A pilonidal cyst (pahy-luh-nayd-l sist) is a hole or a pore 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. Pilonidal in Latin means nest of hairs. Due to this, you may see coarse hair sticking up from the hole or pore along the crack. As the hair burrows into these shallow holes/pores, it creates a sinus tract beneath the skin. This sinus tract creates a tunnel under the skin lined with scar tissue filled with hair, inflammation and/or infection. The hair, inflammation and/or infection will continue to reoccur and flare up until the hair is removed and the infection and inflammation are managed and treated. Since this is a sinus tract or tunnel under the skin, there is no cyst sac to remove since the infection and hair are within this tract.

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

Symptoms of having 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 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.

Treatment

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.

What to Do to Prevent Return Visits to the Surgeon After Healing

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 to Call the Doctor

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

• Pain
• Redness
• Swelling
• Drainage
• Fever