Immediate Treatments: The Pills & Knives Page

This page is designed to be a fast resource for those patients who are sitting (or maybe standing because they can't sit) right now and need HELP.

If you are experiencing a flare-up there are two courses of action depending on the severity:

You are in "manageable" pain. The first choice is usually to try and knock back the infection with antibiotics. Antibiotics WILL NOT, WILL NOT, WILL NOT make the disease go away, they will temporarily kill the infection and provide relief. But not always; sometimes even antibiotics fail if the swelling of the tissue around the abscess is so bad that the blood supply has been severely limited to the area and the drug can't reach the infection.
The type of antibiotic you are given will depend on the preferences of your doctor, some of the usual choices are Keflex, Augmentin, Cephalexin (generic of Keflex). There are hundreds of different types of antibiotics and many are very specialized in terms of which bugs they kill, so you may need to try a few different ones until the right drug for the right bug comes into target. Some doctors are a little gung-ho with the antibiotics and will prescribe a heavy duty broad-spectrum antibiotic such as Cipro; this is a VERY expensive antibiotic and is now available as a much cheaper generic so be sure to ask for the generic.

Keep in mind that over use of antibiotics is a dangerous game and you should not attempt to manage Pilonidal Disease with antibiotics more than twice a year. There are strains of bacteria emerging (MRSA Methicillin-resistant Staphylococcus aureus) that are resistant to almost all known antibiotics, these strains are being created by over-use of antibiotics and not finishing your prescription. Over-use of antibiotics has also been linked to Breast Cancer. ALWAYS FINISH OUT AN ANTIBIOTIC PRESCRIPTION FULLY.
You are in extreme pain. The recommended treatment is to lance the abscess. LANCING DOES NOT REMOVE THE ABSCESS. Lancing involves slicing open the top of the abscess and cleaning out the hair, pus, and debris inside the abscess. The lancing wound is then packed and allowed to heal from the bottom up (not stitching it closed). This is done under a local anesthesia at the doctors office or the ER. This works for a certain percentage of people suffering from the disease and no further treatment is necessary (especially if the pits are removed at the same time or shortly afterward.). If at all possible, get your lancing done at a reputable doctors office instead of an ER. Most Colon & Rectal surgeons will make special emergency appointments to see patient who's in excruciating pain, just ask the receptionist when you call. Any doctor office that is not sympathetic to the amount of pain you are in is a doctor to avoid.
Lancings usually heal within 4 weeks and should be packed as described in the Aftercare section. Curettage is also important in lancings. Curettage to remove dead or infected tissue in the wound improves the rate of healing, with 90% completely healed at one month, compared to just 58% healed at 10 weeks without curettage.

In some cases you may be told that the abscess "isn't ready yet" because it hasn't come close enough to the surface. What this really means is that the center hasn't become liquid enough for the knife to cut effectively. You may be sent home with antibiotics and told to wait a few days. What you need to do is use hot compresses to help things along. This can be done with a heating pad or a washcloth soaked in hot water. Hot baths aren't really as effective.

Any lancing should be done with a local anesthesia, some people have reported on the forums that they weren't given any local to numb the pain -- this is BARBARIC. Any doctor who would do that to a patient is a sadist. What does sometimes happen is that the area is so swollen that the local anesthesia is ineffective.

The ER should be your last resort for a lancing. Doctors working there frequently aren't completely knowledgeable about treating Pilonidal Cysts and the conditions there are not always the most hygienic. Only go to an ER if you absolutely cannot get a C/R Surgeon to give you an emergency appointment.

For those without insurance, many doctors will give a special "cash price" for those paying with check or credit card, just ask when you call.

Decisions

Once you've dealt with the immediate problem, you are going to have to make some decisions about the future. Pilonidal abscesses rarely go away on their own and how you proceed from here depends on how active your abscess is and your attitude towards medical intervention.

Most people who have had a full-on screaming-in-pain flare up are likely to have another, although maybe not as painful. What may happen after a lancing is that future flare ups will "pop" through the lancing scar and drain. This happens because the scar tissue is weak enough to give way when the abscess begins to fill with fluid again. Everyone's Pilonidal is different and will behave in a its own unique fashion, depending on immune system, location of the abscess, how deep it is, whether it can drain or not, etc...

This page last updated: 11/03/2010

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