess doesn't improve after two days of home remedy. Usually at this stage the abscess needs incision, drainage, and packing, and you will likely be given an antibiotic and a pain medicine.

Anorectal Abscess

A peri-rectal or anorectal abscess develops in the glands inside the anus, or near the end of the rectum where it joins the anus. Pregnant women at risk include those with:

  • Hemorrhoids, which may bleed and get infected
  • Anal fissures or tears that may get infected
  • Diabetes
  • A history of sexually transmitted diseases
  • A history of Crohn's disease of the bowel

Symptoms

Symptoms of an anorectal abscess include pain, a lump in the anus or near the rectum, constipation, pain during a bowel movement, and pus from the anus if the abscess is draining. Fever, chills, and increasing pain can occur as the abscess gets bigger and deeper.

Treatment

Though sitz baths can give you some relief, and an anorectal abscess might drain spontaneously, see your doctor if you develop anorectal pain. Early incision and drainage and antibiotics therapy are recommended to prevent extension of the abscess.

If these abscesses spread to deeper tissues around the anus and rectum, they become more difficult to treat. Small, superficial abscesses may be drained with local anesthesia, but deeper and larger ones may require surgery under general anesthesia.

Oral Abscess

Pregnant women are at risk for oral infections during pregnancy. Poor dental health before pregnancy and increased acidity in saliva from a sugary diet or after vomiting can lead to further tooth decay during pregnancy, which may cause abscesses.

Bacteria from the infection can get in your blood, which can lead to premature labor and birth and low birth weight, as well as an increased risk of tooth decay in the child, according to American Family Physician.

Symptoms

Symptoms of an oral abscess include pain in the area of infected tooth, and a painful mass caused by the abscess. You can also have facial swelling and pain because of an abscess.

Treatment

Consult your doctor as soon as possible if you have any tooth pain, painful mass under your gums, or facial pain and swelling. Treatment may include incision and drainage of the abscess, tooth extraction, antibiotics, and an antibacterial mouthwash.

Pelvic and Abdominal Abscesses

Pelvic and abdominal abscesses include those of the appendix, tubes and ovaries, and large bowel. They are less common than skin abscesses during pregnancy. However, there is a greater risk of spread of infection through your blood and lymphatic vessels, and more severe complications for you and your baby.

Appendix Abscess

Appendicitis is the most common reason for surgery during pregnancy, occurring in 1 in 1000-1800 pregnancies, according to Principles of Medical Therapy in Pregnancy. An appendix abscess may form when the symptoms of appendicitis are not recognized and treated early.

Be aware of any new abdominal pain, and note that the location of pain from an infected appendix might be higher in your abdomen in the later second and third trimester as your uterus grows and pushes your large bowel higher in your abdomen.

Other Abscesses

Other, less common sites include abscesses involving a fallopian tube and ovary, which are more likely if you had a history of sexually transmitted infections or became pregnant by in vitro fertilization (IVF), as well as in other parts of the bowel affected Crohn's disease.

Symptoms

Some of the symptoms of pelvic and abdominal abscesses may be ignored as those of pregnancy at first. To ensure early diagnosis and treatment, pay attention to new onset or persistence or worsening of the following symptoms:

  • Pelvic or abdominal discomfort or pain
  • Nausea and vomiting
  • Loss of appetite
  • Fatigue
  • Fever and sweats
  • Chills

Treatment

Prompt diagnosis and treatment of pelvic or abdominal abscesses is important to avoid severe complications in you and your baby, especially if the abscess ruptures. You can become seriously ill and die or lose your baby if you are not treated adequately.

Surgery is usually done to remove the pelvic or abdominal abscess, or they can be drained, depending on the organ involved and the location. Antibiotics are also necessary and may be given by IV in a hospital.

Maternal and Fetal Risk

Maternal and fetal risks from a poorly treated abscess, especially if the infection spreads include the following:

  • Miscarriage during the first 20 weeks of pregnancy,
  • Stillborn and newborn death after 20 weeks
  • Premature rupture of membrane
  • Premature labor and delivery
  • Stillbirth and newborn death
  • Maternal death from septic shock from bacteria or their toxins in the blood

Prompt Attention

Any source of infection during pregnancy should be treated quickly to decrease the risks to you and your baby. Don't hesitate to consult your doctor if your have a large abscess, or one that is not getting better quickly, or if you have new or persistent abdominal or pelvic pain or symptoms of a systemic infection.

Abscesses During Pregnancy