At a glance
After a perianal abscess is drained, the wound is usually left open and packed with gauze. This packing serves an important purpose: it keeps the wound open so it can drain and heal from the inside out. Packing needs to be changed regularly — and for many people, the packing changes are a more significant part of recovery than the drainage procedure itself.
Why packing is used
After drainage, the abscess cavity is empty but needs to heal from the deepest part outward. If the skin surface heals over first (closing from the outside in), pus can re-accumulate in the cavity, creating a new abscess.
Packing:
- Keeps the wound open
- Allows continued drainage
- Prevents premature surface closure
- Promotes healing from the inside out
- Allows the nurse to monitor the wound at each change
What the packing change involves
Who does it
Packing changes are typically done by a district nurse who visits you at home, or at a GP surgery wound clinic. The frequency depends on the wound — usually every one to three days initially.
The process
- The nurse removes the old packing — gently pulling the gauze strip from the wound
- The wound is assessed — size, depth, drainage, and signs of healing
- The wound may be irrigated with saline to clean it
- Fresh packing is gently inserted into the cavity
- A gauze pad is placed over the top
- The process takes five to fifteen minutes
How it feels
People describe the experience with a range:
- Mild end: uncomfortable pressure and a tugging sensation. Not pleasant, but manageable.
- Moderate: noticeable pain during removal, particularly when the gauze has partially dried. Wetting the packing with saline before removal helps.
- More significant: the first few changes, when the wound is fresh, can be genuinely painful. Taking pain medication 30 to 60 minutes before the appointment helps.
The consistent pattern: it gets easier with each change as the wound heals and the cavity becomes smaller.
Tips from people who have been through it
- Take pain relief beforehand — 30 to 60 minutes before the scheduled change
- Ask the nurse to dampen the packing with saline before removal — this reduces the pulling sensation significantly
- Breathe through it — deep, slow breaths during the removal
- Ask about Aquacel or alginate packing — these modern dressings are less adherent than traditional gauze ribbon and are often more comfortable
- Sitz bath before the appointment — warms the area and may soften the packing
- Communicate with the nurse — tell them if it is particularly painful so they can adjust their technique
- Remember it is temporary — the packing period ends as the wound heals
When packing stops
Packing is gradually reduced as the wound heals:
- The cavity becomes smaller
- Less packing material is needed
- Changes become less frequent
- Eventually, the wound is shallow enough that packing is no longer needed
- The wound finishes healing on its own
What to watch for between changes
Between packing changes, monitor for:
- Packing falling out — this can happen and is not an emergency, but contact your nurse for advice
- Increased pain or swelling — may indicate re-infection
- Fever — seek same-day medical attention
- Heavy bleeding — some spotting is normal, heavy bleeding is not
- The packing becoming saturated quickly — may mean the wound is producing more drainage than expected