II have a painful swelling at my tailbone that I think is a pilonidal cyst. I'm traveling and can't see my doctor until next week. What should I do?
November 18, 2010 11:24 AM   Subscribe

I have a painful swelling at my tailbone that I think is a pilonidal cyst. I'm traveling and can't see my doctor until next week. What should I do?

So I've got a painful red lump at the top left of my ass crack, maybe about the size of a peach pit. Doing some web research, I'm thinking it's a pilonidal cyst (human bodies are gross, btw).

It's uncomfortable, but not intensely painful. Which is a good thing, since I'm 2000 miles from home on serious business and won't get to see my doc until sometime next week. I can live with it until then....or can/should I? YANMD, but...

1) Am I endangering my health or making it worse by waiting a few days? Should I run out and find the nearest emergency room ASAP? I don't want to end up with some bad consequence that could have been avoided if I'd only acted sooner.

2) As long as I'm not slumped on my tailbone, I'm OK to function for business all day. But when I get back to the hotel, should I be caring for this by...icing it? Hot towels? Eye of newt?
posted by bartleby to Health & Fitness (17 answers total) 1 user marked this as a favorite
 
IANYD... These are usually drained surgically. If you can't handle the pain, you have to go to the emergency room. Otherwise, try ibuprofen or naproxen to control the pain to the best of your abilities and to relieve some of the inflammation. A Sitz bath won't hurt you, but it's probably not going to do much to help either.
posted by honeybee413 at 11:33 AM on November 18, 2010


Any chance you can stop by a 'doc in a box' at a CVS or find a cash doctor that can take a look and advise you? Maybe they can give you something to get you through the trip.
posted by wrnealis at 11:33 AM on November 18, 2010 [1 favorite]


Best answer: Assuming it is a pilonidal cyst, waiting a week to see the doctor is unlikely to have drastically terrible results. You can try to keep the area clean and (if practical) shaved to avoid having it get irritated by hairs or anything else.

You could also call the dial-a-nurse line of your hometown hospital for advice.
posted by phoenixy at 11:37 AM on November 18, 2010


NSAIDs (to relieve the inflammation a bit), topical antibiotic cream (can't hurt, might help, especially if it is NOT a pilonidal cyst), doc as soon as possible. People do live with those bad boys from years (I have NO idea how) and they do get HUGE, so if this is in fact what you have, it's not liable to kill you overnight.
posted by julthumbscrew at 11:39 AM on November 18, 2010


Honeybee is on it -- applying heat may help. Also, there's a product called Icthamol (smells the same as the stuff in Boil-ease) which a friend of mine swears by. You'll want to apply a large secure dressing over it at night and especially if you use the Icthamol -- that stuff is like motor oil and will soak through anything.

Best case scenario is that you get it to drain on it's own before it gets much worse. But you should know that even if you get it to 'go away', it will probably come back and need to be surgically drained & packed with gauze some day in the future . . .
posted by MeiraV at 11:39 AM on November 18, 2010


Best answer: Hot towels really are the go-to for cysts you can't get drained right away.

The "drawing salve" MeiraV mentions is sold under the names Ichthammol (in case you need to Google it) and Ichthyol. There are other drawing salves, which are available at most largish drugstores.
posted by Sidhedevil at 11:43 AM on November 18, 2010


But don't get a homeopathic drawing salve by mistake--make sure you get something chemically active.
posted by Sidhedevil at 11:44 AM on November 18, 2010


Best answer: Keep an eye on it, too, and if it starts to get drastically worse (turning red, becoming more intensely painful, etc.) then get to an urgent care center or hospital. I've known someone who had what was assumed to be a pilonidal cyst but turned out to be a staph infection.
posted by infinitywaltz at 12:08 PM on November 18, 2010


I assume you've seen pilonidal.org. It seems everyone's experience with this is different. The first time my cyst swelled on me enough to notice, it was mildly painful and the swelling went away on its own in a couple weeks. The second time it happened the swelling became so painful over the course of maybe a week that I went to a doctor. He drained it by squeezing, no surgery required. Let me tell you, that was the most pain I've ever experienced in my life. But the pain dropped dramatically, and over the course of a week or two I continued to drain it myself by squeezing it in the shower or in a bath (you thought you were grossed out by reading about cysts, try this!).

BTW, I was pretty depressed when I first read about the horror stories of removal surgery. I opted not to have it removed and see what happens. Since the initial problems a few years ago it's only swelled up small amounts a few times, barely noticeable really.
posted by Durin's Bane at 12:11 PM on November 18, 2010


I had one of these. Grossest_Body_Thing_EVAR.

I had it for years until the pain became so unbearable that I had to go to the ER. If you're not there yet, then you can probably manage with OTC pain killers until you get home. (I am NOT a doctor!)

When I initially had it drained at the ER, the sucker grew back. I recommend getting it surgically removed. Your chances of having it grow back are smaller.

If you do wind up in the ER, bear in mind that you will be in in a different kind of pain after it's drained, and it will likely interfere with your ability to focus at work. It certainly proved so for me.
posted by omphale27 at 12:26 PM on November 18, 2010


Best answer: I would not recommend draining it yourself, as the only real danger (that I know of) from such a cyst would be if it were to get infected, which is much more likely if you open it up.

Deal with the pain for now, have a doctor deal with the cyst when you can.

And if at all possible try to get it removed via laporoscopic surgery. The usual method of removal involves cutting it out and leaving an open wound that needs to be packed with gauze everyday and tended to until it heals from the inside out, taking weeks. This did not sound fun to me. I had mine removed laporoscopically and they were able to stitch the wound closed, leading to a very quick and relatively painless recovery.
posted by Jawn at 12:46 PM on November 18, 2010


Mine is a sebacious cyst, rather than pilonidal, but in the same location, tip of the tailbone. I scheduled surgery once, but when I showed up for the removal, 11 days after the evaluation, it had healed so completely that the PA didn't want to cut me open to look for it.

The last time it flared up, I started heat treatment and OTC analgesics as soon as it started hurting, and it matured and drained in just a few days without ever getting intensely painful. When I start feeling a soft spot, I wear a folded towel in my pants until it opens up and then until it finishes draining.

I still plan to have it removed, but it's less urgent now that I have a way to manage it.
posted by Bruce H. at 1:07 PM on November 18, 2010


I have one. It flares up occasionally, especially when I've been sitting a lot during hot weather. What helps me is washing it well and draining it in a hot shower, then cleaning the holy hell out of the area with alcohol swabs. This makes me crosseyed with the stinging if I'm doing it right. Whatver bugs grow back there seem to be pretty fragile, though, because it's back to being just my usual tailboniness within about 12 hours after that.

Since this works well enough for me, I haven't bothered to have the cyst removed.
posted by gingerest at 4:15 PM on November 18, 2010


I once had one of these and found sitting in a hot bath with ordinary table salt added worked wonders, and actually helped the cyst to drain without medical intervention. I added enough salt to create a saturated solution, and sat for around a 1/2 hour at a crack (pun intended). I also took several Vitamin C tablets a day to help get rid of the infection. Someone else told me Ichthammol worked too, but I've never tried it myself. And hope never to have to.
posted by motown missile at 6:20 PM on November 18, 2010


I'm going against the grain here, but my Da ended up in hospital and extremely ill from 'waiting to get home'. I've come close with it becoming infected - red, raised and painful is infected, just not terribly so yet. So I'd hit the doctor for the usual round of antibiotics to calm it down and look at surgery. The Other Anachronism had the surgery after a single bout and it seems good. I'd do it but mine hasn't flared in years and they can't find the sinus without opening me up.
posted by geek anachronism at 6:22 PM on November 18, 2010


Glad I'm not the only person who has dealt with one of these! I ignored it for weeks before I finally dealt with it. You will probably be fine for a few days.

Having it drained was awkward and uncomfortable, and really painful afterwards when they packed the wound, but once I took a bath and took the gauze out it healed up quickly and I haven't had a problem since.
posted by radioamy at 11:44 PM on November 19, 2010


Sorry I'm late on this! I also had a pilonidal cyst and ignored it for too long, and when it finally needed taking care of, it was so painful I was willing to do anything to get rid of it. That "anything" meant going to the ER in the middle of the night and getting it drained, which is NOT a 'cure'. It was so effin' painful and awkward. It took a week out of work (it was packed with gauze and I couldn't sit), and it came back less than a year later. The surgery to remove the cyst was easy-peasy and took no longer to heal than the original draining. That was a few years ago, and I haven't had any new cysts! I'd say that's your best option.
posted by two lights above the sea at 7:12 PM on November 20, 2010


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