If you are experiencing a flare-up or excessive
drainage there are two courses of action depending on the severity.
- You are in "manageable" pain. The first choice is to try and
knock back the infection with antibiotics. Antibiotics WILL NOT,
WILL NOT, WILL NOT make your abscess go away, they will temporarily
kill the infection. But not always; sometimes even antibiotics
fail. For some people their abscess can go dormant for months or
even years, other people will have another raging flare-up
within days of stopping the antibiotics. It very much depends on
your immune system and which kind of bug is driving the
infection. 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 to light. Some
doctors are a little gung ho with the antibiotics and will
prescribe a heavy duty broad-spectrum antibiotic such as Cipro;
this is a VERY expensive antibiotic and is now available as a
much cheaper generic so be sure to ask for the generic.
- Keep in mind that over use of antibiotics is a dangerous
game and you should not attempt to manage Pilonidal Disease with
antibiotics more than twice a year. There are strains of
bacteria emerging that are resistant to almost all known
antibiotics, these strains are being created by over-use and not
finishing your prescription. Over-use of antibiotics has also
been linked to Breast Cancer.
- You are in extreme pain. The recommended treatment is to
lance the abscess. This involves slicing open the top, cleaning out
the hair, pus and debris inside the abscess, packing the wound and
letting it 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 and no further treatment is necessary. If at
all possible, get your lancing done at a reputable doctors
office instead of an ER. Most Colon & Rectal surgeons will make
special emergency appointments to see patient who's in
excruciating pain. LANCING DOES NOT
REMOVE THE ABSCESS.
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
aren't really as effective.
Any lancing should be done with a local anesthesia, many 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.
The ER should be your last resort for a lancing. Doctors working
there frequently aren't completely knowledgeable about treating
Pilonidal Cysts and the conditions there are not always the most
hygienic. Only go to an ER 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.
Decisions -
Once you've dealt with the immediate problem, you are going to have to make some decisions about the
future. Pilonidal abscesses rarely go away on their own and how you
proceed from here depends on how active your abscess is and your
attitude towards medical intervention.
Most people who have had a full-on
screaming-in-pain flare up are likely to have another, although
maybe not as painful. What may happen after a lancing is that future flare ups will "pop"
through the 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 will behave in a it's
own unique fashion, depending on immune system, location of the
abscess, how deep it is, whether it can drain or not, etc...
|
