Infected Cyst pain relief?

My Pilonidal Cyst which I have had for a week has just ruptured and I have some questions and concerns. It is a bit long but I am just going to start from the beginning with everything that I have done the past week.

I felt a small lump at the top of my cleft a few days before the pain started and ironically the only reason I even checked the area was because my boyfriend complained of a lump himself and I also had a few years ago found a small lump the size of a pea not at all visible but felt during a sit up. So I didn't think much of it as I figured it was just something I have always had under the skin there.

At some point on Saturday(Mar 16) I started to notice pain and began doing hot compresses to the area hoping to help it along. I can’t remember size or anything about what it looked like at this point. By Monday it was the size of a quarter and was red, swollen and obviously infected. I did a small internet search and came up with pilonidal cyst but stopped reading as soon as I saw lancing and surgery. The pain was so bad I went to the clinic Monday and the doctor confirmed pilonidal and prescribed antibiotics (cephalexin) and said fingers crossed this works because the surgery is not pleasant. He also said to go to ER and get it lanced if it gets any worse.

So I go home and find this website and basically the surgery he described was excision. I live in Canada, Alberta to be specific and have no intention of having an excision ever. So I am going to have to look into getting something done privately if I need surgery. I also became very concerned about the lancing after reading horror stories on this site. The recovery time and seemingly botched jobs really concerned me and also the fact that mine felt so swollen and infected I was worried that the local freezing would have no effect.

The night of the doctor visit I also started to have chills, muscle aches, headaches and a hot feeling on my face. I never did take a temperature but I suppose I had a bit of a fever from the infection. On Tuesday I make an appointment with my family doctor so I can talk about this with someone but he is on holidays so unfortunately it is with a stranger and over a week away.

Wednesday the cyst has continued to grow and I call the doctor again and get an early appointment for Thursday now and hope to be able to get a lancing there instead of the ER. I find out she won’t do it but decide to go there first and expect to probably get sent to ER after my appointment. Wednesday I decide to try going to work. I don’t sit at all at work I am at a bookstore so on my feet walking and occasionally light loads to carry. I take Advil and feel great for 4 hours can feel the pressure of the cyst but the pain and all my fever symptoms are gone. Then with 3 1/2 hours left the Advil wears off and I feel like crap and shuffle along for the rest of the shift.

That night was very bad usually I don’t feel much pain lying on my stomach and that is how I sleep normally but the pain kept me from sleeping. So work not such a good idea certainly aggravated it badly. Thursday I am feeling ready for a lancing to make the pain go away. The cyst is about 1.5” long and a little less wide and very swollen but still does feel firm. I have been doing 3 hot compresses a day followed by a warm Epsom bath because frankly although the hot compress feels fine while I am doing it I often find it leaves the area feeling angry and unbearably painful (there is not a position that I can lay or stand in) for the next 1 or 2 hours without horrible pain. The bath helps relieve this so I am going to stick to baths only at this point.

Thursday is the first day I have really been able and needed to do nothing but lay on my stomach and do the bath soaks. I head to the doctor and she thinks it has been long enough that the antibiotic I was prescribed should have taken effect by now. She definitely considered prescribing a second but didn’t. Not sure how I feel about that. I don’t like taking drugs in general especially antibiotics if they aren’t going to do anything and I have never taken 2 at once. Does anyone have any experience with this? Then she tells me the cyst still feels firm and is not ready to be lanced. At this point I am disappointed I want some of the pain relieved. So I now have an appointment for Monday.

I go home and in the evening after my bath my cyst has ruptured. I am so happy I really thought it would never happen and that lancing was going be the only way. So I decide to do a warm wash cloth with a compress since now that it can leak I figure I won’t get the pain like I did before. Leave it on for 15min and look at the wash cloth and there is nothing on it. Check it out and realize it really hadn’t ruptured yet but it is desperately trying just a tiny layer of skin in the way. So back in the bath and this time it does actually rupture. I let it drain as much as I can then go to bed. At 2 am the pain is not letting me sleep so back in the bath and more fluid comes out. The fluid is yellowish in color with some blood in it. It does not smell at all. Not really what I was expecting. Anyone know what this means with regard to infection etc.? I am a bit disappointed I thought I would have more pain relief once it ruptured.

It is Saturday right now and last night I again woke up in the middle of the night in horrible pain and had a bath to get more drained out. I am doing 3 bath soaks a day and use warm wash cloth compresses also to keep it draining. Any idea why it gets so painful in the middle of the night. My only theory is during the day with my moving around a little the draining is fairly constant but at night while I sleep it stops and the pressure builds up again. I shouldn’t say stops because there is discharge on the gauze when I wake up. Any ideas? I am very disappointed it ruptured a day and a half ago and not much in the way of pain reduction. I got the impression that some people had much relief.

At least with it draining I feel I will be ok to wait till my appointment Monday. Any ideas what draining will mean with regards to beating the infection? Or where I will go from here if the draining has no effect on the infection? The hole is so small I worry not enough is coming out.

Oh and about 12 hours after it ruptured all my fever like symptoms have gone away so far.

So it has now been one week since this started any suggestions or advice is very much needed please.


New Member
Please go to have it lanced, cleaned, and pursue professional advice. I ignored my cyst too at first, but it finally ruptured and I went straight to the ER. They apply local anesthesia, cut it open, squeeze everything out, CLEAN IT with antibiotic wash, and pack it with sterile gauze. It's not completely painless but it's worlds better than walking around with a swolen cyst. Each lancing procedure seems to give me 1-3 months of pain-free life before I have to do it again.

I'm currently discussing surgical options with my drs. Not looking forward to the surgery...

Good luck. Go get it looked at by a surgeon or ER specialist. You really don't want an infection.
Please go to have it lanced, cleaned, and pursue professional advice. I ignored my cyst too at first, but it finally ruptured and I went straight to the ER. They apply local anesthesia, cut it open, squeeze everything out, CLEAN IT with antibiotic wash, and pack it with sterile gauze. It's not completely painless but it's worlds better than walking around with a swolen cyst. Each lancing procedure seems to give me 1-3 months of pain-free life before I have to do it again.

I'm currently discussing surgical options with my drs. Not looking forward to the surgery...

Good luck. Go get it looked at by a surgeon or ER specialist. You really don't want an infection.
I haven't been ignoring it I have pursued professional advice twice now within 1 week and both times they said it was not ready to be lanced.
To do a culture to find out what antibiotic will work best I assume the wound needs to be open. I am thinking of going to the walk in clinic to get a culture done today because I am worried it might not be draining still when I have my appointment tomorrow afternoon and therefore might not be able to do a culture? Not sure if that is how that works or not.


New Member
I've not heard of a cyst too fibrous to be lanced. If it hurts, there should be something a doctor can do about it. Keep us updated on your progress!
I've not heard of a cyst too fibrous to be lanced. If it hurts, there should be something a doctor can do about it. Keep us updated on your progress!
Apparently they like them to feel fluid and close to the surface and mine felt firm still so they thought not much fluid and therefor not ready yet. I wasn't surprised when they said this so I think I have seen a few people on the forum mention it before as being told that as well.

I was glad when it ruptured but I feel like it bursting on its own has not been progress I thought it would be. Hopefully tomorrow I will get a decision about whether they will now lance it to at least get the infection out or whether it draining on its own plus a antibiotic chosen after a culture will clear it up for the time being. At least those are my best guesses as to what might happen next.
So back from my third doctor visit. The doctor helped some pus out of the wound and seemed happy that the infection is on its way out. She said the fluid coming out of the wound looks good and just to keep helping it along. She did send a culture to the lab to be sure we are using the right antibiotic and I will be getting more antibiotic as my 10 days is almost up and we will keep treating it until all signs of infection are gone.

I am still paranoid because of the pain. The doctor didn't really say anything about it. For me I am worried that it is from the infection. But the fluid coming from the wound, the fact that all my fever like symptoms have been gone since Friday and it is now Monday and that apart from the center looking red and angry the edges of the cyst do look like they have calmed down all point to the fact that the infection is getting better. So maybe I am just being paranoid but the pain makes me worry it is going deeper or something.
I went to the ER today and had my pilonidal lanced. I was very scared of the pain as the surgeon kept saying that the local might not do much and it will likely be extremely painful. That scared me even more and I went in expecting the local freezing to have no effect and so was pretty much crying as he started injecting the local. Much to my surprise the local worked he just had to give a little more once he got deeper and started flushing but I was so relieved. I had gotten all worked up for nothing it turned out. I think some doctors are better at this than others. I remember having a few simple moles removed when I was 12 "just in case" and the freezing was horrible I felt like I could feel the needle moving back and forth under the skin over and over again. Yet this doctor freezing my swollen inflamed abscess felt really gentle in comparison.

Such a weird feeling when all the fluid comes gushing out and it feels cold on your skin because of the freezing. He said there was no hair inside. Also he did an ultrasound before he started to see how deep of an abscess I had. This also showed that the abscess was only under the swollen area and hadn't branched out anywhere. So that relieves me.

My instructions are to leave it packed for 48 hours and then take it out. I have seen this before on this site so I am happy about that. I was very much not wanting the constant repacking for weeks that some people get.
Just wanted to update so others can compare experiences as well to keep track for myself.

I decided to go to urgent care to have the packing removed after the lancing because I didn't feel comfortable pulling it out myself as per doctors instructions. Glad I did because the doctor I saw wanted to pack it again. Another 48 hours and I go in and they pack it again but this time the doctor says it is such a small amount of gauze I can pull it out myself in 48 hours.

I actually found the first 36 hours after the lancing to be about the same pain level as the abscess at its worst but from then on had lots of relief. Packing changes had some pain but not bad.

It has now been a full month since the start of the flair up and about 3 weeks since I had it lanced it does appear to have closed over and I can now see my sinus(es). My cycle is about to begin and this did coincide with that so I am a little nervous about it. I do feel a little pinching today in the area when moving around but I am going to attribute that it is from the healing of the tissue and try not to get nervous.

I just wanted to know what all people have done to attempt to prevent flair ups? I do have a coccyx cushion which I use for car rides now and I tend to not sit much at all just in case (not because I am in any pain). If I was going to sit for more than an hour I would probably take my cushion. Not sure if that is overkill or just good prevention. Also despite the fact it has healed over I put a band aid on to shower and then only take it off at the end to wash the area.
I'm so glad you mentioned that the cysts come around during your menstruation cycle. I have found that to be true for me as well. Yet when I mention that to physicians they disregard that this may have anything to do with it or that it could even be a hormonal issue. I mean we break out when we are are on our periods so why not cysts?
My story: I have suffered from this disease (yes, I said disease!) since I was 18. I am 38 now. I have had surgeries, lances, antibiotic name it, and this crap just won't leave my life. I even had laser hair removal but it still reoccurs to cause me unnecessary pain and stress. I won't succumb to the knife anymore. The last lancing and packing has left my cleft slightly scarred to where the doctor recommended me to a plastic reconstructive surgeon.
My first surgical experience gave me the best hope that it was gone for good since I didn't have a breakout for over a year but I believe the sinus just shifted slightly further down my cleft. It's like it's mocking me. But I just can't be out of work for a month anymore to allow for healing time.
I just stick to antibiotics now and they generally work. I'm on Cephadroxil which I take as soon as I feel pain. Usually when I take them, the cyst goes away after 2-3 days. I usually will feel it harden under the skin, then itch, til it finally disappears.
However, a little over a week ago I had a flareup and only 2 pills left. I called my PCP Tuesday morning (pain was unbearable at day 9) to provide me a refill on the antibiotics, but she requested I come in first. I mean, come on! I wasn't asking for codeine or any other type of painkillers, plus she knew my history since she prescribed them to me upon my request from my last incident. Doctors are always trying to cull money at any opportunity from patients' health insurance. Needless to say, I was upset because I didn't have the time to leave work for an unnecessary visit. So I stubbornly refused and decided to wait for the dreaded eruption to occur after hot soaks.
Early this morning, it happened. Blood and clots drained out but barely any pus. I cleaned the open wounds and added the use of baby wipes for good measure to keep it moist and speed healing. Tonight, no pain but the wounds are itching like crazy. I scratch around the wound for relief and it helps without causing further damage to the healing process. I may have to go to the doctor for the Cephadroxil though because I don't want to go through another week and a half of torture and restless nights. I wish a doctor would take my theory about this being a hormonal issue into account. It just might fix this problem. It makes me wonder if there is a correlation with female pilonidal victims having a decrease in flareups after starting on birth control. It's something I need to look into...cuz this is starting to wear on me.
I've been dealing with this disease for 10 years now. I'd say mine is the size of a marble at the top cleft area, but not sure how deep it is. Two years ago i was scheduled to do surgery but my doctor had to reschedule me due to a more serious patient coming ahead of me. Due to other life events I couldn't have it done at that time so I put it off. It would leak from time to time, but then heal by itself. The last 10 months it's been dormant, no pain, no drainage, and it gave me be a false sense of freedom...up until two days ago. It's ruptured so bad in a way it has never happened before; pain and lots of drainage. I went to an urgent care clinic but they wouldn't prescribe me antibiotics and suggested I take sitz baths and go to the ER to get it lanced for more relief. Although i've been reading horror stories, I feel getting it excised is the only way out. I'm so scared.