The human body is sometimes very gross.
June 4, 2011 1:51 PM   Subscribe

TMIfilter: I might have a pilonidal cyst.

YANAD, YANMD etc. etc.

So, I've been dealing with a brutal, extremely painful infection which my doctor thinks might have originated from an inflamed pilonidal cyst. She is going to arrange for me to meet with a surgeon who will be able to confirm it and recommend an appropriate course of action, but that might not be for awhile.

My sister also has this condition, but she was diagnosed when she was a teenager (I guess it usually shows up when you're younger); she had the surgery and I remember that it was horrible for her and she was weeks recovering from it, and then it came back. So, a few things:

- What sorts of questions should I ask the surgeon when I meet with him/her?

- Do you know of any advancements in the surgical treatment for this? When my sister had the surgery, about 15 years ago, they basically just removed a large amount of the surrounding tissue and hoped it didn't come back.

My sister has given me some tips on preventing flare-ups, since she's been dealing with it for so long, so I think I'm covered on that front. I'm mostly interested in hearing about more recent experiences with treatment. I'm quite nervous about this, if I need the surgery and it's the same one she had, I'd have to quit my job (it's a contract until the first weekend in September).

Throwaway email:

Anonymous, because I'd prefer not to have my gross, ass-related problems linked to me publicly.

Thanks, everyone.
posted by anonymous to Health & Fitness (9 answers total) 2 users marked this as a favorite
A friend of a friend (no, really) just had this surgery a few weeks ago. I don't know him well enough to converse with him myself on the matter, but apparently he's been dealing with it for years. He finally decided to get surgery when it reached the point that he had to go to the doctor to get the area shaved (he's a hairy fellow) and cyst drained every week. The last I heard, he was still dealing with the recovery (not able to sit down or leave the house) and had a family member move in with him temporarily to help him through it. Even with all that, he is just completely relieved to have had the surgery, and by all accounts from his doctors there is very little chance of it returning.
posted by phunniemee at 1:59 PM on June 4, 2011

I had such a cyst removed in about 2000, found the recovery period to be not so bad at all, and have never had it return. I believe my treatment was much like your sister's. While I have no advice regarding your two specific questions I can relate, from my experience with it, that whatever inconvenience the surgery presented it was worlds better than living with the damn thing for two years as I had done cause I didn't want to talk to anyone about the gross cyst on my ass. So I say go for it, or wait until you finish your job in september and then go for it.
posted by jrb223 at 2:17 PM on June 4, 2011 [1 favorite]

Response by poster: is a tremendous resource for this. They have a great community along with lists of recommended doctors and reviews of surgeons.

If it's possible, look at getting a pit-picking procedure. If your pilonidal problem is mostly an issue of infection and a pit, then you can get a very easy, very quick surgery that amounts to drilling a little hole around the pit to excise it completely. No horrible wound care, none of that. I guess the latest thinking in pilonidals is that chronic sufferers should treat seeing the doctor like seeing a dentist--about every six months you go, get any pits that have appeared removed, go on your merry way.

For very severe cases the cleft lift is the latest innovation. In that procedure the surgeon actually makes your cleft more shallow in order to decrease the likelihood of pit formation. The long-term success rate for this is much higher than the open or closed excision surgeries.

Pilonidal cysts are a disease where a lot of doctors are about 15 years behind the most current research and procedures. So I would highly suggest you do research on your doctor and surgeon and get all of the facts before getting chunks of your flesh scooped out. Do not be afraid to travel a while to get it treated either--the difference between a good surgeon and a bad surgeon in the success of the surgery is immense. I traveled six hours to get my surgery done with a particular doctor and it was completely worth it.
posted by Anonymous at 4:42 PM on June 4, 2011

I had a pilonidal cyst a few years ago. It didn't get infected I don't think, it just hurt really badly - I initially thought I'd bruised my tailbone. I had a surgeon drain it, and it healed up just fine. However yours sounds a little more involved?

One general recommendation I have is that you push your doctor (and/or the specilalist) to get you an appointment sooner. Emphasize how much pain you are in and how you don't want it to get any worse.
posted by radioamy at 6:15 PM on June 4, 2011

I had mine drained but not removed at urgent care about 10 years ago (I actually drove myself there without sitting down, things had gotten so bad) and there was a really time-consuming recovery period where I had to go back in every day for 10 days to have the packing removed and replaced. My abscess was very bad, and the packing changes for the first 3-4 days were excruciating even on maximum vicodin (but the last 4 I chitchatted with my nurse and was surprised when he was done, so healing was remarkably fast for as hurt as I was).

The surgery schroedinger describes sounds a million times better than that. I have recurrences, sometimes 3-4 times a year, and they're nothing like that first abscess was but they are still sometimes enough to make for a bad day or two.

Don't be nervous about a conversation with a doctor. You are in no way obligated to follow through with his plan if you don't like it. Just collect information from him and decide your next step then.
posted by Lyn Never at 7:21 PM on June 4, 2011

I had a pilonidal cyst twice. The first time it got so bad I had to go to the ER and get it drained and packed. That's not (NOT) a permanent solution, however. In about a year it came back, and I scheduled the surgery. I was out of work (but not on my butt :D) for about a week. The post surgery was better than all of my other surgeries, including my wisdom teeth and an appendectomy. You just can't sit for a week after. But it was, as far as I know, a good as-permanent-as-it-gets solution, because 3 or so years later, I've had no problems. They did to me what it sounds like they did to your sister, though I'm guessing more precisely? My bum is not mangled or funky-looking though. Just a little scar tissue. You wouldn't even notice it unless I pointed it out, probably.
posted by your mom's a sock puppet at 7:30 PM on June 4, 2011

Oh, and yeah, just getting it drained, as Lyn Never says, was horrible, especially getting it repacked. Just get the surgery. You'll save yourself so much grief.
posted by your mom's a sock puppet at 7:32 PM on June 4, 2011

My 18 year old son had an experience similar to what  Lyn Never mentioned.  My son had such pain, we thought he broke his tailbone. The ER doc drained and packed the wound and referred us to a surgeon.  The surgeon evaluated the site and referred us to a wound care clinic.  

I had to learn to clean and re-pack the wound. Not fun for a squeamish mom and a sheepish son, who was not happy about having to strip down everyday to have the bandaged changed. We managed though. It took about four weeks for the wound to heal.

The surgeon suggested that my son have laser hair removal in the wound area to prevent it happening again. 

Good luck to you, and I hope you feel better soon.  
posted by dorkydancer at 9:53 PM on June 4, 2011

I had surgery twice to remove the cyst. The first time it came back a few months later. The second time was a lot deeper, but it's been 8 years and I have a bump of scar tissue but it doesn't hurt or drain pus like it did as a cyst. I was warned about recovery ... but mine wasn't bad at all. I have a high pain tolerance, but I was back playing softball within days. Just keep it clean & dry.
posted by ilikemethisway at 9:00 AM on June 5, 2011

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