Disclaimer: I am not a physician. I am a businessman and a mechanic. Nuts and bold do not the body make…
My advice simply details what worked for me. These tips should not be taken as absolute, nor in lieu of the direction and advice of a licensed physician. The story begins… In retrospect, I should’ve known something was up as for several years (late teens) I could feel something I could only describe as a deep itch in the upper-most area of the cleft of the buttock. I remember thinking as early as kindergarten that I was a hairy individual (hairy fingers only at that point). Anyway, by the time I reached these teen years I was significantly hairy from the waist down. I had no previous knowledge of the complications that could plague us manly men.
Shortly after returning home from my final semester of college (age 23) I noticed that this area had become sore. I reasoned that it had happened before and gone away on its own, but this time I could actually feel the abnormality by touch in the shower. I made what I believe to be a mistake by concluding that this was a subcutaneous zit (like the ones we get on our nose, shoulder, or neck or such) and attempted to force the intruder to evacuate by using my middle finger and thumb knuckle to squeeze the area with a significant amount of pressure. I felt no relief as would be associated with a successful evacuation like would be achieved with other areas of the body.
So I ignored it and accepted the fact that I had bruised my butt. Over the course of the next few days the would began to swell more significantly. It became increasingly obvious that this time would be a problem that would not subside by itself. By the fourth day or so, I couldn’t sleep, sit, or even bend over to put pants on or tie shoes. Called the doctor who correctly diagnosed the problem over the phone and said he had set up a surgical consultation for me day after next. That night I went to bed and managed to fall asleep. I awoke to the most intense pain I have ever experienced and an overpowering odor. It was plain to conclude that the void had ruptured and presented an immediate need for medical intervention.
My loving parents dressed me, gave me a cookie and some cranberry juice, and drove me to the hospital even though my appointment wasn’t until the following day. Upon arrival I realized that my exhaustion was not only from a lack of sleep for several days, but also because I had become septic. I was running a fever of 103 degrees. Part-way through filling out the form I had been handed on a clipboard I recall answering the question: “How often do you exercise?” to which I responded “When necessary.” At that moment I handed the clipboard to my mother, seated to the right, and lost consciousness. I came-to in just a few seconds at which point nurses and hospital staff were mid-heave in pulling me from the chair and onto the floor on my hands and knees to make it easier for my blood to flow to the brain. I tried to crack a joke but nobody seemed to realize I was just trying to be a smartass and lighten my own spirits.
We proceeded to an outpatient surgical room and waited only minutes for the surgeon. When she arrived she asked some questions regarding the history of the issue, my lifestyle, and whether I had eaten that day. When I mentioned that I had a cookie and some juice she recommended that I go home, don’t eat, and come back the next day so that they could administer anesthesia safely. My response seemed to surprise her: “I hate forfeiting control and I don’t want to be put under anyway.” She responded, “well in that case we can administer localized anesthetic and irrigate the wound right now if you don’t think you can make it until tomorrow.” I took this as another opportunity to make a cheap joke and said, “you’ve gotta cut me, coach.”
Again, the humor was lost on the staff that was very obviously oblivious to movie references. Anyway, up on the table I went (face down with no restraints). She prodded the area to gauge how close she could get before the pain was intolerable. Once established, she applied iodine and began to inject the anesthetic with a needle in a circumference around the target area. This was absolutely excruciating. We waited a few minutes to let the anesthesia to take effect. She initiated another round of prodding to see how successful the injections were. I reported a stimulation response of a low scale even when she touched the epicenter. Time to proceed. The finger prod was no biggie, but the first incision seemed to erase the effects of the anesthesia entirely. I remember cursing and tensing my entire body and remarking that this was the most physically painful moment of my entire life. I was wrong. Once the wound was open it was time to irrigate with a sterile saline solution and a syringe. The infection inside filled the entire room with its odor, which was embarrassing. It was easy enough to ignore the scent when the pain was consuming all focus.
With each blast of solution I couldn’t force myself to breathe, talk, or even blink. For the first time in several years I cried from the pain. In high school I broke my back in a snowboarding accident and this blew that out of the water of Pain Lake. Last but not least, the surgeon had to pack the wound with a considerably long strand of surgical dressing. This is approximately 0.5 inches wide and a fabric-like woven mesh. This was also incredibly painful. Makes a body feel like he’s about to head down the road, get strung up a tree, and whacked by blindfolded children with sticks (like a pinata, if you’re not digging the cheap humor like the hospital staff).
The entire procedure lasted about 45 minutes. Exhausted, the surgeon and an assistant cleaned me up and put me in an adult diaper so that the fabric fibers of a pair of boxer shorts wouldn’t enter the wound. It was at this point that I realized that the pain was gone, though in large part thanks to the anesthesia. After getting dressed I laid in the back seat of the car on my side and slept the 20 minute ride home. Recovery: The surgeon instructed that the packing needed to be changed very frequently, I think it was daily. This was accomplished after showers and, given the location of the wound, required assistance.
For those of you that don’t have someone to help at home you would likely have to head back to the hospital to have a nurse do it. I was so fortunate to have the care of my parents through this terrible time. They would sterilize their hands and irrigate the wound before packing it with more of that odd material. Though mom is an avid knitter, it was my dad that used a small knitting needle to push the packing up into the wound. I would have to instruct him when to start and stop based on my pain level and also guide his direction of packing because you can actually feel where there is and where there isn’t packing yet and the entire void needs to be filled. I was told the wound needed to heal from the bottom up and that sealing it with stitches or glue would promote another opportunity for a cyst to form an infection.
The promised recovery time was 4-6 weeks. It took over 4 months before we couldn’t fit any packing in the wound. This was a very disappointing thing. Long-term prognosis: At the time of writing this about four years has passed. There were a few instances where the wound would get sore and infected again. It is imperative that you have your doctor prescribe you antibiotics to battle the infection before it can infect too much tissue. My doctor prescribed Cephalexin and Metronidozol (spelling?). I had to have him do this two or three times over these four years. He arranged for another surgical consult to provide me with options.
The surgeon (different person, a younger man this time) said that the only way to eliminate the occurrence entirely was to actually cut the entire area out of me; to literally remove the tissue almost all the way down to the tailbone and let it heal from the bottom-up again. Knowing how long the whole “from the bottom-up” process takes I told him no thank you. Even over the past few months the thing would occasionally get a little itchy. One of the most notable things that has happened is that somewhere over the course of time my body has formed fistulas (one or two) from the depth of the wound to the surface to drain any fluid automatically. Though, it does help to gently assist this draining with strategic pressure from certain directions. Just make sure your hands are clean and you check yourself throughout the day for any lint buildup. This is usually felt in the form of a more sharp itch, like little stabbing feelings in the area.
I keep the area clear of hair by epilation or hair removal products. I kept a box of alcohol swabs in my toolbox at work to disinfect the area about three or four times during the day. DO NOT shave the area. This creates tiny cuts on the epidermis and forces existing bacteria into the squamous. It’s a risk you don’t need to take no matter how tempting.
Epilogue: I’d like to tell you that the recovery is timely and that surgery fixes the problem for good. Unfortunately, I can’t report that the problems are entirely gone. However, I can tell you that the flare-ups are getting less frequent as is the amount of periodic discharge when it does happen.
Suggestions: Address the issue before it becomes an all-out infected mess like mine was. If you can, time your bowel movements such that you can shower immediately afterwards to prevent the possibility of fecal matter being introduced to the wound. This is important even if you haven’t had the surgery yet! Each time you use the bathroom during the day, take the opportunity to check for and remove lint from the area which can soak up sweat and bacteria and just hold it to your skin and work its way in deeper. Also use bathroom breaks to disinfect the surface over the problem with alcohol swabs. Do not be afraid to share the existence of the issue with your employer if you feel they need to understand what you’re trying to manage. Mine were very understanding and supportive.
Lastly, from the most macro-perspective: be proactive. Don’t put off a shower or a cleaning. Don’t put off calling your doctor for antibiotics or a visit. I would wish this ailment on so very few people and even then I’m not sure I’d really mean it. I hope you’re reading this early enough to avoid some of the experiences I’ve had. Please know that you aren’t a problem creature that has some rare and embarrassing injury. There are so many others that have the same trouble and I know I speak for us all when I say that we truly wish you the best in managing and recovering from this stupid problem.
Be well!