Immediate Treatments for Those In Pain
This page is designed to be a fast resource for those patients who are suffering right now and need HELP.
If you are experiencing a flare-up there are two courses of action depending on the severity.
You Are in Manageable Pain
In some mild cases you can knock back the infection with antibiotics. Antibiotics WILL NOT, WILL NOT, WILL NOT make the disease go away, they will temporarily kill the infection and provide relief. But not always; sometimes even antibiotics fail if the swelling of the tissue around the abscess is so bad that the blood supply to the area has been severely limited and the drug can’t reach the infection. The recommend treatment for abscesses is still lancing in order to removed the gunk inside the abscess, but you can buy yourself a little time with antibiotics.
The type of antibiotic you are given will depend on the preferences of your doctor, some of the usual choices are Keflex, Augmentin, Cephalexin (generic of Keflex). There are hundreds of different types of antibiotics and many are very specialized in terms of which bugs they kill, so you may need to try a few different ones until the right drug for the right bug comes into target. Some doctors are a little gung-ho with the antibiotics and will prescribe a heavy duty broad-spectrum antibiotic such as Cipro or Levaquin; these are VERY expensive antibiotics and have been tied to nasty, permanent side effects.
If you have any concerns about your antibiotic prescription, have a long talk with the pharmacist even though you are in pain and desperate to make it stop. Keep in mind that over use of antibiotics puts you at risk for developing resistance and you should not attempt to manage Pilonidal Disease with antibiotics more than twice a year.
There are strains of bacteria emerging (MRSA Methicillin-resistant Staphylococcus aureus) that are resistant to almost all known antibiotics, these strains are being created by over-use of antibiotics and not finishing your prescription. Over-use of antibiotics has also been linked to Breast Cancer. ALWAYS FINISH OUT AN ANTIBIOTIC PRESCRIPTION FULLY.
You Are in Extreme Pain
Lancing (incision and drainage) is the normal treatment for abscesses because the pus and debris inside the abscess needs to be drained in order for it to heal. LANCING DOES NOT REMOVE TISSUE. Lancing involves slicing open the top of the abscess and suctioning out the hair, pus, and debris inside the abscess. The lancing wound is then packed and allowed to heal from the bottom up (not stitching it closed). This is done under a local anesthesia at the doctors office or the ER. This works for a certain percentage of people suffering from the disease (15% or so) and no further treatment is necessary. Most people will need further treatment since the cause of the abscess has not been addressed and we strongly encourage you to have the “Pits” picked 10 days after the lancing when they are more visible. Removing the Pits shortly after the lancing improves your odds of not needing further treatment to 85%.
Most Colon & Rectal surgeons will make special emergency appointments to see patient who’s in excruciating pain, just ask the receptionist when you call. Any doctor’s office that is not sympathetic to the amount of pain you are in is a doctor to avoid. Lancings usually heal within 4 weeks and should be packed as described in the Aftercare section.
Curettage is also important in lancings. Curettage to remove dead or infected tissue in the wound improves the rate of healing, with 90% completely healed at one month, compared to just 58% healed at 10 weeks without curettage.
In some cases you may be told that the abscess “isn’t ready yet” because it hasn’t come close enough to the surface. What this really means is that the center hasn’t become liquid enough for the knife to cut effectively. You may be sent home with antibiotics and told to wait a few days. What you need to do is use hot compresses to help things along. This can be done with a heating pad or a washcloth soaked in hot water. Hot baths alone aren’t really as effective.
Any lancing should be done with a local anesthesia, some people have reported on the forums that they weren’t given any local to numb the pain — this is barbaric. Any doctor who would do that to a patient is a sadist. What does sometimes happen is that the area is so swollen that the local anesthesia is ineffective, but this is rare.
The emergency room should be your choice of last resort. Doctors working there frequently aren’t completely knowledgeable about treating Pilonidal abscesses and the conditions there are not always the most hygienic. Only go to emergency if you absolutely cannot get a C/R Surgeon to give you an emergency appointment. For those without insurance, many doctors will give a special “cash price” for those paying with check or credit card, just ask when you call.
Once you’ve dealt with the immediate problem and are out of pain, you are going to have to make some decisions about the future.
While it is possible that a lancing might be the only treatment you ever need (if you can have the pits excised shortly afterward those odds go up), you are likely not done with Pilonidal infections. Pilonidal abscesses rarely go away on their own as long as the pit remains that allows bacteria to continue to enter under the skin; how you proceed from here depends on how active your abscess is and your attitude towards medical intervention.
Some of you will want to avoid any possibility of further problems and head right to more extensive surgical options. Some of you will wait and see how your body heals and if further treatment is indeed going to be necessary. The right answer is the one that you feel comfortable with, knowing all your options.
What may happen after a lancing is that future flare ups will “pop” through the lancing scar and drain. This happens because the scar tissue is weak enough to give way when the abscess begins to fill with fluid again. Everyone’s Pilonidal is different and we can’t tell you for certain exactly what yours will do, it’s up to you to work with your doctor and monitor the need for further treatment.
The main overview page for our Treatments section where you can review surgery options, plan for surgery day.
Choosing a Plan
What is the right plan for YOU? It depends on how active your abscess is and how fast you want to proceed with treatment.
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This page last updated: January 27, 2016