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Using steroid cream for painful split on top of butt crack. Started itching, used neosporin. Effective cure?

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General Surgeon
Practicing since : 2008
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I have been dealing with an embarrassing and painful issue for about 2 months now. I have a painful split from the top of my butt crack down approx 3 inches long. It has been treated for a month by an OB/GYN who has no idea what the problem is, however, prescribed a steroid cream to use 2x a day for a month. The cream worked well and it healed but now I find if I have sex after it has healed in any other position beside gentle missionary it gets split open again sometimes to the point of bleeding so it's a continous cycle. This had never been a problem for me and the first symptom when it's started was severe itching at the top of the crack so I thought it was dry and used lotion and it's been worse ever since. Besides the Rx cream I have kept it gently cleansed with mild soap, used neosporin, powder to keep it dry, no more thong underwear and avoid sex until it heals which usually takes 2 weeks. This time it is so painful I can hardly sit or bend over. I read somewhere that if this has happened it may just be healing back with scar tissue so any little pull rips it again.... Please help! I just can't go on like this!
Posted Tue, 16 Apr 2013 in General Health
Answered by Dr. Grzegorz Stanko 5 hours later

Thank you for the query.

What you are dealing with is pilonidal cyst. This is nothing more that hair which has gotten ingrown and caused tissues inflammation and a cyst. Such cyst gets infected cyclically what leads to an abscess. And such abscess is usually very painful. This situation keeps repeating and it wont stop as long as you wont get it removed.

Here is what you should do:
1. If the inflammation and pain is present right now, you should visit general surgeon and have it incised so the pus can be evacuated (you can be surprised how many pus can accumulate in this area).
2. After the acute inflammation healing, you should get scheduled for surgery. It is necessary to remove it and put some stitches.

Hope this will help. Feel free to ask further questions.
Above answer was peer-reviewed by
Follow-up: Using steroid cream for painful split on top of butt crack. Started itching, used neosporin. Effective cure? 56 minutes later
Thank you for your time, however, I do have a few more questions. Why upon 2 examinations has this not been seen? Also, is it going to be under the skin or will it be noticeable becaue I have not seen or felt any swelling or inflammation?
Answered by Dr. Grzegorz Stanko 56 minutes later
This condition has very characteristic symptoms and such diagnose is usually not very hard to establish. But it is not very popular disease for other than surgeons doctors so the general practitioner might simply not know what is it.
This is located under the skin, in the soft tissues so swelling might be not visible from outside.
What you should be able to notice is small pinpoints-like holes (or hole) - compare to this pictures: WWW.WWWW.WW
If it looks much different, please provide some pictures of it so I can give more exact answer.

Hope this will help.
Above answer was peer-reviewed by
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