Pilonidal Cyst 2018-02-15T10:58:13-05:00


Pilonidal Cyst

Having a pilonidal cyst can be extremely painful. Pilonidal cysts occur at the bottom of the tailbone and are close to one of the hairiest places on your body. Hair easily gets embedded in what is known as your “natal cleft”. The presence of hair in the natal cleft causes a reaction that can lead to inflammation and possibly infection. When the cyst needs to be removed, a pilonidal cystectomy is needed.

Causes of a Pilonidal Cyst

Most doctors think that ingrown hairs are what cause a pilonidal cyst to form. Pilonidal means “nest of hair.” If you have increased friction, abrasion, or hair in that area.

If you feel feverish, are experiencing pain, swelling, and redness at the bottom of your spine, and notice pus draining, it is likely that you have a pilonidal cyst and not a pimple as sometimes commonly assumed.  Like all boils, a pilonidal cyst will not go away with antibiotics. It is an abscess and needs to be lanced or drained by a physician.

Checking for Pilonidal Cysts

A doctor can diagnose your pilonidal cyst with a couple of physical checks and a possible blood sample. Typically your doctor will check the area affected by the pilonidal cyst for tenderness, redness, and swelling. They will most likely take your temperature to check for fever.

Early on in your infection, soaking in a warm tub may help with the pain and hopefully prevent the cyst from developing to the point where drainage is needed. Under no circumstances are you to attempt to drain your cyst on your own. This is dangerous because it can lead to a staph infection.

Treating Pilonidal Cysts

Your doctor can perform a variety of procedures to treat your cyst. The three most established methods are:

  • Incision and Drainage: Your doctor will put you under local anesthesia, make an incision, and drain the cyst. The hair follicles are removed, and the cavity that was once holding the cyst is packed with gauze. With this procedure you need to be sure you are changing your gauze packing frequently, and until the cyst is healed. This can take up to three weeks sometimes.
  • Marsupialization: A doctor will make an incision, drain the wound and remove all the pus and hair, and sew the edges of the fibrous tract to the edges of your wound. This creates a pouch. It requires about six weeks to heal fully, but there is not as much of a chance of re-infection because you don’t need to change any gauze regularly but still minimizes the size and depth of your pilonidal cyst.
  • Incision and Drainage (Surgical): The wound is completely closed right away without the need for gauze. However, there is a high rate of recurrence, since it is hard to remove the entire cyst it may come back.

Post-Op Expectations

After surgery to drain a pilonidal cyst, you will need to do as many follow-ups with the doctor, as well as follow-ups with yourself and your behavior or hygiene. At all costs, avoid repetitive physical activity. Activities that involve running, friction, and twisting should also be avoided. You will also benefit from making sure you sleep on your stomach or on one side until the wound heals. Obviously, hygiene is of paramount importance when recovering from a cyst or abscess of any kind, but in a place as sensitive, unique, and dirty as the area under your tailbone and above your anus, you need to keep the proper hygiene going. Talk to your doctor about hygiene and how it affects your health. If you have a significant amount of hair in that area, you may benefit from hair removal techniques.

The follow-up appointments with your doctor depend on the type of procedure they performed with you. Generally you will need to follow up with your doctor within two weeks and then as needed. Daily wound care may be required. This involves packing the wound with clean gauze and covering it with tape or tight underwear.

Dealing with a pilonidal cyst can literally be a pain in the backside. But, with a proper routine, rest, and following your doctor’s instructions, you can make a full recovery.


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