New: Pilonidal Cyst, Drainage, and Treatments


I was diagnosed with a pilonidal cyst 5+ years ago when I was in high school (I'm currently 22, male, in good shape, and in college in Rochester, NY). At that time, all I had was a small, non painful nodule. I was referred to a surgeon who recommended an open excision. However, my family and I decided to wait until a convenient time to do the surgery. Since the cyst wasn't causing me any problems, we kept on pushing surgery back.

About a year and a half ago, my cyst got slightly swollen and tender. It ended up returning to its previous state on its own in short order.

This past December, the cyst got swollen, and very painful to the point where it was difficult to sit. This lasted about two weeks. I ended up getting a coccyx cushion, taking tylenol for the pain and inflammation, and taking hot baths. The nurse practitioner I saw recommended getting antibiotics and perhaps lanced if it didn't improve (it improved shortly after I saw her). At this point I was experiencing mild drainage (I didn't know about it until the nurse told me about it).

A few months ago, my lymph nodes in my groin swelled and were tender, which the nurse practitioner attributed to the cyst. They went down in short order.

About a month ago, I started experiencing more drainage than usual from my cyst, in the form of crusty, dark matter with some blood in it. Sometimes it would just be clear fluid though. Hairs would come out with the drainage too sometimes.

I saw the head of the colorectal surgery department for our University hospital about 2 weeks ago. He explained the history of the disease, clarified that while it was more prevalent in hairier individuals others could have it as well, and tended to be self-limiting in older people (mostly affected younger people). He said that the various surgeries had decent rates of recurrence (20 - 50%), so for the time being, he'd rather keep me out of the hospital/surgery, especially as I'd been living with it relatively problem free for so many years. He recommended something the army did during WWII, the Buddy Technique, where I, with the help of someone, keep the area free of hair (he recommended wax or nair but not shaving due to the risk of infection from nicks) and keep the area clean of any drainage.

I naired the area, without too much problem, though the cyst bled through the drainage hole a bit for a few days after. If I nair again, I need to figure out how to keep it away from where the cyst drains. The bleeding stopped though. This was about a week and a half ago. However, a few days ago, I started getting increased discharge and more bleeding (not a large flow, but I've noticed a decent amount of staining on my undergarments, so I've started attaching liners there). Sometimes hair will come out as well. This has remained consistent these past few days, and it seems that most of the time the drainage site is damp with a mixture of clear fluid and some blood, though usually its not too much blood. I did see what looked like some pus last night (light brown and thickish) I'm thinking that if it doesn't clear up, I should speak to the surgeon again.

Has anyone experienced drainage like this before? Right now, the site is raised and cratered like a volcano, The center is red and moist looking and about the size of O. Is this normal/heard of for pilonidal cysts? Also, if I continue nairing, what's the best way to avoid it from getting into the drainage area? It's somewhat difficult to see myself around there. I also welcome any other thoughts/comments/questions/suggestions :)

I've been fine with having the cyst before, aside from the couple times it flared up and was painful, but I don't like the fact it's so visible due to all the draining and draining of blood right now. As a single gay man, I feel embarrassed about it and how to tell potential dates.

Pics of the area with the drainage spot:

The excision surgeries have reoccurrence rates of 5% for cleft lift and open excision to maybe 20% for closed excision. You might be a candidate for pit picking, which has a reoccurrence rate of around 15%.

Honestly I'd go to a qualified general or colorectal surgeon and see if he does pit picking/cleft lift. The cleft lift is the miracle surgery advocated here, but finding a surgeon outside of a major city is rare. However, the procedure does reshape your butt a bit by flattening, and I don't know how'd you feel about it as a single gay man, but it is considered the best surgery.

Good luck!


Very Helpful
I'm gay and I am delighted with my cleft lift. It's worth it. You can't tell I had surgery until I part my cleft and you can see it is shallower.

The surgeon is talking crap. Hair around the site is not the problem. Nair will do nothing but inflame your wound. My advice is stop using it and just clean the area with hibicleans. If you want to keep it free of hair, use a little electric trimmer. Your drainage is not abnormal, but do yourself a favour and find a surgeon that knows what they are talking about and can offer a surgery that isn't from wartime. There is hope, trust me. I found it.
I live in syracuse ny and we have s good group of surgeons here. U should try margaret plocek she did my friend and is doing mine. Cny colorectal associates 315 458 2211. I dunno if u wanna come all the way down here. If it's draining u have sinuses like me and it needs to come out. It will only get worse!
Oh wait just ur cyst is open.sorry didn't see the pics first. Id def go to a more qualified physician or even the er so they can lance it. That might be all u need for awhile

Just thought I'd give an update. I got a referral to a second surgeon, who I met with today. He thought my cyst was somewhat solid, so that lancing wouldn't do much. He recommended a closed excision, but said I could think about it. I asked if he had heard about the pit picking procedures or the cleft lip procedures, and he hadn't. He felt that the cleft lip sounded like a cosmetic procedure, and probably wasn't needed in my case since my cyst is small and defined and he sounded confused as to what I was describing about pit picking.

Honestly, I'd prefer to avoid the larger scale excision surgeries due to the healing time from the deep tissue removal (especially since my primary mode of transportation is via bike).

Do you have any suggestions on locating a surgeon who is somewhat familiar with preferably both pit picking and the cleft lip procedures? I know that the database on here has a listing, but the only somewhat local surgeon who is listed for the cleft lip is still kind of far for me to travel (I'm in Rochester). I'd like to find a way to get rid of this constant on and off drainage from my rear end :)


P.S. Apparently I just have one sinus leading to the PC