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    Old 07-19-2005, 10:45 AM   #1
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    Wound at base of spine

    Hi everyone, I'm new here. I'm not really sure where this thread should go.
    I'm a 21 year old male and I have this 'wound' which developed at the base of my spine about a year ago. It's the point where your back ends and your butt begins. It's really embarassing to even discuss it online. It secretes some fluid which is then followed by blood and it hurts, which makes it a real pain when I have to sit someplace for long. It use to be worse but it doesn't secrete that often now, but it's still not healing at all, like I hoped it would.
    Do you guys have any clues what it could be ? I'm still too embarassed to have it examined by the doctor. I would really appreciate any help.

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    Old 07-19-2005, 11:02 AM   #2
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    Re: Wound at base of spine

    Please do not be embarresed to have a doctor check the area. Remember, doctors have seen it all and they do not pay attention to anything other than what they are checking to find a solution to the problem.

    Learn how to disassociate your mind from your body when being examined. We take our cars into the shop and discuss the problems with the mechanic, we can do the same with our body, think of it as your car and discuss problem with the doctor. This works for me when I see a male doctor.

    If you are too embarresed to see a woman doctor, see a male doctor.

    Your problem needs attention now and not later, it is not normal.

    Old 07-19-2005, 03:19 PM   #3
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    Re: Wound at base of spine

    This is almost certainly a pilonidal cyst. These cysts develop almost exclusively in the area you mentioned and nowhere else.

    The cyst is not healing because it is currently infected and continues to get reinfected as hair and detritus enter through the unhealed opening.

    Odds are VERY good that it will NOT heal unless you seek medical attention.

    Unfortunately, this is NOT a simple problem. Pilonidal cysts are controversial for many reasons and there are several different types of surgery available to treat them. Do understand one thing, though: there is NO home treatment that will "cure" this -- the cyst will NEVER go away without surgery. Don't believe myths telling you otherwise -- you'll hear many of these as you begin to learn more about your condition.

    The GOOD news is that with care and treatment, nothing serious is going to happen -- the cyst will not develop into something worse. Only if you let it go for years and years and years is there a chance of promoting the growth of precancerous cells. This is EXTREMELY rare and unlikely: no one with a pilonidal cyst ever lets it go for that long.

    The bad news is that you may get repeated flare-ups with intense pain if you do not do something about it. Don't be fooled, either: just because the pain is lessened right now and the oozing is slowing down does NOT mean it is going away and will heal -- it will NOT.

    This is a topic that could be discussed for hours -- I could write a ton here, but the bottom line is to see a doc NOW.

    However, I have to strongly advise you to start learning about your condition so you understand your options when you visit the doc.

    You will have to decide if you want to undergo elective surgery. THINK CAREFULLY about this. The surgery for this is NOT easy. It will require at LEAST a month of recovery time -- PAINFUL recovery time. Wound packing is involved -- this is NOT fun. Sometimes, pilonidal surgical wounds do NOT heal well at all (the area they are in makes healing difficult). MOST surgeries turn out just fine -- some do not. You shouldn't be afraid to consider surgery, but you MUST be informed. This is ELECTIVE surgery.

    If surgically removed, a very large hunk of tissue will be taken out -- imagine a large, pie-shaped wedge that MAY extend all the way to the anal opening. It all depends on the size of the cyst inside, the technique the surgeon would use and how badly the cyst is infected. It is the healing of this large area of missing tissue that is very difficult to deal with -- the surgery itself generally takes less than an hour and you often go home the same day.

    However -- you have another option: have it lanced, cleaned out inside, and let it heal. You'd be given powerful antibiotics to make sure it doesn't get infected again. These MAY work -- or they may NOT. Reinfection can happen at any time, but you may get several months of relief -- or years of relief -- or permanent relief. No way to say -- a doc cannot tell you for sure.

    Some docs try to sell a surgery -- but YOU have the final say in this.

    My personal recommendation -- get it lanced and cleaned, take the antibiotics and see if it heals up. It may take a full month or more to heal -- so be patient, even after the lancing.

    The lancing will NOT remove the cyst inside -- it will only clean it out for you and allow it to (hopefully) heal. No promises, though -- but it is WELL WORTH a try before jumping into surgery.

    You CAN ultimately "live with it" if you can get it to stop draining and keep it free from infection.

    You would need to avoid sitting for long periods of time -- and when you do sit, purchase a coccyx cushion (just ask your doc, or get one at any surgical supply store). The pressure on the base of the spine as you sit promotes further infection, keeps the cyst open, and forces fluid into the membranous sac surrounding the cyst. By alleviating pressure on the coccyx, you can hopefully keep it from swelling up again. Stand up often if you have to sit for long periods of time. Change position when watching TV, using the PC, working at a desk, etc. This is extremely important!

    Shave the area. Even if you are not hairy in that spot, there are micro-hairs on EVERY human being. These can sometimes get into the hole of the cyst at the surface of the skin and spur another infection. Shave with a wet razor, no shaving cream. Make sure that area remains free of hair.

    Keep it CLEAN. Use a heavy-duty antimicrobial wash like Hibiclens over the cyst when you shower once or twice daily. You can also use antibacterial soaps, but Hibiclens kills bacteria much longer. You can buy it in any pharmacy -- READ the label and use accordingly.

    Keep it DRY. After bathing, take two minutes and use a hair dryer on your rear. Don't burn yourself, but DO dry off the area of your buttocks where the cyst is and also between the cleavage.

    Avoid wearing clothing with lots of loose fibers.

    When the cyst is draining, keep it covered with a bandage of some sort to catch the fluid. Change once or twice daily or as needed, depending on the amount of fluid.

    Eat well, keep hydrated.

    If you have it lanced, taking SMALL doses of vitamin A after the surgery will help with healing. DO NOT EVER take more than recommended on the bottle. Vitamin A can be toxic in mega doses. One tablet is enough daily. Stop using it after about a month.

    DO NOT cover up the cyst with gels or creams or anything else -- they won't do a thing and can actually promote bacteria growth -- and that's the last thing you want.

    Many people have good luck living with a pilonidal cyst, but ONLY if it is NOT draining and the infection is cleared. Almost everyone MUST AT LEAST have it lanced. NOT everyone elects for surgery.

    A lancing takes five minutes in a doc's office and you go home immediately.

    Bottom line: you may not need surgery, but you can elect to do it if you want. Some people have flare ups of infection that happen ALL the time, causing great pain and discomfort and make surgery a necessity. Others are "luckier" and only get a flare up maybe once a year or every few years. Some get flare ups once or twice and rarely ever again.

    A lancing can allow for a period of remission that can last -- well, no one knows. It may work, it may not. But it is WELL worth trying first, before considering more serious surgery. If you properly care for yourself after a lancing, you may find that the wound heals, stops draining and there is no more pain. This may last for a long time -- or the cyst may get infected again IMMEDIATELY. It is impossible to say; each person is different.

    Last word: there are at least THREE different surgical techniques to remove a pilonidal cyst. MOST surgeons do the "full removal" method of cutting out that huge wedge of flesh -- this is the easiest surgery for them to do, but the hardest for YOU to recover from. Another method involves the same procedure but the wound is closed with stitches instead of being left open. This is easier for the patient to recover from -- but very risky -- post-op infection increases dramatically for a closed surgery. If you get an infection after surgery that is closed, the stitches have to be removed and the wound must be left open to heal anyway. The final method of surgery involves newer techniques that not many surgeons perform. The cyst is opened up and portions of it are removed (more or less), then it is allowed to heal. This is a NEW technique, very expensive, and most surgeons do NOT have experience with this.

    So your little problem, I'm afraid, is much more complex than you thought. Do not panic -- it can be a horror finding out this is what you have going on. Take your time -- do not jump into surgery. But by all means SEE A DOC right away and get it cleaned out and lanced so you can see if it will heal properly.

    Finally -- yes, this COULD be an anal fistula or something else entirely -- but I HIGHLY doubt it.

    Once you are diagnosed, if you want to come back and talk more details, I'll look for your post. Meanwhile, you at least have enough information to get the ball rolling.

    Oh... you can also start using the suggestions above for "living with it" RIGHT NOW, before you get it lanced. These will at least HELP -- but they will NOT substitute for having it taken care of by a doc.

    PS: The docs don't blink an eye when you drop your pants a little to show them the cyst -- they've seen it all. Most don't even make you take your pants off completely. Don't worry about this. Your problem is not life-threatening but it has the potential to cause you YEARS and YEARS of torment. You HAVE TO get up the nerve to see a doc and get this over with NOW.

    Trust me.

    Old 07-19-2005, 08:20 PM   #4
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    Re: Wound at base of spine

    Hi nuts
    I agree that it is most likely a pilonidal sinus. This occurs when a hair becomes "ingrown" into a "pitted" skin area around the base of the spine. It requires removal of the hair and draining of the area until it has healed up.
    A family member of mine had this done and spent one day in hospital. He had the cyst removed and the wound left open to drain. It was covered with gauze
    Daily salt baths were very helpful in healing, as well as careful drying after the baths. The hairdryer mentioned above is a good idea.
    He had regular visits to the doctor afterwards to check the area and the whole matter cleared up in about 3 weeks.
    If the sinus is not secreting much at the moment, it sounds like a good time to have it seen to.
    Tell the Dr that you seem to have a cyst at the base of the spine and he/she will be very familiar with it. It only takes a moment to get over the embarrassment. It's always a bit awkward isn't it to deal with "private issues" but the dr will put you at ease I am sure.

    Old 07-19-2005, 08:32 PM   #5
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    Re: Wound at base of spine

    Marie55, ScruffyGuy, I really thank you for your replies, and for the major info from ScruffyGuy. Guess it was more serious than I thought. I'm going to get it checked out as soon as possible. Thanks a bunch for the support guys. I'll be sure to keep you posted.

    Old 07-19-2005, 08:34 PM   #6
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    Re: Wound at base of spine

    Thanks bassie, I really needed the support. I'm getting it checked as soon as I can. I'll be sure to keep you posted.

    Old 07-20-2005, 03:19 PM   #7
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    Re: Wound at base of spine

    You're welcome, Nuts.

    I'm glad someone else mentioned the hot baths -- I can't believe I forgot to suggest that to you! These can be extremely helpful!

    Not all pilonidal cysts have hair in them, upon examination after excision -- and technically they aren't "true" cysts either, but... that's just semantics.

    Their cause is up for debate. It IS true that ingrown hairs are the culprit in many cases and it is also true that extensive pressure on the area or repeated jarring can initiate a pilonidal cyst, too.

    In World War II, thousands of soldiers were diagnosed with these cysts after spending countless hours riding in jeeps, bouncing up and down. Today, jobs that require long periods of time sitting down can be problematic as well as bike riding or even being a couch potato. Mostly, though, their ultimate cause probably varies person to person and there isn't really any solid agreement among professionals. It is also thought that there may be a genetic component -- not so much that it necessarily runs in families, but that some folks are simply born with a weakness in this area which allows for the cyst to form more easily later in life.

    Do go get diagnosed properly and treated in the manner in which you believe to be the best suited for your life right now. Just keep in mind a couple things as you go about the process:

    While a lancing, as stated, will NOT remove the cyst, it MAY allow for healing so that you don't have that leaking anymore. For lucky folks, a lancing is all they need -- they may then elect to live with it and be fortunate enough to not have any future problems.

    If it flares up over and over -- it can become very painful and difficult to manage daily life. Surgery is a good idea in these cases.

    There are different ways these cysts manifest -- and it can change at any time. Some folks have the draining like you mentioned, but never really see it flare up and become painful. Others get flare ups over and over every couple months. Still others, every couple years. If you choose NOT to have surgery you would just have to "wait and see" what happens. A doc cannot know what might happen in the future.

    The more often it gets infected, the worse it CAN become. Repeated infections produce more sinus channels and drainage points quite often, expanding the area inside that can hold infected fluids. This is one good reason to consider removing it while it is still small.

    The smaller the cyst, generally the easier the surgical recovery for the patient. Folks who have it treated fast and early in life do well. Some folks who may wait many years and suffer repeated infections will find that surgery later requires that larger area to be removed -- and the recovery time much longer and more complicated.

    MOST surgeries for pilonidal cysts go well, as the other poster mentioned. A very small percentage, however, have great problems healing. This is a very important consideration to keep in mind. It can be quite horrible to have an unhealed slice of tissue removed from your posterior that remains open for months and months.

    Surgeons can give you an IDEA of how much tissue they'll need to remove, but they can't be exact in that estimate -- sometimes during the surgery they'll find that they need to take out more tissue than expected.

    The larger the wound, the harder it is to heal. The smaller the wound, the easier it is to heal, obviously.

    Make sure you can take time off work, you'll need it.

    My personal advice: get diagnosed. Discuss a lancing and try that first. Have it cleaned, drained, and the doc will give you antibiotics. You may get immediate improvement that COULD last many years -- or it may not work at all. Most cysts are lanced prior to removal anyway and infected fluids cleaned out, with the patient being put on antibiotics before surgery, if there is active infection. So, lancing would often be "Step One" no matter what. May as well see if that is all you need, right?

    If you do opt for surgery, be wary of general surgeons who dismiss the healing process as no big deal -- it IS a big deal. Find a surgeon who has a lot of experience with this. Though it is not a true colo-rectal problem, many colo-rectal surgeons often have more expertise treating pilonidal cysts, being familiar with newer techniques and the anatomical structure of the buttocks. Most surgeries for pilonidal cysts are performed by general surgeons, though.

    Good luck.

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