Response to pilonidal query

A patient wrote, "I have a few questions for you which I was hoping you might answer:"

How and why do people like me keep developing sinuses again and again? Two answers--the buttocks fall together and seal close the cleft, much like the Zip-Lock on a re-sealable plastic bag, seals 24/7, creating a poorly drained anaerobic abscess which will not let surgical wounds in the cleft to heal. Second reason--more common in earlier disease, pits in the midline, enlarged hair follicles, continue to inject bacteria into underlying fat where bacteria generate abscesses--painful pus under pressure.
Is it a bad idea to wait till December to have another surgery? There are ways to get the problem likely solved by Sept 15--on the basis of your good photographs we likely would recommend a cleft lift operation.
I can probably get my internship shortened if need be.
Will the pain keep rising/stay constant, or is there ANYTHING

I can do
to alleviate it? e.g. If I stay off my backside for a couple of weeks,
will it get better? Not likely.
Am I allowed to exercise i.e. play soccer and squash, or is that bad
for the situation? Little difference
How do I remove the hair in that area because it is difficult to
reach? The hair removal creams say not to apply to perianal regions so
what other methods can I use? We have not found hair removal of much help. Some doctors do.
I received the list of cleft lift surgeons who do your procedure, but
do you know of any personally that have good records with this? No. Telephone calls to surgeons in your area are a nuisance for you but give much information
How effective is the cleft lift? It is usually the best way to fix
this problem? What is the recovery time associated with the cleft
lift, as I will have a maximum of 4 weeks in December of winter breaks
to get this taken care of? After Cleft Lift surgery 90% are ready to go back to class in 2-4 weeks--ready to fly cross country in 5-7 days.
If there is any other advice or information you could give me, I would
really appreciate it. Study the material at http://www.pilonidal.org/