Health Library

Pilonidal Cyst

Who Is Most Likely to Get a Pilonidal Cyst?

Most patients with pilonidal disease are teenagers and young adults of all genders. We do not know what causes one to have pilonidal disease, but there are some factors that may lead to one having this disease.

Some things that are common in people that have them are:

• Lots of coarse body hair, especially in the lower back / buttocks area
• Being overweight / obese
• Lots of sweating, especially in the buttocks area
• Pressure to the area, either from sitting too long or from wearing tight pants
• Someone else in the family has had pilonidal cysts
• History of irritable bowel disease or hidradenitis suppurativa

What Are the Symptoms of a Pilonidal Cyst?

• Pain in the crack or tailbone
• Drainage from the pores / holes

Redness or swelling in the crack. Open holes along the crack

Why Should You Visit the Doctor?

Most people ignore the first signs of an infected cyst (a small, hard, raised red  spot that could be sore or painful). They think it is similar to an acne pimple and will go away on its own. As the pilonidal bump gets bigger, it may become redder and / or progressively hurt more. The red area might break open and bleed or leak pus-like drainage. Your child may not have this area open and drain on its own. Your child may need to come into the hospital to get this area opened and drained, or what we call an incision and drainage of the pilonidal cyst. When this happens, the pain gets better or goes away, but a doctor still needs to treat the infection that caused the problem. If the doctor thinks that the area needs extra attention, they will send the patient to a surgeon. The opening and drainage of the pilonidal at home or in the hospital does not treat the patient with pilonidal disease. It temporarily treats the patient’s pain, infection and inflammation.

How Is a Pilonidal Cyst Treated?

The symptoms that you have and how long you have had them will help the doctor decide how to treat you. At first, you may start with:

• Antibiotics to treat the infection
• Warm soaks or warm compresses to help with the swelling and pain

If the spot still hurts, is swollen, open (with or without drainage), or needs special treatment, the doctor will tell you to see a surgeon. The hair in those sinus tracts or tunnels will continue to be below the skin until discussion about further surgical interventions with the surgeon. The surgeon may do any of the following:

• Shave the buttocks and crack / cleft and remove hairs from the pores / holes; they will tell you to do this weekly at home because hair removal is important.
• Obtain a photo of the area to monitor the changes and improvement with the holes/pores over time.
• Tell you to shower twice daily to keep the area clean.
• Keep you on the antibiotics you are already taking or change / add a new one
• Tell you to do warm soaks or warm compresses if there is pain and swelling in the area.
• Tell you to clean the area after having a bowel movement.
• Schedule surgery for a pilonidal minimal excision or a GIPS procedure or a wound debridement to clean out the area to make it healthy for healing. If more extensive surgery is needed, the surgeon may discuss the cleft lift procedure.

How Can You Prevent the Cyst from Coming Back?

To help keep the symptoms from coming back, you should:

• Wash area twice a day
• Shave or trim hairs from around the area every week
• Maintain a healthy weight
• Don’t sit for long periods of time
• Don’t wear tight or uncomfortable pants
• Don’t wipe stool / BM into the area

When Should You Call the Doctor Again?

Call the surgery office if any of these symptoms return after healing:

• Pain
• Redness
• Swelling
• Drainage
• Fever