Infection Gone, but still lump

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New Member
Hi everyone,

I am new to this experience. I am 27 year old male.

Several weeks ago, I noticed blood when I'd go to the bathroom. It continued and got worse, and I started waking up with blood in my underwear. I did not have any pain to begin with, just blood and puss discharge.

By the time I got a doctor's appointment, there was some pain. I went and he quickly identified it, rightly, as a pilonidal cyst. He said it was draining profusely through one large sinus. He said to apply hot compresses and take a prescribed antibiotic and Vicodin for pain, which I did. He said since it had already ruptured, and had a solid center, an incision and drainage wouldn't be beneficial.

Over the next three days, I applied hot compresses every several hours and started everyday with an Epson Salt bath. The pain increased a lot in the first day, but gunk regularly came out during the night and with the application of the compress, including several gooey looking hairs. Yuck!

Today I went back. I no longer have 'pain' but there is still definitely discomfort, pulsating when I sit down, etc. I can feel a lump where the pain once was before and it's very hard. He said that virtually all signs of infection had cleared, there was no redness, there was very little swelling, and no more pus or discharge. He said the hard center had reduced and what remained was probably scar tissue from the ordeal. He has referred me to a surgeon for the next step. He extended my antibiotics by 4 days to cover the time in between now and my surgical consult.

So my questions
1) Is it possible I WOULD benefit from an incision and drainage? Is it possible there is still hair or something in there?
2) As I move forward with a surgeon, what option should I pursue? Based on my research, it seems to me like 'pit picking' is the best approach for now as this is my first incident and my flare up was fairly contained.
3) Is it wise to continue to take the EXTENDED course of antibiotics? I am concerned about another flare up, but tomorrow, the initial course will have finished, and I am wondering if I should just stop there. I don't want to compromise my body's ability to deal with things naturally.



Very Helpful

1) If your cyst is already draining, there is NO benefit from a lancing/incision. Lancings rarely cure this problem, if ever. They are only meant to give relief from pain while considering surgical options. Oftentimes the lancing wound will not heal, as in my son's case, and the result is disasterous.....instead of a small draining hole, you end up with a larger one.

2) Pit picking is a good starting point. My son's cleft lift surgeon had alot of faith in that procedure, but because of how far away we were, it wasn't a viable option for us to travel so much. If pit picking doesn't work, you've lost nothing..... and you have cleft lift to fall back on.

3) I would NOT take an extended course of anti bios. Not only can the bacteria grow resistant to them if exposed to them repeatedly, but anti bios upset the normal workings of your digestive system..... sometimes with fatal results.[:xx] Their use in this disease is extremely limited to minimal to moderate SHORT TERM pain relief. They cannot kill off all the bacteria in your cysts, and the bacteria will recolonize...... My opinion, forget another round of anti bios. They can only give you small benefit, while the danger they pose in repeated courses, is serious!~!!


Staff member
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You *SHOULD* consider going ahead with the lancing. Having it drain on its own is no substitute for having a doctor clean the abscess out. There are cases where a lancing has cured the problem. If it fails, you can always consider more extensive treatment. It is the general opinion of this organization to start with the small treatments before moving up to the larger ones (except in certain cases where there is extensive involvement and many sinus openings.)

If it were me, I'd hold of on another round of antibiotics until they were needed -- as long as you completely finished the first round. Most of the antibiotic problems come from people stopping them as soon as they feel better and not continuing the full prescription.


Very Helpful
He said since it had already ruptured, and had a solid center, an incision and drainage wouldn't be beneficial.

Sasha, Alot of surgeons won't do the lancing if it's already draining as cws said his surgeon told him. We had that problem, also.....we had to try three different surgeons to get one to do a lancing on Jared. They just kept saying that if it is draining then lancing isn't needed.

I pressed the issue until I found one that would do an incision/curettage, and wish I hadn't.:(

Sure, a lancing may be all that's needed in SOME cases, but wouldn't you say the greatest majority will need something other than a lancing since a lancing will NOT remove the abscess itself, remove the pits nor change the cleft anatomy?

As this site states:

Most studies quote that 85% of patients require further surgical treatment after a lancing
I stand by my statement that lancing rarely cures the problem.

Now, I know that to lance or not to lance is a personal choice, but with odds like that, i fail to see the point in investing your time or money or pain, just my opinion. Then again, alot of people play the lottery, and the odds of them winning are a good deal less than 15%... In all seriousness, those are not good odds, especially considering that there is a possibility that you will have non healing or wound breakdown. In the end, as always's up to each person to consider all the variables and go from there.

As for me, I can only speak from my experience with Jared, and for us incision/curettage was a total waste of time and money, caused him needless pain....and actually made the problem WORSE.


New Member
I am presently thinking of not doing a lancing. I have no pain anymore and only minor discomfort if I sit on it too long. I'm continuing hot compresses treatments, and I decided not to renew my antibiotics.

The only two things that worry me are

1) I can still feel a lump there, but I know from having pimples and small wounds that it very well may just be scar tissue from the rupture. It's still tender, but I guess I would be the most rapid healer alive if it wasn't.

2) The other thing that sort of concerns me, is I sometimes feel really hot, and this is actually what I went to the doctor in the first place for. I am actually going through a really stressful period in my life, and am pretty sure I am having anxiety, made worse by this condition. But occaisiaonlly I get fearful that I somehow have a systemic body infection. That's paranoid right? I just did a 10 day course of antibiotics, there is no sign of infection on the actual cyst anymore, and I am not in any pain.


New Member
I think that there could be tunnels under the skin which is often the case with pilos.

Iwould recommend seeing your surgeon and seeing what he recommends, as it is likely if you have tunnelling that t will continue to get infected and tunnel deeper, meaning a bigger excision the longer you wait unfortunately :(

Good luck.
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