Pilonidal cyst when everything is canceled?
May 7, 2020 8:30 AM   Subscribe

I've recently developed a small pilonidal cyst (do not recommend googling if you are unfamiliar!). It is minimally bothersome at the moment (barely painful, not draining) but I am freaked the hell out after reading about the associated horrors online. Plus, even if I wanted to get surgery RIGHT NOW, my understanding that anything "elective" is not happening at the moment (I'm in MA). So how do I 1. calm down and 2. prevent some sort of quarantine buttpocalypse??

Because we live in a hell world now, I literally showed my butt to a doctor on a video call a few days ago. She was sure about what it was right away, but I'm also sure after feeling it (feels like a small hard lump under the skin) and having my husband (bless him) take some photos. You can't see MUCH, but the area is very slightly red and there are two teeny tiny pinprick holes right next to each other. So it's pretty definite as far as I can tell.

It really doesn't hurt unless I poke it directly or flop down onto the floor butt-first (which is how I noticed it in the first place, and initially took it for a mystery tailbone bruise). But I gather these things can get worse with little warning, and I'm very nervous about it.

Does anyone who's been through this have insight on how bad it is to do nothing for some period of time? Is there anything specific I can do to minimize the chance that it'll get super gross and infected and cause a more immediate problem? Do you always end up needing surgery for this, or is there a chance it'll just stay the way it is and/or go away?

I'm trying to minimize my exposure to discussions of this elsewhere online, since it's largely people who had horrible experiences being like "I had 75 butt surgeries and my butt is still one giant cyst" or whatever and I can't really handle that level of anxiety right now. But y'all are generally smart and reasonable so I figured I'd check here.

(I did read all the previous Asks about this, but it seems we haven't talked about butt cysts in a few years.)
posted by catoclock to Health & Fitness (19 answers total)
Did you ask the doctor these questions, or does your doctor have an email that you can use to follow up?
posted by pinochiette at 8:40 AM on May 7

Can you get to a CVS relatively safely? Call your local store and see if they have their Ichthammol ointment in stock, otherwise order it online. Get a pack of larger nonstick gauze pads. Put a pinto bean sized blob of ointment on it. Tuck the annointed gauze pad into your crack and put on some snug underpants or bike shorts or leggings (this stuff stains, don't use your faves, try to wear black, sit on a towel). Leave it a few hours.

In the meantime, don't touch it unless you're in the shower with soap on your hands. Poking at them makes them angry, washing does seem to help as it's a poorly-ventilated place, so I have done 2-3 quick showers a day just for those purposes, and then put on fresh ointment. It's generally taken less than 24 hours for the ointment to either get it to open and drain (which is preferable but you don't have much say in this) or subside (it'll come back eventually, you'll learn to sense it coming).
posted by Lyn Never at 8:50 AM on May 7 [3 favorites]

Actually, doctors will soon start begging for electives, if they haven't already, since they've now lost their primary source of income. Baker has been saying for the last couple of weeks at his pressers that people should really, really, really go to the hospital for non-covid things.
posted by Melismata at 8:56 AM on May 7

Note: Boil-Eaze had a little ichthammol in it the last time I checked, but is mostly lidocaine and is not nearly as effective as ones that have ichthammol up in the first couple of ingredients. It's tarry-looking and smells like gasoline but it stops the pain within a minute or two and does a good job of encouraging it to drain. Powerful enough to draw abcesses out of horse hooves AND butt cysts.
posted by Lyn Never at 8:57 AM on May 7

Hi from a member of a family where all of us are prone to jeep butt. I'm the only one (of five) who hasn't had corrective arse surgery, but had to drain one a couple of times. Cleanliness, avoiding hard surfaces and ichthammol /gauze work. Ichthammol's a nasty old tarry sulfa compound, but damn does it work. It can soak through/stain almost anything.

Do not do not do not be tempted to lance it/pop it unless you wish to redecorate.

(And for those lucky enough never to have experienced this: a) good; b) do not google this)
posted by scruss at 9:16 AM on May 7 [4 favorites]

I had one when I was 12? 13? It gradually became excruciatingly painful. When I was nearly unable to walk, I was taken to the doctor, who probed at it with a cotton swab, declared it a pilonidal cyst, and told us to come back in couple of weeks if it didn’t drain on its own. That night it did, and I’ve never had another problem in the subsequent five decades.

Interestingly one of my best friends also had one the very next year. I wonder if it was just coincidence or if some environmental factors can trigger them.
posted by HotToddy at 9:26 AM on May 7 [1 favorite]

Keep the area really clean and shaved, and don’t poke. Especially avoid the temptation to lance it—it could fill right back up again even worse. Ideally you can find a doctor to excise it using a local anaesthetic, but if you wait it out, there’s also a chance it could just subside, I’m pulling for you!
posted by oxisos at 10:00 AM on May 7

My friend just had to get surgery for exactly this. We are in New Mexico USA. He had no problem getting the procedure immediately.
posted by WalkerWestridge at 11:22 AM on May 7

I had one of these, and just to bring down the freak out a little bit, I did see a "surgeon" but it was the least surgery-like surgery you've ever heard of. It was just in an office, about the same level of invasiveness as when a dermatologist removes a mole. They did pack the wound and it was a bit uncomfortable to remove the packing later, but other than that, pretty straightforward. I imagine you could see a doctor in a fairly low-risk manner about this pretty easily if you want to get it taken care of now.
posted by radioamy at 11:30 AM on May 7

I had one of these several years ago. It eventually went away without any medical intervention, but I'm pretty sure at one point it got infected. The worst smell, and for awhile I had to wear menstrual pads backwards to catch any potential leaks. Never used ichthammol or anything but mine was never particularly painful.
posted by neckro23 at 12:40 PM on May 7

+1 to everything that's been said.

As an additional data point, I had one in my late teens which was rarely very painful but often uncomfortable, and later on repeatedly burst. Mine was removed under general anaesthetic, with a follow-up appointment to remove the stitches, which seemed OTT at the time but I've never had any further problem in the following two decades or so.
posted by A Robot Ninja at 3:46 PM on May 7

The surgery is technically elective, but cysts generally get worse the longer you wait and the surgery to repair them gets more invasive. If you're early enough in then you can just get "pit picking" done. It's very simple, in and out, removing the packing is uncomfortable but that's it. But it's not an option for larger cysts, and next thing you know they're taking a goddamn ice cream scooper to your backside. There's also a higher likelihood of them coming back. I would definitely not sit on this (heh) if I were you and press your doctor to see if you can get this taken care of.
posted by schroedinger at 4:06 PM on May 7 [1 favorite]

Don't shave! Introducing ingrowns or microcuts is going to make it worse.

Wash thoroughly and leave your buttcrack til last, particularly when washing your hair. Don't sit in a way that puts pressure on it, or at the top of your cleft.
posted by geek anachronism at 4:49 PM on May 7

If you have any kind of a boil you can put a hot teabag on it as a hot compress to encourage it to come to a head and drain. Don't squeeze the cyst or apply pressure. Just fish the bag out of your tea and apply. The tannic acid in ordinary black tea is a mild astringent and the heat and moisture will also encourage the thing to drain safely. This can also make it less painful.

I also suggest you don't shave. You don't want any stubble coming in, especially not in an area where there are nasty bacterium.
posted by Jane the Brown at 4:57 PM on May 7

Oh, on the washing and drying tip - do good soapy washing in the shower, and then use a dedicated dry washcloth to gently pat dry there and then put that cloth in a hamper without using it on anywhere else. Sleep in clean underwear and change into fresh in the morning, as well, until the swelling is gone.

As the doctor who had to drain mine said, "this isn't technically automatically staph or MRSA, but you should act like it is MRSA and protect yourself and household members accordingly". You absolutely should not shave anywhere near it.
posted by Lyn Never at 5:05 PM on May 7

Some of the self care advice above seems reasonable. In NH the hospitals are looking to ramp back up to full schedules. I would assume MA is in the same general boat. You can likely get an appointment if you need one.
posted by MadMadam at 5:26 PM on May 7

They’re going to try and ramp up elective surgeries in MA soon, my MIL is in charge of the OR at a suburban hospital and that’s the goal.

I have NOT googled so I’m not sure of the level of surgery we are talking about, but if it’s something like a biopsy or mole removal it would happen in a as dr’s office vs an OR, and those are definitely open. I’m going for my regular annual gyn exam next week and, while they’re being very thorough with COVID management, the office is running as usual.
posted by lydhre at 6:44 PM on May 7

Thanks all! An update if anyone is curious: I ended up having another video call with my doctor yesterday afternoon and expressed how freaked out I was. She was very sympathetic and referred me to a local surgeon. The surgeon's office called me literally half an hour later with an appointment for this morning. (Big thanks to everyone who pointed out that non-emergency medical care is ramping up here in MA, I had just assumed it was pointless to even ask.)

Anyway, the surgeon examined my butt and poked around where I was feeling a lump and declared that I do not currently have a problem. She said nothing is infected and wasn't even convinced that the lump wasn't just part of my tailbone. She DID see the little pore openings but said they were not stretched out enough to worry her. Her ultimate conclusion was that she's not 100% sure if I have a cyst or not, but if I do, it's very small and could have been there for any length of time without issue. She said I'm free to ignore it unless I have additional symptoms.

I'm still pretty freaked out by the whole visible butt pore thing (why is that a thing???? where do they go????), but it appears that I do not need to rush into surgery at this exact moment. So that's a relief.
posted by catoclock at 7:47 AM on May 8 [2 favorites]

I am glad you don't have one. You will know when it is infected and needs to be addressed. I had mine surgically drained 16 years ago and it's been fine since then.
posted by notjustthefish at 6:37 AM on May 9

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