Pilonidal cyst treatment depends on how severe the problem is. Mild cases may calm down with careful hair removal and skin care, an infected abscess needs to be drained, and long-lasting or repeat disease often needs surgery to remove the tracts under the skin. Healing can take anywhere from a few weeks to a few months, depending on the procedure.

What is a pilonidal cyst?

A pilonidal cyst is an inflamed pocket under the skin at the top of the buttock crease, just above the tailbone.

Doctors often call it pilonidal disease or a pilonidal sinus. Loose hairs and skin debris get pushed into the skin and form tiny openings called pits. The body treats the hair like a splinter. This can lead to swelling, infection, and tunnels (tracts) under the skin.

A pilonidal cyst is not cancer and is not contagious. But it can be painful, and it often comes back if it is not treated fully.

Who gets pilonidal disease?

It is most common in young adults, especially men, but anyone can develop it.

Things that raise the chance of pilonidal disease include:

• Thick or coarse body hair
• A deep crease between the buttocks
• Sitting for long periods, such as for driving, desk work, or school
• Extra body weight
• A family history of pilonidal disease

In a large city like Houston, long commutes and desk jobs mean many people spend hours sitting each day, which adds pressure and friction to this area.

What are the symptoms of a pilonidal cyst?

The most common symptoms are pain and swelling near the tailbone, often with drainage.

• Pain at the top of the buttock crease, often worse when sitting
• Redness, warmth, or a tender lump
• Drainage of pus or blood, sometimes with a bad smell
• One or more small holes (pits) in the middle of the crease
• Fever, if an abscess has formed

A swelling that gets bigger and more painful quickly, or that comes with fever, should be checked soon.

Can a pilonidal cyst go away on its own?

Some mild cases calm down with hair removal and good hygiene, but symptoms often return if the tracts under the skin stay in place.

Guidelines from the American Society of Colon and Rectal Surgeons (ASCRS) say that pilonidal disease without an abscess is best managed first with regular shaving or other hair removal, such as laser hair removal. Keeping the area clean and dry also helps. Please do not squeeze or try to pop a pilonidal cyst. This can push infection deeper.

How is an infected pilonidal abscess treated?

An abscess is usually drained in a short procedure using numbing medicine.

A small cut lets the pus out, which relieves pressure and pain quickly. Antibiotics are sometimes added if infection is spreading into the nearby skin. Drainage treats the infection, but it does not always remove the tracts. Some people need a planned surgery later to lower the chance of it coming back.

What surgery options are there for chronic or recurring pilonidal disease?

Surgery removes the infected pits, cyst and tracts. The main difference between techniques is how the wound is handled afterward.

• Excision left open: The wound is left open and heals slowly from the inside out. This avoids trapping infection under the skin. It needs regular dressing care and takes longer to heal, but there are no stitches to break open. This is the approach Dr. Belizaire uses most often.
• Excision with stitched closure: The wound is stitched closed. It can seem faster at first, but wounds stitched in the middle of the crease often break open, and take just as long to heal as wounds that were left open from the start.
• Other techniques: Flap procedures that move the scar off the midline, and smaller procedures that treat only the pits, are used in some cases.

The best choice depends on the degree of inflammation or infection, how many pits and tracts there are, whether the disease has come back before, and your daily life.

How long does it take to heal after pilonidal surgery?

Open wounds usually take several weeks to a few months to fully heal, while closed wounds often heal in about 2 to 4 weeks. Many people return to desk work within 1 to 2 weeks. Jobs that are more physical, or more pain, can mean more time off.

Until the wound is fully healed, it is best to avoid long periods of sitting and hard exercise. Helpful habits include:

• Keeping the area clean and dry
• Following your dressing and wound care instructions
• Keeping hair removed around the area
• Using a cushion and changing positions often
• Going to all follow-up visits so the wound can be checked

Can pilonidal disease come back after treatment?

Yes. Pilonidal disease can return, even after surgery, which is why choosing the right procedure and keeping up with hair control both matter.

Studies show that recurrence rates vary a lot from one technique to another. Ongoing hair removal after healing may help lower the risk. If symptoms return, a colorectal surgeon can review what was done before and suggest next steps.

Why see a colorectal surgeon for a pilonidal cyst?

Colorectal surgeons are trained in the anatomy of this area and in the full range of pilonidal treatments, from simple drainage to more complex repairs.

ASCRS publishes guidelines specifically on pilonidal disease, and these guide treatment choices. Dr. Ritha Belizaire, a double board-certified colorectal surgeon in Houston, evaluates and treats pilonidal disease, including first-time and recurrent cases.

If you are trying to decide who to see, this guide on how to choose a colorectal surgeon in Houston may help. If you have already had surgery and the problem returned, you can also learn about getting a second opinion. For tips on getting ready for a procedure, see how to prepare for colorectal surgery.

Frequently Asked Questions

Is a pilonidal cyst dangerous?

It is usually not dangerous, but it can be very painful and keep coming back. An untreated abscess can spread infection, so a swollen, painful lump with fever should be checked soon.

Should I pop or squeeze a pilonidal cyst?

No. Squeezing can push bacteria deeper and make the infection worse. A doctor can drain it safely.

Can laser hair removal help?

Hair removal, including laser hair removal, is recommended by ASCRS for mild disease and may help lower the chance of the problem returning after treatment.

Can I sit after pilonidal surgery?

You can usually sit for short periods, ideally on a cushion. Long sitting is best avoided until the wound has healed. Your surgeon will give you specific guidance.

Why would my surgeon leave the wound open?

Wounds in the middle of the buttock crease are under a lot of pressure and often break open when stitched. Leaving the wound open lets it heal from the inside out.

Request a consultation

If you have pain, swelling, or drainage near your tailbone, you do not have to keep living with it. You can request a consultation with Dr. Belizaire at houstoncommunitysurgical.com to talk through your options.

Sources

• Johnson EK, et al. The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum. 2019.
• Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment. (NIH PubMed Central)
• The Management of Pilonidal Sinus. (PubMed)