First time pilonidal

#1
Hi all,

I'm a 29 year old male who first experienced inflammation in my tailbone area around 3 weeks ago. It grew to become very painful and that's when I noticed a lump down there. It eventually burst on it's own and there was some discharge via a pencil tip sized hole. I went to see the doc the next day and she prescribed me some antibiotics and polysporin.

During the course of the next two weeks I had some intermittent pain along with some more discharge but at the end of two weeks (4 days ago) I was checking out the area and I pressed around it to find a bunch of pus come out. I went to see the doc again (a different one) and she said that anit-biotics are mostly useless and told me to take hot water baths to draw out the infection.

So I've been doing that and applying a hot compress on it and I press on the area to find some more discharge everytime. The discharge is very very minimal (say 5 drops worth) and I was wondering if I should be pressing on it or just leave it alone. It's been a while now and I've read that discharge is usually for 1-2 weeks but I'd like it to be over soon :(

Any advice?
 
#2
The hot baths will definitely help to draw out the discharge. When I had mine lanced, I had to go to the Dr. every other day for packing, and every time, she would press all over and around it to try and get more to come out. So I don't think that pressing on it is a problem. The more that you can get out the better, because if it stays in there, it will build back up again. That's the reason to have it lanced, to try and get all of the infection out. Packing it once it is lanced also helps it to drain and then heal from the bottom up. I would say just keep an eye on it. If that hole stays open, it's possible that it could continue to drain constantly.
 
#3
Hey!

So I have a quick update, I actually ended up going to a general surgeon for a consult. He said that I shouldn't be pressing it to force the liquid to come out. He said that he saw atleast one other pit and that he would do a closed excision surgery :(

I asked him about a non-invasive procedure like simple pit picking or just making an off midline incision and cleaning out the sinus tract but he said that it looks simple but it's quite similar to excising the abcess sac anyways so he would rather just do that.

So now I need to decide whether I get this done or not. I'm scared :(
 
#4
Hmmm...my only recommendation would be to maybe go see a colo-rectal doctor as they tend to have more experience with this. I know that the closed excision has a higher reoccurance rate...but people also have had bad experiences with the open excision and that's what I had with no problems at all. So it's up to you completely, but it never hurts to have a second opinion. Good luck to you and keep us updated on what you decide!
 
#5
Get a second opinion from a doc that does cleft lifts. Chances are this doc hasn't learned it so doesn't know any better! (It doesn't matter if he's a colo-rectal surgeon or whatever.. just that he has experience with cleft lifts!)
 
#6
Don't just do what he would rather do. You will be on a longer road to recovery.

Get the cleft lift with a Hall of Fame surgeon on this site. You story sounds like mine 18 years ago.

After 18 years of draining and pain and 2 weeks for surgery healing - I have had no issues for 2 years after the procedure.
 
#7
Hello all!

Thanks for all the support - so I have another update - as it turns out my parents are in India and I had flown out here on Sunday to visit them for a couple of weeks. I figured that it would be worth getting a private surgeon to have a look at it and get an opinion since traversing the healthcare system is a royal pain back home in Canada.

Anyways, there's an ancient herbal form of medicine that is practised here in India called Ayurveda and they have a solution to pilonidal sinus called "kshar sutra". A couple of folks from India have posted on these forums regarding this treatment and I did some research and there's a doc here who does this. I went to see him today and he was very knowledgable about the pilondal sinus and he explained the treatment to me in detail : basically what he does is inserts a probe from one of my pits (I only have a couple very close together) all along the sinus tract and he pushes the probe out on one end and inserts a medicated thread into the sinus tract. This medicated thread is left in there for 7 days during which it basically burns out all the tissue and cuts the skin on top so that the entire tract is exposed. Once exposed, a bunch more medicine is put in there along with daily dressing changes for around a couple of weeks until the new tissue is formed from the ground up. The difference between this and the wide open excision is that while the surgical excision is rather invasive and removes all of the sinus tract, this remedy simply burns out the infected tissue very slowly so that the tract is unroofed along with promoting healing at the same time. Anyways here's a case study if you'd like to see some pics: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924975/

Ok so the main advantages of this technique are that it is non-invasive, only require local anesthesia for the initial operation to insert the thread and it has pretty much 0 downtime. You can go about your daily activities without any problems - maybe rest the first day. Another crucial advantage is that the recurrence rate with this procedure is 2-4% only. The only catch is that I'll have to go in every day for the next 2 weeks to get my dressings changed and for him to inspect the wound to make sure that it is healing ok and that there are no hairs getting in there.

So long story short I have decided to go ahead with this procedure - it's not too expensive - costs 30,000 INR which is around $600 CDN ($600 US) everything included from medicines to daily visits for around 3 weeks.

Wish me luck!!!

PS: I'm going to try and get some pictures and if people are interested send me a PM and I can share. I will also share my experience on here, hopefully it will be positive.

PPS: I did a lot of googling and I cannot find a single failed case of kshar sutra, admittedly there are not a lot of personal stories, but there are a few positive ones (here on the forums themselves) along with a few videos and pictures. The only thing that has me concerned a little bit is the doc here himself - he's got a very rundown clinic in a pretty seedy spot however he did seem pretty knowledgable about everything and he usually treats all sorts of ano-rectal problems like piles, anal fissures, etc.
 
#9
Hmm that is a good question - I think that part of the recurrence problem is with the fact that the tissue that regrows after excision is a lot of scar tissue and thus more susceptible to getting torn up due to excessive sitting whereas this method has much less scar tissue regrowth. I could be wrong though ...
 
#10
Oh I also got this done today. Turns out I that I have a 2 inch sinus tract and there was a bunch of hair in it! Gross. Anyways the doc went about an inch north, made an incision and put one thread in there and another inch south, made an incision and put another thread on the other end. Going to go back tomorrow to get my dressing changed :)
 
#11
Glad to see you updating on your progress since we see so few people write about this procedure. Hope everything goes as planned for you. :)
 
#12
I find this really interesting. And I would be curious to hear a personal story of how it works (I have never heard of it). And I agree with Robert regarding the low recurrence, since the natal cleft is unchanged. Look forward to your future posts!
 
#13
Quick update,

So couple of days ago the doc pulled out the thread and basically cut open the entire sinus tract and packed it with some herbal medicine. So three days later here I am with an open wound healing by secondary intention. I go everyday to the doc who inspects it and packs it with gauze dipped in medicine :)

The wound is around 4 inches long and 1 cm deep. It's not very wide, it's pretty much just a midline incision ... doc is confident it'll all heal in 21 days. Here's hoping, heh.
 
#14
Interesting...

So, it is more like a straight incision, so they don't take out as much tissue as the traditional open excision then? And then they are packing it with the medicinal herbs.

Are you able to do all your daily activities? Are the packing changes painful? I have to admit that it sounds quite similar to a regular open excision...so I'm curious as to how your experience will go. Thanks for sharing!
 
#15
Hey Razzy!

Yes exactly, it's pretty much a straight incision to lay the entire tract open but the key is the thread that they put in initially which burns out the tract so new tissue can form all around.

All in all it's more discomfort than pain but then I guess we've all been there, haha. The insertion of the thread is done under a local anesthetic and it doesn't hurt too much. There will be some pain the first day when the incision is done to lay the tract open. But from day two onwards, there is not so much pain. In my case I cannot sleep on my back nor lay back in my chair. There is some stinging pain when I move around but if I'm still I can sit up straight and walk around without any pain or discomfort. As far as daily activities go, I'm on vacation so I don't have much to do, haha. But yes, if you had a job sitting on the computer or something you could easily do it. If you did have some pain, you could take some pain medication (in the last 5 days I've only taken 1 tablet and I'm a bit of a wuss when it comes to pain).

Going daily to see the doc is also annoying but he inspects the wound and and dresses it for you so I suppose that's a good thing. Taking off the bandages is the worst part as I'm pretty hairy and pulling off that tape hurts.

All in all, from what I've read and experienced, this procedure is a cheaper and much less painful version of the open excision which we know has a pretty low recurrence rate. I would recommend this procedure over the other surgical options except for the cleft-lift. The cleft-lift eliminates the root of the problem and healing is quicker so it's a superior option :)

Of course, I'm only into day 3 of post-op and I've only had part of my sinus tract opened up. The last portion, which is another good inch will be opened up tomorrow so my journey really only has begun ... wish me luck!
 
#16
All in all, from what I've read and experienced, this procedure is a cheaper and much less painful version of the open excision which we know has a pretty low recurrence rate.!
I think you meant pretty HIGH recurrence rate.

I get the impression the cutting and thread didn't go down very deep... is that correct?

Robert
 
#17
As far as I have read, the open wound healing has more complications with the wound healing part more than anything else. The recurrence of the pilonidal cysts themselves is less than 10% (with cleft-lift it's around 4%).

The depth will depend on how deep your sinus is - the thread just goes into one of the pits and an incision is made at the end of the sinus so it pops out from the incision. In my case, the sinus was a good 2 cm deep :s
 
#18
As far as I have read, the open wound healing has more complications with the wound healing part more than anything else. The recurrence of the pilonidal cysts themselves is less than 10% (with cleft-lift it's around 4%).

The depth will depend on how deep your sinus is - the thread just goes into one of the pits and an incision is made at the end of the sinus so it pops out from the incision. In my case, the sinus was a good 2 cm deep :s
Hi,

Are you still active in this forum? Could you please update your experience after your treatment through Kshar sutra. I am also planning for the same hence what to know its success rate and best place from where I can get it done.
 
#19
Hi,

Are you still active in this forum? Could you please update your experience after your treatment through Kshar sutra. I am also planning for the same hence what to know its success rate and best place from where I can get it done.
Hi Saurabh,

So it has been 4 years since the surgery now without any recurrence (fingers crossed).

To wrap up my story - my open wound took quite some time to heal. It also got quite painful once I stopped with the painkillers. After 21 days I had to fly back to Canada and from there on my open wound took a good 3 months to completely close. It was quite frustrating at times and I tried quite a few things including medicinal honey to try and get it to heal faster.

Anyways, the ordeal is over for the moment. I got my surgery done in Panaji, Goa and I can PM you the doctor's details.

Cheers,
 
#20
Hi Saurabh,

So it has been 4 years since the surgery now without any recurrence (fingers crossed).

To wrap up my story - my open wound took quite some time to heal. It also got quite painful once I stopped with the painkillers. After 21 days I had to fly back to Canada and from there on my open wound took a good 3 months to completely close. It was quite frustrating at times and I tried quite a few things including medicinal honey to try and get it to heal faster.

Anyways, the ordeal is over for the moment. I got my surgery done in Panaji, Goa and I can PM you the doctor's details.

Cheers,
Hi

How r you doing now. I am planning to under go kshar sutra after 2 failed surgeries. Any advice from your side regarding kshar sutra?
 
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