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Pilonidal cysts and their treatment - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Constipation
Answered by

General & Family Physician
Practicing since : 2009
Answered : 590 Questions
User :   I have delicate skin between my buttocks above my my rectum. I sometimes get these small tears in that cleft and try not to wipe hard as to not further irritate. Recently within the last week, I have noticed that I felt another tear and am not sure why this one is not healing as quickly as they normally have. The tear appeared after a bout with hemmrhoids and my menstrual cycle. What is this and what can I do to help expedite the healing process? I sat in a warm epson salt bath tonight and I feel some better ( not as much itching).
User :   Hi
User :   Hello.
User :   Where exactly are these tears noticed?
User :   Is it close to the anus or is it seen at the clefts where two buttocks meet?
User :   Above my rectum almost to the top of my clefts.
User :   Ok
User :   Do you notice any kind of lump or swelling there?
User :   Is there a discharge from it?
User :   No. nothing like that. I have noticed in the past that when I wipe too hard or am experiencing excessive moisture due to hemmrhoids or cycle that I sometimes have this problem. This time there is a slight discharge since it is a larger lesion.
User :   Ok
User :   Is it occurring exactly at the same location every time?
User :   Are you there?
User :   Not really, but close. I have had to use preparation H this past weekend because of the swelling and I thought that I allowed that to go too long before treating and I didn't know if it was related or not or if the moisture aggrevated me. The tears are usually above between the clefts but never this irritating. I have some 2% hydrocordisone that I tried tonight once I got out of the bath.
User :   Ok
User :   May I know your age?
User :   Do you have diabetes?
User :   42
User :   Not that I am aware of. My mother was diebetic and recently passed from metasticising breast cancer. Diabetes does run in my family, but every time I have been tested, it has been negative. I normally have really good numbers when my blood work is done. I am about 50 pounds overweight though.
User :   Ok
User :   Let me brief you.
User :   ok
User :   ok
User :   Based on your description and the location of the lesion, its unlikely that it is related to hemorrhoids.
User :   I do have hypothyroidism though.
User :   The symptoms are suggestive of pilonidal cyst.
User :   What is that?
User :   This is not a serious condition, however, this can be recurrent and chronic in nature.
User :   What do I do to help reduce or eliminate the problem?
User :   Pilonidal cyst is a lump/swelling that arises at the areas of excessive moisture and probably due to presence of hairs.
User :   They are commonly located at the buttock clefts, thanks to the moistures with or without presence of hairs.
User :   They cause problems if they get infected.
User :   What type of problems?
User :   Infection rates are higher, if one tries to manipulate them.
User :   Let me suggest you the measures that you can follow
User :   So, the bath I took tonight in epson salt and the 2% hydrocordisone may have caused more prpoblems?
User :   ?
User :   Saline water baths are fine, however, I would not recommend you to use the steroid creams further.
User :   Ok
User :   Saline water sit baths will help in controlling the inflammation and reduce the discomfort.
User :   What can I do to help the healing process and to prevent?
User :   The other measures that you will need are
User :   1. Remove if there are excessive hairs around the affected region.
User :   You can get some depilatory creams and remove the hairs.
User :   Do I have to see a doctor in the office for the creams or can those be obtained from the pharmacy over the counter?
User :   2. Use antibiotic creams such as silverex/Polysporin Creams can be used instead of steroid applicantsto prevent infections
User :   Do I need oral antibiotics?
User :   3. Use other measures to control the moisture. Simple talcum powder should help in this.
User :   4. Oral antibiotics will be needed if the lesions is getting bigger or if you notice pus discharge/or develop symptoms of fever.
User :   As mentioned earlier, this can be a recurring condition,
User :   Why is this?
User :   The recurrence is common due to excessive sweating, presence of hair and moisture.
User :   Regular depilation of hairs, use of talcum powders will prevent the pilonidal cysts.
User :   You should also avoid sitting for a long time at a single place.
User :   This condition most often can be treated by conservative measures as explained to you.
User :   Oh, ok. I am not a very hairy person. I teach school so I do stand quite a bit until I get home. I have the moisture due to the medication I use at times from the hemmrhoids and once a month during cycle time.
User :   Occasionally you may need oral antibiotics, if the local measures doesn't cure the symptoms.
User :   On few occasions, when nothing is helping, then surgical incision of the cyst is the treatment then.
User :   Let me summarize the things that I have said.
User :   How do I know that I am or am not a candidate for a surgical solution?
User :   1. Use talcum powders and control the moisture
User :   2. Continue with the saline water sit baths
User :   3. Use local antibiotic creams(topical silverex creams or polysporin creams to be applied at the affected region
User :   4. Avoid handling the lesions with bare fingers.
User :   5. Avoid sitting constantly for a long time
User :   6. If the symptoms are not controlled with topical creams or if find any of these symptoms- increase in the size of lesions, presence of pus discharge, aggravating pain or discomfort, fever, then you will need oral antibiotics.
User :   If you develop these symptoms, consult a doctor who will prescribe you with the oral antibiotics.
User :   7. If the conservative measures(as suggested above) are not helping,
User :   then you will need surgical procedure.
User :   Have you followed what I have suggested?
User :   Do you have any other query?
User :   It seems you have moved out of the chat window. Please log in back if you have medical queries
User :   I ran out of time.
Doctor :   Dr XXXXXXXX here
User :   I understand the steps that you are outlining. I just wanted to make sure that if I needed to get oral medication that I did that ASAP.
Doctor :   I think You need to visit a general surgeon or a proctologist for a physical examination
Doctor :   We cannot acurately diagose Your condition without physicaly examining You nor can we offer You any medications
User :   Is this to determine if I need surgery?
Doctor :   Yes
Doctor :   Also he may be able to suggest certain investigationa and a line of treatment
User :   I do understand.
Doctor :   I think You should avoid straining
Doctor :   When passing stool
Doctor :   Avoid constipation
User :   Should I still go ahead and get the oral meds or just use the topical first and see what happens? Also, should I be taking the salt baths more than once a day?
Doctor :   You can do thin by taking a mild laxatibve at noght probably some isapghol powder disolved in water
Doctor :   keep the area clean and dry to avoid infection and do visit a proctologist or general surgeon without fail
User :   Do I find that powder in the pharmacy or health food store?
User :   May I ask a different question since I have a little time remaining?
Doctor :   I think You should see a proctologist
Doctor :   yes
Doctor :   yes
Doctor :   Ok do see a general surgeon without fail for physical examination .do not attempt to treat Yourself
User :   I will locate one locally. I have recently relocated and my general practicioner is about 50 miles away. I will go online tonight to try to locate one to contact tomorrow to set up an appointment.
Doctor :   Ok where zare You located/
User :   I have been diagnosed with hypothyroidism since October 2003. I seem to have been having difficulty with weight ever since. I never had weight issues before that and it has been quite taxing to find something to help me with reducing my weight. I am in
Doctor :   Ok
User :   I have tried naturalpathy to regulate my temperature as well as try to jump start my thyroid. I changed from taking synthroid to taking armour thyroid. I tried taking T3 with the synthroid and it seems to be very difficult to get regulated and leveled out with my weight and energy level. I am not a bit eater and never have been.
Doctor :   Ok
Doctor :   People with thyroid problems are prone to weight or weight loss
User :   I also need to find a good endocrinologist in the area because my general practicioner was the one who prescribed my thyroid meds.
Doctor :   Ok
Doctor :   I am not familiar with the doctors in your area
Doctor :   so i am afraid that I cannot help you out
User :   So, is there nothing that can be done or prescribed to help me drop some of the weight? I have attended boot camp for women, gone to bariatrics (with some success that didn't last once I stopped with the foods), and tried a variety of other methods. I would like to know if iodine or iodide is something that I should be using to help my meds absorb better?
Doctor :   I think Your endocrinologist will be able to help You best in this regard
User :   Not a problem about the doctors. I will ask a few people on this end and research on line.
Doctor :   Hope You have understood
User :   Thanks.
Doctor :   Is there anything else I can help You with?
User :   No, thank you for your help. Good night.
Doctor :   Bye for now
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