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Pilonidal cyst spine. Pilonidal Cyst: Symptoms, Causes, and Treatment Options Explained

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What is a pilonidal cyst. How is it diagnosed. What are the treatment options for pilonidal cysts. When should you seek medical attention for a pilonidal cyst. How can you prevent pilonidal cysts from recurring.

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Understanding Pilonidal Cysts: A Comprehensive Overview

A pilonidal cyst, also known as a pilonidal sinus, is a small hole or tunnel in the skin located at the top of the buttocks, where they divide (the cleft). While often asymptomatic, these cysts can become problematic when infected, leading to discomfort and requiring medical intervention.

What Exactly is a Pilonidal Cyst?

A pilonidal cyst is essentially a cavity beneath the skin that can contain hair, debris, and other materials. The term “pilonidal” comes from the Latin words “pilus” (hair) and “nidus” (nest), aptly describing the nature of these cysts. They typically develop in the sacrococcygeal region, which is the area between the buttocks just above the tailbone.

How Common are Pilonidal Cysts?

Pilonidal cysts are relatively common, particularly among young adults. They tend to occur more frequently in men than women and are often seen in individuals who lead sedentary lifestyles or have occupations that involve prolonged sitting.

Recognizing the Symptoms of an Infected Pilonidal Cyst

While an uninfected pilonidal cyst may go unnoticed, an infection can cause a range of uncomfortable symptoms. Recognizing these signs is crucial for timely medical intervention.

What are the Tell-Tale Signs of an Infected Pilonidal Cyst?

  • Pain and swelling in the affected area
  • Redness and tenderness
  • Formation of a pus-filled abscess
  • Bleeding or discharge from the site
  • Foul odor emanating from the cyst

These symptoms often develop rapidly, sometimes within a matter of days. If you experience any of these signs, it’s important to consult a healthcare professional promptly.

Causes and Risk Factors of Pilonidal Cysts

Understanding the underlying causes and risk factors associated with pilonidal cysts can help in prevention and management of this condition.

What Causes Pilonidal Cysts to Form?

The exact cause of pilonidal cysts is not fully understood, but several factors are believed to contribute to their formation:

  1. Ingrown hair: When hair grows back into the skin or is forced into the skin due to friction, it can lead to cyst formation.
  2. Trauma or injury to the area: Repetitive pressure or friction in the sacrococcygeal region can cause skin irritation and cyst development.
  3. Hormonal changes: Hormonal fluctuations during puberty may increase the likelihood of cyst formation.
  4. Genetic predisposition: Some individuals may be more prone to developing pilonidal cysts due to their genetic makeup.

Who is at Higher Risk for Developing Pilonidal Cysts?

Certain factors can increase an individual’s susceptibility to pilonidal cysts:

  • Age: Pilonidal cysts are most common in young adults between the ages of 20 and 35.
  • Gender: Men are more likely to develop pilonidal cysts than women.
  • Obesity: Excess weight can create deeper skin folds, increasing the risk of cyst formation.
  • Sedentary lifestyle: Prolonged sitting can exert pressure on the tailbone area, potentially leading to cyst development.
  • Excessive body hair: Individuals with coarse or abundant body hair may be more susceptible to pilonidal cysts.
  • Poor hygiene: Inadequate cleansing of the area can contribute to cyst formation.

Diagnosis and Medical Assessment of Pilonidal Cysts

Accurate diagnosis of a pilonidal cyst is crucial for determining the most appropriate treatment approach. Healthcare providers employ various methods to assess and confirm the presence of a pilonidal cyst.

How are Pilonidal Cysts Diagnosed?

The diagnostic process for pilonidal cysts typically involves the following steps:

  1. Physical examination: A healthcare provider will visually inspect the affected area and may gently palpate it to check for tenderness or swelling.
  2. Medical history: The doctor will inquire about symptoms, their duration, and any previous occurrences of similar issues.
  3. Imaging tests: In some cases, an MRI or ultrasound may be ordered to determine the extent of the cyst and rule out other conditions.

In most instances, a pilonidal cyst can be diagnosed through a physical examination alone. However, additional tests may be necessary if there are complications or if the diagnosis is uncertain.

Treatment Options for Pilonidal Cysts: From Conservative to Surgical Approaches

The treatment of pilonidal cysts depends on various factors, including the severity of symptoms, the size of the cyst, and whether it’s a recurring issue. Let’s explore the range of treatment options available.

Conservative Management for Uninfected Pilonidal Cysts

If a pilonidal cyst is not infected, a “watch and wait” approach may be recommended. This involves:

  • Maintaining proper hygiene of the affected area
  • Regular showering or bathing
  • Avoiding shaving the area unless advised by a healthcare provider

Treatment for Infected Pilonidal Cysts

When a pilonidal cyst becomes infected, more active intervention is necessary. Treatment options include:

  1. Antibiotics: To combat the infection and reduce inflammation
  2. Pain management: Painkillers such as paracetamol and anti-inflammatories may be prescribed
  3. Incision and drainage: A minor surgical procedure to drain the abscess

Surgical Interventions for Recurrent or Severe Pilonidal Cysts

For persistent or severe cases, surgical options may be considered:

  • Wide excision and open healing: The cyst is removed along with surrounding skin, and the wound is left open to heal naturally
  • Excision and wound closure: The cyst is removed, and the wound is closed with stitches
  • Endoscopic ablation: A minimally invasive procedure using an endoscope to clean and seal the sinus
  • Plastic surgery: For large affected areas, reconstructive techniques may be employed

Each surgical approach has its own benefits and potential drawbacks, which should be discussed thoroughly with a healthcare provider.

Recovery and Aftercare Following Pilonidal Cyst Treatment

Proper post-treatment care is essential for successful healing and prevention of recurrence. The recovery process and aftercare instructions may vary depending on the type of treatment received.

What to Expect During Recovery?

Recovery times can range from a few weeks to several months, depending on the treatment method:

  • Incision and drainage: 4 to 6 weeks
  • Wide excision and open healing: 6 to 12 weeks
  • Excision and wound closure: Quicker than open healing, but with a higher risk of infection
  • Endoscopic ablation: About a month for complete healing

Essential Aftercare Tips

To promote healing and prevent complications, follow these aftercare guidelines:

  1. Keep the affected area clean and dry
  2. Change dressings regularly as instructed by your healthcare provider
  3. Wear loose-fitting, comfortable cotton underwear
  4. Consume a high-fiber diet to promote regular bowel movements
  5. Avoid strenuous activities or prolonged sitting during the initial recovery period
  6. Attend follow-up appointments to monitor healing progress

Preventing Recurrence: Long-Term Management of Pilonidal Cysts

While treatment can resolve an active pilonidal cyst, taking preventive measures is crucial to reduce the risk of recurrence.

How Can You Prevent Pilonidal Cysts from Recurring?

Implement these strategies to minimize the chances of cyst recurrence:

  • Maintain good hygiene: Regular cleaning of the buttocks area is essential
  • Hair removal: Consider laser hair removal or other methods to reduce hair in the affected area
  • Weight management: Maintain a healthy weight to reduce pressure on the tailbone region
  • Avoid prolonged sitting: Take regular breaks and use cushions designed to reduce pressure on the tailbone
  • Wear appropriate clothing: Choose loose-fitting, breathable underwear and pants

When to Seek Medical Attention?

Be vigilant for signs of recurrence or complications. Consult a healthcare provider if you experience:

  • Pain, swelling, or redness in the affected area
  • Drainage or bleeding from the site
  • Fever or other signs of infection
  • Persistent discomfort or changes in the healing process

Early intervention can prevent minor issues from escalating into more serious complications.

Living with Pilonidal Cysts: Impact on Quality of Life and Coping Strategies

Pilonidal cysts can significantly affect an individual’s daily life, both physically and emotionally. Understanding these impacts and developing effective coping strategies is crucial for maintaining overall well-being.

How Do Pilonidal Cysts Affect Daily Life?

The presence of a pilonidal cyst can impact various aspects of life:

  • Physical discomfort: Pain and tenderness can make sitting or certain movements challenging
  • Work and school: Symptoms may interfere with productivity or attendance
  • Social interactions: Embarrassment or self-consciousness about the condition may affect social activities
  • Personal relationships: Intimate relationships may be affected due to discomfort or self-image issues
  • Mental health: Dealing with a chronic or recurring condition can lead to stress, anxiety, or depression

Coping Strategies for Living with Pilonidal Cysts

Implementing these strategies can help manage the physical and emotional challenges of pilonidal cysts:

  1. Education: Learn about the condition to better understand and manage it
  2. Support groups: Connect with others who have similar experiences
  3. Stress management: Practice relaxation techniques or mindfulness to reduce stress
  4. Lifestyle modifications: Adapt daily routines to minimize discomfort and prevent flare-ups
  5. Open communication: Discuss concerns with healthcare providers, family, and friends
  6. Pain management: Explore both medical and alternative methods for pain relief

By adopting these coping mechanisms, individuals can improve their quality of life while managing pilonidal cysts effectively.

Pilonidal sinus – NHS

A pilonidal sinus is a small hole or tunnel in the skin at the top of the buttocks, where they divide (the cleft). It does not always cause symptoms and only needs to be treated if it becomes infected.

Check if you have an infected pilonidal sinus

Most people with a pilonidal sinus do not notice it unless it becomes infected and causes symptoms.

An infection will cause pain and swelling, and a pus-filled skin abscess can develop.

See what an infected pilonidal sinus looks like

An infected pilonidal sinus is red, painful and may bleed or leak pus

Credit:

GIRAND/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/127112/view

Non-urgent advice: See a GP if:

  • you have a small lump at the top of your bottom (between your buttocks) that’s painful, red, bleeding or leaking pus

These symptoms can develop quickly, often over a few days. They’re signs of infection and need to be treated.

A pilonidal sinus that’s not infected

Treatment is not needed if there are no signs of infection. A “watch and wait” approach will be recommended.

It’s very important to keep the area between your buttocks clean by showering or bathing regularly.

Do not shave the affected area unless a GP advises you to.

Treatments for an infected pilonidal sinus

Treatment for an infected pilonidal sinus will depend on:

  • your symptoms
  • the size of the sinus
  • whether it’s your first sinus or it keeps coming back

A pilonidal sinus abscess will need treatment with antibiotics. The pus inside will also probably need to be drained.

There are a number of treatment options for a pilonidal sinus that keeps coming back and that’s painful, bleeding or leaking discharge. Your doctor will discuss these with you.

In most cases you’ll be offered painkillers, such as paracetamol and anti-inflammatories to help reduce pain and swelling.

Minor operation to drain pus from sinus

Incision and drainage

Hospital procedure for an uncomplicated abscess. A small hole is made in the abscess so the pus can be drained.

  • general anaesthetic or local anaesthetic, depending on the size of the abscess
  • hospital stay (you can leave the same day)
  • regular (daily) dressing changes
  • recovery time is 4 to 6 weeks

Surgery to remove sinus (wound left open)

Wide excision and open healing

Surgery for a large or repeatedly infected sinus. The sinus is cut out and some surrounding skin removed. The wound is left open to heal naturally.

  • general anaesthetic
  • hospital stay (you can usually leave the same day)
  • regular (daily) dressing changes
  • lowest risk of sinus coming back
  • recovery time is 6 to 12 weeks

Surgery to remove sinus (wound closed)

Excision and wound closure, often with flattening of the groove between the buttocks

Surgery for a large or repeatedly infected sinus. The sinus is removed and an oval-shaped flap of skin cut out on either side of it. The 2 sides are stitched together.

  • general anaesthetic
  • hospital stay (you can usually leave the same day)
  • stitches removed about 10 days after the operation
  • quicker recovery time than wide excision and open healing
  • higher risk of infection (the wound may need to be opened and dressings changed regularly)

Procedure to clean sinus and encourage healing

Endoscopic ablation for a pilonidal sinus

An endoscope (a thin, flexible tube with a camera on the end) is used to give a clear view of the affected area.

Hair and infected tissue are removed, and the sinus cleaned with a special solution. Heat is used to seal the sinus.

  • spinal or local anaesthetic
  • hospital stay (you can usually leave the same day)
  • less invasive than surgery as no cut needed
  • good success rate with low risk of complications
  • recovery time is about a month to completely heal (but can be quicker)

Plastic surgery is sometimes used if the area being treated is particularly large. The sinus is removed and the surrounding skin reconstructed.

Less invasive procedures, like injection with fibrin glue, are also available in some places.

Follow-up

You’ll have a follow-up appointment with your specialist after your surgery. This is usually about 6 weeks later, but may be slightly longer.

What to do after your operation

Do

  • keep the affected area clean

  • wear comfortable, loose-fitting cotton underwear

  • eat plenty of fibre to make going to the toilet easier and avoid straining

Don’t

  • do not lift heavy objects or do strenuous exercise for the first week or so

  • do not ride a bike for 6 to 8 weeks

  • do not go swimming until your wound has completely healed

How soon you can return to work depends on:

  • the procedure you had
  • how quickly you recover
  • the type of job you do

Most people are able to return to work within 2 weeks of surgery.

Your surgeon will be able to give you more advice about your recovery.

Causes of pilonidal sinus

It’s not clear what causes a pilonidal sinus.

A skin problem, pressure or friction may cause hair between the buttocks to be pushed inwards.

This may either be hair growing around the buttock area, or loose hair shed from the buttocks or elsewhere that gathers around the buttock cleft and enters the pilonidal sinus.

Pilonidal sinuses are more common in men because they tend to be hairier.

Sitting for long periods can also increase your chances of getting a pilonidal sinus.

Page last reviewed: 11 December 2020
Next review due: 11 December 2023

Symptoms, Causes, Diagnosis, Treatment, Surgery

Written by WebMD Editorial Contributors

  • What Causes a Pilonidal Cyst?
  • Symptoms
  • When Should I Call a Doctor?
  • Diagnosis
  • What Can I Do to Feel Better?
  • Treatments
  • After Surgery
  • More

There’s a type of cyst you can get at the bottom of your tailbone, or coccyx. It’s called a pilonidal cyst, and it can become infected and filled with pus. Once infected, the technical term is “pilonidal abscess,” and it can be painful.

It looks like a large pimple at the bottom of your tailbone. It is more common in men than in women. It usually happens more often in younger people.

People who sit a lot, such as truck drivers, have a higher chance of getting one.

They can be treated. If your cyst becomes a problem, your doctor can drain it or take it out through surgery.

Most doctors think that ingrown hairs are the reason for many of them. Pilonidal means “nest of hair,” and doctors sometimes find hair follicles inside the cyst.

Another theory is that pilonidal cysts appear after a trauma to that region of your body.

During World War II, more than 80,000 soldiers got pilonidal cysts that put them in the hospital. People thought they were because of irritation from riding in bumpy Jeeps. For a while, the condition was called “Jeep disease. “

You might be more likely to get one if you were born with a small dimple in the skin between your buttocks. This dimple can tend to get infected, though doctors aren’t exactly sure why.

Other risk factors include obesity, large amounts of hair, not enough exercise, prolonged sitting, and excessive sweating.

The symptoms of a pilonidal cyst include:

  • Pain, redness, and swelling at the bottom of the spine
  • Pus or blood draining out of it
  • Bad smell from the pus
  • Tenderness to the touch
  • Fever

They can vary in size. Yours may be a small dimple or cover a large, painful area.

A pilonidal cyst is an abscess or boil. Treatment may include antibiotics, hot compresses and topical treatment with depilatory creams. In more severe cases it needs to be drained, or lanced, to heal. Like other boils, it does not get better with antibiotics.

If you have any of the symptoms, call your doctor.

Your doctor can diagnose a pilonidal cyst with a physical exam and by asking you questions about it. Among the things they may ask you:

  • When did you first feel symptoms?
  • Have you had this problem before?
  • Have you had a fever?
  • What medications or supplements do you take?

Early in the infection of a pilonidal cyst, the redness, swelling, and pain may not be too bad. Some things you might want to try:

  • To ease any pain, soak in a tub of warm water. Sometimes, your cyst may open and drain on its own this way.
  • Take nonprescription pain medicine, but follow the dosing instructions.
  • Keep the cyst and area around it clean and dry.

Antibiotics do not heal a pilonidal cyst. But doctors have any number of procedures they can try. Here are some options:

Incision and drainage: This is the preferred method for a first pilonidal cyst. Your doctor makes a cut into the cyst and drains it. They remove any hair follicles and leaves the wound open, packing the space with gauze.

Advantage — It’s a simple procedure done under local anesthesia, meaning just the area around the cyst is numbed.

Disadvantage — You have to change the gauze often until the cyst heals, which sometimes takes up to 3 weeks.

Marsupialization: In this procedure, your doctor makes a cut and drains the cyst, removing pus and any hair that are inside. They’ll sew the edges of the cut to the wound edges to make a pouch.

Advantages — This is outpatient surgery under local anesthesia. It also lets the doctor make a smaller, shallower cut so that you don’t need to take out and repack gauze daily.

Disadvantages — It takes about 6 weeks to heal, and you need a doctor specially trained in the technique.

Incision, drainage, closing of wound: In this technique, the cyst is drained, but it’s not left open.

Advantage — You don’t need to pack gauze because your doctor fully closes the wound right after surgery.

Disadvantages — You’re more likely to have more problems with the cyst down the road. It’s harder to remove the entire cyst with this method. It’s usually done in an operating room with a specially trained surgeon.’

Other surgical procedures include complete cyst and cyst wall excision along with the pilonidal sinus tracts, the use of fibrin glue, and taking (core out) only diseased tissue and the cyst out with punch biopsies.

Follow all of your doctor’s instructions about at-home care, especially if you need to remove and pack gauze. Other tips:

  • Try to keep the area clean.
  • Check for any signs of a new infection, such as redness, pus, or pain.
  • Keep your follow-up appointments with your doctor so they can see how your cyst is healing.

A complete cure is possible, but remember that a pilonidal cyst may recur even if you had one surgically removed.

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Pilonidal cyst – article

Pilonidal cyst, epithelial pilonidal cyst – a congenital disease, the formation of a cystic cavity from skin cells in the projection of the coccyx and sacrum. It can fester and externally manifests itself as an infiltrate or abscess.

Epithelial coccygeal passage – a congenital epithelial immersion in the sacrococcygeal region – outwardly manifests itself as a depression, a funnel, a passage from which hair often stands out. The epithelial coccygeal passage is subject to inflammation. Often inflammation and suppuration are repeated. Purulent fistulas may form.

Epithelial coccygeal cysts and moves must be operated on.

We operate on such patients in different ways, depending on the specific situation of the individual manifestation of coccygeal cysts and passages. The meaning of operations is to radically remove the affected tissues, which will avoid relapses. We use methods of radio wave surgery and author’s methods of treatment.

The author of the article:

Ivanova Natalya Vladimirovna

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