Pilonidal Cyst

Resources

Background

A Pilonidal Cyst  is an abnormal pocket in the skin that usually contains hair and debris. A pilonidal cyst is almost always located near the tailbone at the top of the cleft of the buttocks.

Pilonidal cysts usually occur when hair punctures the skin and then becomes embedded. If a pilonidal cyst becomes infected, the resulting abscess is often extremely painful. Virginia Surgery Associates seeks to alleviate your pain and keep you informed about Pilonidal Cysts. Please check out our other resources on the subject.

Care for the incision:

If your wound has been left open, keep the wound clean. Within 24 hours of surgery, removedressing and the packing. You should perform a Sitz bath (soak in warm water in tub for 15 to20 minutes) three times a day, and then re-apply a clean dressing. You will need a supply of4X4 inch sterile gauze pads and sterile saltwater solution called “saline”, both of which areavailable at drug stores. Soak a piece of gauze in the saline, unravel it, and place it inside of theincision. Then place several dry gauze on top of the wet dressing and tape it into place. Do acomplete dressing change two to three times a day. Additional detailed instructions are attached.If your wound has been closed, do not tub bathe. After 24 hours, you may remove yourdressing and shower (do not tub bathe); pat the incision dry. Re-dress the incision with dry 4X4inch gauze pads. Change as needed to keep the incision dry.

Activity:

We encourage resuming walking and light activity immediately, as soon as you are sure you arenot going to have issues with dizziness or lightheadedness. You may resume driving when it iscomfortable to walk up and down stairs. Don’t plan on any strenuous activities, like sports orgoing to the gym, until your post-op appointment. Your surgeon may have specific instructionsto add to this; usually these are outlined to you before surgery. The bottom line: if it hurts, don’tdo it!

Eating:

The basic rule is take in what your body is telling you. Unless you have been given a specificdiet plan, you may eat what you wish, even the day of surgery. Beware of nausea or queasinessthe day of surgery, though. Some find it easier to digest bland foods, light foods, orpredominantly liquids that evening. As you feel better, however, you can eat whatever seemsgood to you. Make sure you stay hydrated, and avoid excessive caffeine. Also, no alcohol if youare taking prescription pain medications.

Elimination:

Constipation is very common after surgery. We recommend staying well hydrated, and usingMiralax, prune juice, or Milk of Magnesia for a few days until things are back to normal. If youare at all prone to constipation, or if you need several days of pain medicine, it may help to addBenefiber, Metamucil or similar bulk fiber agents for a few days as well. Do not let more than48 hours go by without a bowel movement without starting the above medications. If they fail tohelp within another 24 hours, call our office.

Diarrhea is common if you are taking antibiotics. If you have this problem, we would suggesteither probiotics while you are on the antibiotics, or eating yogurt with active cultures. Ifdiarrhea occurs more than 4-6 times daily for more than 48 hours, call us.

You should be able to urinate within 6-8 hours of leaving the facility. If you are unable to do so,call our office. Make sure your doctor is aware of any chronic difficulties with urination (likeprostate trouble) before surgery.

Drains:

If you are sent home with surgical drains, you will likely be given instructions at the time ofdischarge for care of them, and a log sheet to record the output. It is important to note the dailyoutput of the drain(s) so we will know when to remove them. Drains that empty into a suctionbulb or attached bag can get wet in the shower. If there is gapping of the skin around the drain,Neosporin or similar ointment may be used to protect the area while you shower. Do notsubmerge the drain site underwater, such as tub bathing or swimming. Slight pinkish oryellowish drainage from around the tube is normal while it is in place, as is a small amount ofredness at the site. Gauze over the site may help protect your clothing from staining. Foulsmelling or copious drainage around the drain, or spreading redness around the drain, is notnormal and should prompt a call to our office. If the drain reservoir fails to hold suction whenyou squeeze it, or if the drainage suddenly drops to near zero, call our officeNormal care of drains includes emptying the fluid in the reservoir every 8 hours and recordingthe amount per 24 hour period. Bring this record to your postoperative appointment. The fluidmay need to be emptied more frequently if the drainage is heavy. Fluid will often be red at first,then pink, then yellow as the wound heals. Stringy material in the tubing or reservoir is normal.

Medications:

Prescription pain medications are there to help you recover comfortably, but stop them as soon asyou are able. Side effects of nausea, vomiting, dizziness, fatigue, poor appetite, and above allconstipation, are common. If you have these issues, try to use ibuprofen and Tylenol instead (seebelow). Do not use alcohol or drive if you are taking prescription pain medications.Unless you are told differently by your surgeon or primary doctor, you can take 400 mgibuprofen every 4-6 hours, or 800 mg every 8 hours, for the first 3-5 days after surgery, for amaximum dose of about 2400 mg/day (refer to the label for specific dosing based on age andweight). It is best if you can take some food with this medication.

Tylenol is also acceptable to help with the baseline pain after surgery. It can be taken inconjunction with ibuprofen, and with your prescription (unless your prescription already containsacetaminophen--which is Tylenol). Be very careful not to exceed the dosage on the bottle.Taking more than 3 grams/day is not advisable.

Blood thinners should only be restarted after surgery according to the plan discussed with you byyour surgeon or prescribing doctor before surgery. If this was not made clear to you, call ourOffice. All other medications should be resumed once you get home. Vitamins and supplements are notnecessary to help you heal, unless you have a known deficiency. You may resume them afteryou get home if you wish. We would suggest sleep aids not be used while you are on narcoticpain medications.

If Difficulties Arise:

Please call us if any problems or questions arise. We can be reached any time, includingevenings and weekends, by calling our office number (703) 359-8640 and selecting to speakto the on call physician.

Call your doctor if you have any of the following:

  • Fever over 101°F or chills
  • Increasing pain, redness, or drainage at an incision site
  • Vomiting or nausea that lasts more than 12 hours
  • Prolonged diarrhea
  • Chest pain or shortness of breath
  • Bleeding which soaks through your bandages
  • Inability to urinate within 8 hours of discharge