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Pilonidal Cyst Advice Sought for Prevention

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Pilonidal Cyst Advice Sought for Prevention & Surgery

Posted by S on July 29, 2001 at 11:57:25:

Dr. Stoll,
Thank you very much for your bulletin board. You are doing a great service for many many people!!! If not for your bulletin board, I would have been scheduled for surgery in ignorance of the complications, long recovery, and recurrence issue. As I have read most of your bulletin board and archive on this topic, my questions are very specific. I would also appreciate hearing other peopleís experiences.

First the background. I am a 42 year old male. Had my first pilonidal cyst about 2 weeks ago. It resolved itself on its own, with only moderate pain and slight discomfort.. It was swollen and somewhat painful to sit on and drained 2-3 nights on its own on its own before I could even get in to see my doctor. From the swelling to the draining was about 5 days. I took sitz baths (that was before I read about hot compresses on the bulletin board). It is now about the size of peach pit with no swelling or pain. I do have a moist colorless spot on the back of my underwear, but Iím not sure if that is due to normal summer heat or this.

I saw 2 surgeons, both recommended surgery, neither discussed prevention, both said I would only be out of work 4 days, neither discussed the long recovery period or the 50% recurrence issue. I am taking Augmentin. One surgeon stuck a probe in there and told me I had a sinus tract and would definitely have a recurrence.

As this is the first occurrence, based on information on your bulletin board, I have decided to wait and see if it recurs and how painful the recurrences are. I would prefer to avoid surgery, based on the long recovery period and recurrence issue. If there is a recurrence, I plan on using hot compresses and some Augmentin and see if I can treat this locally on my own and avoid surgery.

1. My cyst is now the size of a peach pit. Should I use hot compresses to try to reduce it further or as there is no pain or swelling, leave it? Some of the posts mentioned antibacterial soap for hot compresses and some did not. I take it that hot compresses should have some antibacterial soap and that they are better than a hot soak or a sitz bath. After the hot compresses, is it okay to take a regular shower or does that defeat the purpose of concentrating the heat on the cyst?

2. If I understand correctly, surgery is necessary if there are painful recurrences and then there is only a 50% chance of solving the problem by getting all the nidi. So I can discuss this with doctors, where does the 50% rate and the other dismal rates for the second (60%) and third surgery (70%) come from? With the 50% recurrence issue, does recurrence happen more if there is a surgery vs. no surgery? I do not understand why someone would get surgery, if they can either prevent or handle the recurrences. (Of course, the 2 surgeons did not discuss options with me.)

3. I like your idea of doctors as consultants, rather than just telling me I need surgery. Is there another type of specialist, besides surgeons, I can see who would be well experienced with pilonidal cysts to discuss prevention of flares up based on my own case? Do dermatologists immediately refer out to a surgeon? I would like to have a doctor look at this and discuss in more detail prevention options and issues. Sometimes you mention specific doctors. I am in NYC.

4. Hair removal: I read in one post that after 40 years, hair is less of an issue. Is this the case?

I did not understand where to remove hair from. Do I put the hair removal right on top of the cyst? Or in the space above the cyst. My cyst is at the top of the crack of my butt on the left hand side.

5. Donuts: You recommend donuts after the first surgery to prevent flare up. Do you also recommend donuts after the first occurrence without a surgery?

How does the donut work? You sit so that your tailbone does not come in contact with either the seat or the donut or you sit directly on the donut?

Please explain what you mean by prevent pressure on the tailbone. Is it the BACK of the chair or the BOTTOM of the chair you do not want the tailbone to come in contact with. Is it okay if the butt comes in contact with the BOTTOM of the chair.

I am wondering if a different chair design might avoid using a donut at work. (Some chairs do not have a back, but are open, where the butt means the chair). I am wondering if a different seating posture might avoid the need for a donut at work, on the train, and on the subway. Or whether soft pillows might be enough?

6. You mentioned taking zinc to prevent recurrence. How does the zinc help? If I take the 100mg zinc without otherwise altering my diet, does taking zinc alone put something else out of balance?

Once again thank you so much for your bulletin board.

Re: Pilonidal Cyst Advice Sought for Prevention & Surgery (Good summary.) Archive.

Posted by Walt Stoll on July 30, 2001 at 07:51:20:

In Reply to: Pilonidal Cyst Advice Sought for Prevention & Surgery posted by S on July 29, 2001 at 11:57:25:

Hi, S.

Thanks for looking at the archives before asking your questions. If everyone would do that, my ability to keep up this 'site would be greatly prolonged without anyone losing any options for learning what they need to know.

So long as your cyst is draining (sinus) the mess is the only thing you will have to deal with. Wearing a little gauze pad over the drainage with hypoallergenic paper tape will take care of the mess but not the bother.

In response to your questions in order:
1. Hot compresses will only take care of the secondary infection caused by the blocked drainage--not the cyst itself. The antibacterial soap helps prevent the infection a little. A shower is fine--even right after or before the soak. All the effect of the hot soaks takes place right at the time. They are best uses when one notices an abrupt increase in discomfort since that means an infection is starting.
2. The only problem with no surgery is that the problem will continue to drain (hopefully) for the rest of your life without the 50% chance of a cure with surgery. See above for the "mess factor". The problem with surgery is:IF you are one of the unlucky 50% the problems can get worse fast and there is no going back.
3. Any responsible doc will explain exactly what I am explaining on this BB. See the archives for holistic practitioners to find a good one close to you. Personally, I know I would never opt for surgery.
4. Hair removal is only important IF it is practiced from puberty on. An ingrown hair can precipitate the problem. How often to people get ingrown hairs in this area???
5. Yes & yes. Pressure on the area is the most common precipitating factor in this problem. The nidi can sleep for all your life without chronic minor injury to the area from sitting or an acute injury from a fall. The idea of a donut is to keep pressure off the area to prevent nidi activation.

Soft pillows help. There are chairs with a hole designed right into the seat to take pressure off the tailbone area. Those are the very best and require no donut.

6. Zinc only helps with the healing process.

Hope this helps.


Re: Pilonidal Cyst Advice Sought for Prevention & Surgery (Good summary.) Archive.

Posted by Frank on July 30, 2001 at 18:43:17:

In Reply to: Re: Pilonidal Cyst Advice Sought for Prevention & Surgery (Good summary.) Archive. posted by Walt Stoll on July 30, 2001 at 07:51:20:

The surgeon I went to made it sound like the recovery from operation would be a picnic. He said he was riding a bike within a couple of days, and said I just would need my girlfriend to shave it every day (or, or a different girlfriend each week). It is probably just me, but, I found that a bit annoying, especially as I was wearing a wedding ring. It made me wonder about his bed manners (though, he is supposed to be a good surgeon). Anyone, he mentioned nothing about risks.

The one benefit, though, was I started reading through the archives. I may have missed it, and I apologize if I am asking an old question, but the above prompts me to ask:
Can the infection lead to an anal fissure. That was the concern expressed by my family doctor (who aggreed it would be good to get a second surgeon's opinion, particularly a rectal and colon surgeon). The concern seems to be that, without sugery, an infection could make its way to the intestines. I had an infection, but, it has not bothered me since then (it has been two months). What are your thoughts about the infection doing this?

Re: Pilonidal Cyst Advice Sought for Prevention & Surgery (Good summary.) Archive in Rectal Problems.

Posted by Walt Stoll on August 01, 2001 at 08:16:01:

In Reply to: Re: Pilonidal Cyst Advice Sought for Prevention & Surgery (Good summary.) Archive. posted by Frank on July 30, 2001 at 18:43:17:

Hi, Frank.

Your surgeon was so eager for the fee that he became just a technician. Yet he got paid as a surgeon! That is why so many docs are tempted to do the same thing--they can get away with it!

Since nidi can be anywhere in the area, it is POSSIBLE that one could be associated with a fissure. However, that is like looking for zebras in KY when one hears hoofbeats! At least 99.99% of fissures are caused by a large stool splitting the skin and can be cured by a month of assuring no large stools. See the search engine.

Since there is no way to tell, without a microscopic examination of the tissue removed at fissure surgery, it is not even ethical for a surgeon (let alone your gatekeeper physician) to suggest this before any such surgery AND adequate conservative treatment failure.

"To a hammer, everything looks like a nail!" It is the responsibility of the gatekeeper physician to do the conservative approaches and THEN, if they fail, to refer to the surgeon, etc. You can bet that a surgeon will suggest a surgical solution! It is time for you to find a better gatekeeper as well!

Hope this helps.


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