A pilonidal cyst (pahy-luh-nayd-l sist) is a cavity or hole in the skin at the top part of your buttocks where the cheeks come together, at the cleft / crack. You may see lots of coarse hair stuck into the skin at this hole.

Anyone can get these cysts but white males, in their late teens or early 20s, get them more than others do. We do not know what causes them.

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 area, either from sitting too long or from wearing tight pants
  • Someone else in the family has had pilonidal cysts

Why Visit the Doctor

Most people ignore the first signs of an infected cyst (a small hard, red sore spot). They think it is similar to an acne pimple and will go away on its own. As the cyst gets bigger, it gets redder and hurts more. The red area might break open and bleed or leak pus-like drainage.

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 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
  • Sitz baths, warm soaks or warm compresses to help get rid of 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 surgeon may do any of the following:

  • Shave the site and remove hairs from the cavity; they will tell you to do this weekly at home
  • Keep you on the antibiotics you are already taking or change / add a new one
  • Tell you to do sitz baths, warm soaks or warm compresses
  • Have you clean the area with special soaps or wipes
  • Do an incision and drainage (minor surgery) to remove any hairs or pus-like drainage that would keep the spot from healing
  • Have you start doing dressing changes at home
  • Schedule surgery for a “cyst excision” (removal of the cyst) or another type of treatment

What to Do to Prevent Return Visits to the Surgeon

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

  • Wash area well and dry completely
  • 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 to Call the Doctor

Call the surgery office if any of these symptoms return:

  • Pain
  • Redness
  • Swelling
  • Drainage
  • Fever