I experienced my first pilonidal abscess at age 19.
Ten years have passed since then, I have had it reoccur many times, and drained twice. Both times it needed to be drained and needed wound care were the first two times, since then I’ve become a doctor of traditional Chinese medicine, and experienced in herbal medicine. I have developed a regime that treats the abscess at the first sign of tenderness in the area. It requires a few items and a couple days at home. It will usually resolve in 2-7 days.
My situation: First occurrence was so painful and I had no idea what was happening. I kept ignoring it, until one day I couldn’t even lay on my side without being in excruciating pain. The ride to the hospital I literally stood hunched over in the car. I was given morphine at the ER and they performed an incision and drainage. 2 full syringes on debris was removed from the cyst.
After recovering from that ordeal, I was abscess free for 4 years when I had a 2nd occurrence. This time I tried every online remedy and read every pilonidal blog I could find. My regiment at the time was castor oil + tea tree oil applied consistently throughout the day on a taped cotton ball with occasional baths. Unfortunately, it had to be I&D again. The wound care and packing of gauze this time was so deep and painful, this experience of going to the hospital every couple days and bracing myself in pain traumatized me.
I think it’s easy for those who have not experienced a pilonidal abscess to think of it as not a big deal or an easy procedure, but for me it was an enormous stressor. I’ve noticed that if the cyst becomes tender, usually it’s the week before my period, I’ve been drinking alcohol regularly, and the back of my tongue has a persistent thick white coat (in chinese medicine, this represents dampness in the lower part of the body).
Okay, so here is my cyst protocol: first I regularly check the area by gently applying pressure with a finger. When it’s not inflamed, there’s no tenderness. At the first time of local tenderness I start taking the herbal formula Bi Xie Sheng Shi Wan, I prefer the Plumflower line from Mayway herbs, 15 pills 3x/day. This should be differential dosed by a TCM practitioner, but if you have a thick tongue coat and do not have loose stool, this formula will probably be fine for you.
Next, I mix a tsp of Ku Shen and one tablet of Huang Lian in about 2 oz of warm water. I fold up a small square of paper towel, lie on my stomach, soak the paper towel in solution and apply to the region. I then place a layer of plastic over top, a heating pad, and a small pillow for a bit of pressure. I then watch an hour of netflix. I do this as much as possible in hour increments for 2 days. 1 hour moist herbal compresses, 1 hour off. 2x/day I’ll substitute for 1 hr soaks in the tub with 5-8cups Epsom salts.
This may seem like a lot of effort, but I find it’s totally worth it. Basically, the moist heat has two functions, it decreases inflammation, and opens the pores and increases vasodilation so herbs can be absorbed. It always feels good afterwards. I also believe the frequency helps move your body away from an inflammatory pathway by giving it the opportunity to have decreased inflammation consistently throughout the day.
In addition, I eliminate alcohol, refined food, and added sugar from my diet, and increase water consumption as well as cooked vegetables. For the past 6 years, I have a very mild re-occurrence approximately every 6-12 months, but I immediately start my herbal protocol, change my diet and it’s clear in 2-7days. Visually, the area looks normal, other than 3 sinus tracts.
Personally, I’d rather deal with the cyst the moment I notice tenderness than have an expensive, potentially deforming surgery that has an extremely long heal time.