One of the most common questions I see online is: “I had my pilonidal abscess drained several weeks ago, but I still have drainage, a lump, pain, or an open wound. Did the procedure fail?”
Usually, the answer is “no”.
The confusion comes from the fact that draining an abscess treats the acute infection, but does not necessarily eliminate the pilonidal disease that caused the abscess in the first place.
What is the purpose of the drainage procedure?
The purpose of the drainage is is to:
- Release pressure
- Drain pus
- Relieve pain
- Control infection
But, the underlying pilonidal disease usually remains.
Why is there still a lump where the drainage was performed?
A lump does not necessarily mean the procedure failed. A lump may remain because:
- The swelling from the infection has not yet resolved
- The cyst remains present
- The drainage site has not sealed
- There are additional sinus tracts
Why is there still an opening where the cyst was drained?
This depends on several factors:
- The infection is still draining, and needs an opening to let fluid out
- The incision was in the midline of a deep fold, and local factors are preventing healing
- It just needs more time. The abscess cavity heals from the bottom up, and it can take several weeks before the opening completely seals.
- A sinus tract has developed
When should I be concerned that the drainage procedure didn’t take care of the acute infection?
- Pain persists or worsens, gradual improvement is not happening
- In spite of having an incision made, there really hasn’t been any drainage of infected material
- Fever persists or worsens
- Most patients begin feeling noticeably better within 24-48 hours after successful drainage. If you are not improving, or are getting worse, you should be re-evaluated.
If it seems that the drainage procedure didn’t work, what should I do?
At this point, you should be re-examined by someone to see if further drainage is necessary. This could be an emergency room, urgent care, or (preferably) by a general surgeon. There are times when the initial drainage procedure didn’t get to the pocket of infection, and more thorough drainage is needed.
Once I’ve had successful drainage, what do I do next?
This depends on a number of factors, including whether you have had a pilonidal abscess before, what the physical findings are once the drainage procedure has healed, and your personal philosophy about being proactive or having a “wait and see” approach. If this has been your first, and only, episode of pilonidal cyst infection, this web page will be useful: Pilonidal Disease with Minimal Symptoms. If you have had multiple pilonidal abscesses, or only one but want to be proactive prevent this from recurring, we recommend the cleft lift procedure. This link will bring you to a discussion about the cleft lift.
