I was 26 and heavily active (running 20-40 mi / week) when I first felt acute soreness and some bleeding at the highest point of my ‘natal cleft’. It was not a major inconvenience, but it did make long drives and plane rides uncomfortable over the course of 2 or 3 months.
The first surgeon I saw confirmed that it was a non-infected pilonidal abscess, but did very little to explain treatment options, and the risks and benefits of surgery, just kind of said ‘the nurse will schedule your surgery’. I opted to seek a second opinion 3 months later after finding a ton of online resources (like this great website). Surgeon #2 did a great job letting me make the decision for myself, and after appreciating the likely inevitability of excision surgery, I decided to go ahead while it was still small and life was less busy than normal.
The procedure was almost a non-event, as I was under anesthesia for 4 hours, and woke up in minimal pain. I had little appreciation at the time for how long my mobility would be limited and how even longer and intensive the wound healing process would be. If your wound was 6″ in length and 1″ deep like mine, consider yourself bed-ridden and useless to the world for the first 2 weeks and account for regular wound packing and 2x daily dressing changes for the first 8 weeks.
The most miserable day was day 5, as the drugs fully wore off and my body likely inflamed the wound in response to the surgery. Awful, nauseating pain. My surgeon facilitated my wound packing everyday for weeks 1-2, every other day for weeks 3-6, and 2x a week for weeks 7 and 8. Drainage was a particular nuisance for me, with irregular and almost unpredictable discharges of reddish (and later yellowish) terrible-smelling liquid for the first 8 weeks.
While embarrassing to be caught buying as a guy, tampons were my savior during that whole ‘period’. I also used a coccyx cushion in the car, and used standard medical tape with 3″ x 3″ gauze for the 2x daily dressing changes. I’m nearing the end of week 8, wound closure is imminent, and I’m probably another 6-12 months from having a backside that is prone to less pain than before the symptoms first occurred.
After my diagnosis, my 67 yo dad revealed that he’s also had it for most of his life. If the surgery ends up giving me 39 years of pilonidal-free living, I can say it was worth it the misery.