Pilonidal cyst

#1
Hi everyone

24yr female. I current have a cyst which I've been taking anti biotics for, for over a week. At first I just felt a small lump and each day went bigger and more painful but never drained. The anti biotics are working for now but it's since gone really bruised looking. Is this normal because of all the pressure?

I'm seeing the doctor on Monday for a referral to hopefully get a cleft lift but in the meantime really want to know why it's gone from angry red and inflamed to a black/brown bruised looking mess!

This is my 2nd cyst in 8 weeks so Any answers would be greatly appreciated

Rachel
 
#2
This was how mine started and was not fun! Unfortunately for me the bruising was a buildup of pressure and blood causing it. I had a sinus that had to be excised but mine seams to be returning only 4 months later... keep looking for the cleft lift is all I can suggest!
 
#3
Hi everyone

24yr female. I current have a cyst which I've been taking anti biotics for, for over a week. At first I just felt a small lump and each day went bigger and more painful but never drained. The anti biotics are working for now but it's since gone really bruised looking. Is this normal because of all the pressure?

I'm seeing the doctor on Monday for a referral to hopefully get a cleft lift but in the meantime really want to know why it's gone from angry red and inflamed to a black/brown bruised looking mess!

This is my 2nd cyst in 8 weeks so Any answers would be greatly appreciated

Rachel
Yeah it's possible brushing. Months ago I had that. Hit it the wrong way got extra big and changed colors when it spilled it was a mess. Get to a surgeon or colon doctor asap. The longer you wait the worst. Take their advice. Cleft lifts generally work but still no gurantee with any of it. The sooner it's looked at the better the odds of correcting the issue. Surgeon needs to look.
 
#4
This was how mine started and was not fun! Unfortunately for me the bruising was a buildup of pressure and blood causing it. I had a sinus that had to be excised but mine seams to be returning only 4 months later... keep looking for the cleft lift is all I can suggest!
Thankyou

It's easing off now but I know it will return so I think surgery is the only way forward

I'm so scared as I've never had surgery but seems the cleft lift is the least painful afterwards and quicker recovery

Rachel
 
#5
Hi Rachel, I'm kinda in the same boat as you right now. Have a pilonidal cyst that turned into an infection and abscess, have been on antibiotics and the pain and swelling is down, but has now slightly a darker discolored shade to it. I'm also currently looking for a certified cleft lift surgeon in Michigan who will do my surgery, as I do not want an open excision due to lower success rates and higher risk of infection. But not having much luck on my search. I wouldn't totally be opposed to closed excision I guess, but I still am attracted to the cleft lift cause of the higher success rate and quicker recovery time, as I work a physical job. I have a consultation with a general surgeon on Tuesday and will ask his opinion on the cleft lift. I've never had surgery before either, so I don't know what to expect when the day comes. It's normal to feel scared about this, but don't feel alone, I along with many others on here, are pilonidal sufferers too. Keep us updated on how it's going
 
#6
Hi Rachel, I'm kinda in the same boat as you right now. Have a pilonidal cyst that turned into an infection and abscess, have been on antibiotics and the pain and swelling is down, but has now slightly a darker discolored shade to it. I'm also currently looking for a certified cleft lift surgeon in Michigan who will do my surgery, as I do not want an open excision due to lower success rates and higher risk of infection. But not having much luck on my search. I wouldn't totally be opposed to closed excision I guess, but I still am attracted to the cleft lift cause of the higher success rate and quicker recovery time, as I work a physical job. I have a consultation with a general surgeon on Tuesday and will ask his opinion on the cleft lift. I've never had surgery before either, so I don't know what to expect when the day comes. It's normal to feel scared about this, but don't feel alone, I along with many others on here, are pilonidal sufferers too. Keep us updated on how it's going
Cleft Lift not for everybody it's a big procedure. Usually only done if other surgeries fail.

Excision with Open Wound has a low risk for infection. Everybody mixes this up. In a cut a your body will scab and could trap bacteria resulting in infection. In an open wound excision the body constantly drains fluids on to gauze etc flushing the bacteria out. The risk for infection is like 2%.

An Excision that is stitched shut has the high risk for infection in some cases 1 in 4 shot. The bacteria can't get out if it gets in. This is a dirty area too. The bright side is healing is half the time.

Short story

Open Wound Healing can take 1-6 months depending. Usually a few months, there have been cases where it took a year but the risk for infection is low.

Closed Wound Healing can take about 2 weeks to a month sometimes slightly longer. The risk for infection is higher.

Point is you have to choose the surgery that fits your lifestyle and consult a doctor. Everyone is different. Cleft Lifts are not a first resort if you have not had this looked at. Cleft lifts, plastic surgery and they will reshape your behind and many insurance companies will not cover it. Most people that get them, get them when other surgeries fail. Many have a excision and flap stitched with no reoccurrence.

Point is you just need to sit down with a surgeon. That's first priority.

I opted for a Closed Excision. Shower wash put antibacterial ointment on. Can't drive on disability rather be back at work soon. That was my preference. Usually that is done first as it's the fastest way in and out. Just take care of it. This is a one shot deal. You mess up or your wound gets infected or you don't eat enough protein the healing can fail.

I had my cyst excised first before I had the sinuses excised. First surgery was easy no anesthesia. Cyst came out I packed the wound for a month almost. Then when infection went away they went in for the sinuses. I was put out stitched that shut. Something to consider. Open Wound has a low infection rate but takes forever to heal and seriously screws up your lifestyle. Went through that with the cyst itself that's always open wound. But the sinuses you get more of a choice. Take the stitches. Most docs will prefer you do as it seriously will put you out of work and packing your butt with gauze for awhile takes its toll.

To finalize the post when the remove the actual cyst and core first part it's numb area cut it out or grind it out. Not bad you pack the thing and it heals. It's almost always open wound as they want it to drain the puss etc. Sucks changing gauze but infection don't worry about.

If you have sinuses which you probably do if it's reoccurring or draining they will cut those out when the cyst heals. Those run down your crack and have holes for fluid to drain. Since the cyst is gone there's not much fluid anymore in those sinuses so they can stitche those with a flap usually. Fastest way out. Open Wound will allow you to not worry about infection but 2 weeks out of work and months of healing or stitch it and do your best to keep it clean and be out of work 2 weeks and practically healed. All these pilondial cases are different. But if you haven't been operated on it first those should be your options. Cleft lifts are more for people that have failed surgeries etc. It's plastic surgery so I'm not surprised not many perform that procedure. Billing your insurance company would be difficult for them. A flap of skin is boarder line plastic surgery but insurance does cover it. They technically do that for free.
 
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#7
Hi Rachel, I'm kinda in the same boat as you right now. Have a pilonidal cyst that turned into an infection and abscess, have been on antibiotics and the pain and swelling is down, but has now slightly a darker discolored shade to it. I'm also currently looking for a certified cleft lift surgeon in Michigan who will do my surgery, as I do not want an open excision due to lower success rates and higher risk of infection. But not having much luck on my search. I wouldn't totally be opposed to closed excision I guess, but I still am attracted to the cleft lift cause of the higher success rate and quicker recovery time, as I work a physical job. I have a consultation with a general surgeon on Tuesday and will ask his opinion on the cleft lift. I've never had surgery before either, so I don't know what to expect when the day comes. It's normal to feel scared about this, but don't feel alone, I along with many others on here, are pilonidal sufferers too. Keep us updated on how it's going
Hello

been to the doctor today hoping for that referral. He took a look. He didn't really say much about it. I think he was uneducated with these cysts so just said I'd have to wait for the referral to come through the post

Will keep you updated

Rachel
 
#8
Hello

been to the doctor today hoping for that referral. He took a look. He didn't really say much about it. I think he was uneducated with these cysts so just said I'd have to wait for the referral to come through the post

Will keep you updated

Rachel
Some docs don't know much about it. US Military has the most research and knowledge as 80k cases sprung in WW2. They still treat more cases per year than anyone else.

Colon or Rectal Doctors, General Surgery usually see the most etc.

I had arterial bleeding from the first procedure. Panicked should of called my doctor went to the ER and a large hospital. Short story they had to call my surgeon to get it to stop. ER said they haven't seen anything like it. I cracked a joke saying sorry you guys got to look down there. The ER doctor said don't apologize usually the cases are straight forward. This makes my job interesting because I haven't seen anything like this. I got worried thinking my doctor messed me up. I said can you fix it he said oh yeah she performed the procedure you just have some bleeding. I bleed right through the stiptic powder. I had small arterial bleeding due to the core being removed. Should of gone straight to my Surgeon as she stopped it over the ER phone. So yes there are Doctors unfamiliar with Pilondial. Small post surgical complication after the cyst removal. But it taught me to trust my doctor as she stopped it over a cordless phone. Bleeding and infection common with this during healing.

The procedure for the Sinuses I'm having zero complications. So some doctors don't know but when you have one that knows or has done it before you have to try to learn to trust them.

Then again usually surgery is only done if its chronic or you have major issues with it. So like I said everyone is different.

If it helps...

The reason why so many cases sprung up in WW2 is because of Jeeps and sitting in them which probably resulted in hairs getting pushed in. That's why it was nicknamed Jeep Seat.

My lifestyle former US Navy. I travel for a living, rental cars. Probably about 100k miles per year maybe less. I drive a Mini Cooper S stiff suspension. Very stiff lol. Point is I agree with the military's findings. It is common in people who drive or sit a lot and have hair. But it's not ruled as the main cause. For me it probably is. For others it could be attributed to other reasons.

Just putting it out there. Lifestyle changes may help, diet etc. So use the advice as you see fit.

Wanted to add I have a coworker who I call in my travels out of boredom etc. He had the same issue. His surgery was performed by the US Airforce. Same procedure as mine. Cyst Removed, Sinuses Excised and Closed with a Flap. His surgery was done in the 60's. Never had a reoccurrence. No plastic surgeries after that nothing.

Personally I would try the least threatening or the most common solution first if you have a sinus it should be Excised although as leaving it will just allow bacteria to get in and the cyst to come back. Lancing is temporary relief. Life's too short and personally god gave me my ass, before i ask them to reduce what god gave me, cleft lift. Let's see what happens.

Not trying to talk you out, but a good doctor is who you need to see. If you've never had anything removed before or the area touched then I would try to avoid the cleft lift. Unless the doctor opts for it.

The people with relief from a cleft lift are the ones with reoccurrence after surgeries. Although the people that never have a reoccurring issue will never be on this forum again. Me included. So like I said consider that before jumping to a cleft lift. There are many people who succeed with the flap and excision and cosmetically dosent change your butt.
 
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#9
Whether a cleft-lift is a first line operation, or should be saved for recurrences is a controversial topic. I surveyed my last 85 patients for their thoughts on this, and obtained the results below.

The graph on the left is of patients who had a cleft lift at our clinic as their first operation (not counting drainage of an abscess); the graph on the right is of patients who had one or more previous failed operations.

As surgeons, we certainly can have our opinions, but in the final analysis the opinion of the patient is what really matters. In this group of our educated patients, the opinion is overwhelmingly in favor of the cleft-lift as the first operation for this problem. Also, a cleft lift is more uniformly successful in patients who have not had previous failed surgery.

Dr Immerman

 
#10
That's good advice! Doctor! Most patients with failed ops will consider a cleft lift although. But what about a flap off the midline. I could be in for another round of surgery but some patients have done well with it.

Failed surgeries with reoccurrence I have read and found does complicate the issue as the tissue changes.

But there are quite a few who never experience the issue again. Age and BMI seems to help from what I've read.

PSD - definitely needs a preferred method with low risk and short of out work time. Colon Cancer 10 days back at work Gall Baldder drill some holes remove it.
 
#11
The difference between an "off midline closure", "flap closure", "cleft-lift" and "Karydakis procedure" is elusive. They are all similar, and vary in the hands of the particular surgeon. The main thing is that it flatten the entire cleft, remove the disease, and bring the incision off the midline.

Yes, PSD does need a uniformly successful procedure - however performing a successful flap procedure of any kind requires lots of training, experience and technical knowledge. Unfortunately, there is not much training in the university programs in these flap procedures, and it is hard to get enough experience in a normal surgical practice.

Dr I
 
#12
I agree. Many Dr's clueless. And many will avoid the surgery until sinuses develop and are severe. Not to say I don't trust a doctor. Mine has been on the board at many large hospitals and remains on them and has started her own surgical center. She was able to describe many cases to me. Even one post surgical a male cheerleader who ripped his wound open post surgery once he was healed.

A good doctor who knows PSD is definitely the first choice. The procedure well it needs to be uniform. If the cleft lift is as successful as it seems then insurance companies should be obligated to cover without a hiccup and more reasearch should be done in comparison to other methods. Flattening the area is the idea though my Surgeon did try to do that with a flap.

Universities problem should chime in and do more studies. Most of the studies are closed healing vs open Wound. I personally had a small issue before the sinuses were removed. My doctor removed the cyst and it's core. That night I drenched jeans in blood. Small arterial bleeding my surgeon was 24/7 for emergencies but I got scared and drove to a big hospital. My butt elevated using my elbow to keep my butt off the seat and a towel from ruining the leather in my car. Getting there they asked me to sit. It was open Wound for this procedure so I sat. Drenched the chair in blood then they rushed me in. I had arterial bleeding they through the styptic powder on came back and said how are you doing I said feels damp I'm still bleeding they pulled the covering off. Still bleeding. Asked many questions? They called my Surgeon she gave the ER doctor instructions. She stopped it. That ER doctor said in 15 years I've never seen anything like this before usually are cases are routine. I was doubting my doctor/surgeon at this point. He said ride the course. She stopped it.

Poin is that experience is living proof many doctors don't have a clue. Being concerned I learned my doctor was a board member at that hospital. Started her own surgical center miles away then I found out she was a board member at many.

Point is trusting the doc and finding one that understands PSD is a need. More should be familiar with it along with the methods to cure it and the cleft lift.
 
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LILLY

Very Helpful
#13
Whether a cleft-lift is a first line operation, or should be saved for recurrences is a controversial topic. I surveyed my last 85 patients for their thoughts on this, and obtained the results below.

The graph on the left is of patients who had a cleft lift at our clinic as their first operation (not counting drainage of an abscess); the graph on the right is of patients who had one or more previous failed operations.

As surgeons, we certainly can have our opinions, but in the final analysis the opinion of the patient is what really matters. In this group of our educated patients, the opinion is overwhelmingly in favor of the cleft-lift as the first operation for this problem. Also, a cleft lift is more uniformly successful in patients who have not had previous failed surgery.

Dr Immerman

Thank you for sharing this.
 
#14
When I saw the doctor he said most people are born with this dimple and that it's really weird at the age of 24 it's only just causing problems. He's also said he knows the cysts to be closer to the anus?

I have done lots of research on this and I don't think he knew much about it so now I'm worried

Rachel
 

LILLY

Very Helpful
#15
Ok, I just read through the entire thread and I feel compelled to clear up some misconceptions.

First, cleft lift is NOT classified as plastic surgery. It is repair for pilonidal disease. There is no problem getting insurance to cover the surgery.

Second, cleft lift is NOT a last resort only option. People have their opinions- yes- but it is a disservice to suggest that cleft lift surgery is not suitable as a first line of defense.

There are many of us who have spent years here in an effort to keep this straight. Most of those members are not around anymore because the information seemed to have taken hold.

Please research all your options including cleft lift. You won't find a random surgeon who knows about the surgery. You have to seek them out. There is a list of surgeons on this website and there are patient recommendations on the Hall of Fame forum. It takes some extra steps but it is well worth it in the long run.
 
#16
Thanks for your input everyone! And that is a very helpful and intriguing chart, Dr. Immerman. I had my consultation yesterday with the general surgeon I saw when I was in the ER for my infected pilonidal cyst/abscess. He said the infection is gone from the antibiotics and it looks to be healing okay, albeit slow. It's not really causing me pain anymore, just some discomfort when sitting like I can feel a lump there beneath my tailbone. It is still draining some blood from the sinus, so he cleaned some hair and gunk from around the sinus and put more gauze on it. He said he wants to see how it progresses in the next week or two and then decide on if he thinks surgery is a good option for me. I mentioned a cleft lift and, of course, he's heard of it but he or no one in his practice performs it. He said if he was to do surgery, he would probably do a closed excision. So I may schedule an appointment for a second opinion with a surgeon I found with the help of this forum. He routinely performs cleft lifts for the purpose of treating pilonidal disease, so I'd like to get his opinion on it too. If it can heal and I don't get another flare up for 12 years like last time, I'd almost rather do that then go thru surgery, miss time off work, $$$ to pay for it, etc. But I'm open to surgery if they think it's best for my case. And as far as mine being born with it, the surgeon I saw yesterday told me there's no way for him to really know. I have a little bit of body hair, so that may have played a role into it too if it wasn't congenital. Keep your head up Rachel, I'm confident we're all gunna get past this.
 
#17
Ok so today I've been to see the specialist. He examined me and said there is nothjng he can do because at the moment I don't have an infection. (I have to go back when I'm in agony basically) the area is still dark brown/black from when it was infected and he said it's just scar tissue. He also said I have no pits or openings ? I'm so confused and really can't see an ending to this horrible thing
 
#18


Hi Dr. Immerman, thank you for doing this.

Do you think the numbers would change if it were your FIRST 85 patients, and if so, how? I am tremendously interested in long-term feelings on this, as I still struggle with some anxiety about my cleft lift from 4 years ago and worry/wonder about its progression as the years go by. People on the forum are generally under 5 years post cleft lift.

Can you please provide the responses of the 8 people on the left, and 8 on the right, who answered "Other"?

What feedback did the "the scar is unacceptable" guy on the left have?
 
#19
hello, im really new today.....while in the military, overseas, during the viet nam war, I crawled in and out of planes that just landed. we had to do inspection on them...inside an out under so many hours. the island was hot, the insides of the sealed planes were hot, and I had a heavy tool box to drag around w me...….needless to say...my fatigues were always hot, sweaty and perspiration soaked-daily-and we were on alert.

early 1975-i feel a sore pimple on my tailbone....i go see sick call. ok, it looks like a pimple...lets wait and see what develops. Every month its growing, and killing me. the sick call medic just want to observe it and see if it will go away by itself...….this this is painful

the pain affects how i sit on the potty, how i move, how i sleep, how i bend and twist. mid year i can barely walk because the pain has crept up my spine. putting on my fatigues is slow and painful....im not offered support or assistance to get my inspections done.

my military husband was helping me dress. I just could not bend down. I could not lift my legs without feeling the pain.

Finally on a weekend i was taken to basic medical clinic, where the large, hot, painful cyst was sprayed w cold spray, and lanced with a hot bovine: talk about a painful nightmare. my husband helped the medic,

i was send home-off base. I think we had some painkillers like aspirin laying around the hot apartment. I could not go back to work because i was out of commission. My husband unpacked, drained, and repacked my open wound. He was just another aircraft ground support person like me. It took some months to quit draining. ( i was discharged w honorable and stuck on an island.)

later- current day: I learned that i could have been put into another field of work. I was not offered support or assistance w my heavy toolbox; I was snubbed by my flightline support staff . I now read that this happens alot to military service peoples-

current statistics . they feel that if you cannot wear the military uniform as required in your afsc? then get the best surgery offered: id take the anesthisia and pain killers. today i get flashbacks and i realized they should have lanced my tiny pimple cyst from the onset.

thank you all.
 
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