How Can I Reduce the Risk of Pilonidal Cyst Recurrence?

Medically reviewed by: Gary H. Hoffman, MD

Pilonidal cysts can be painful. Unfortunately, they also are often a chronic problem. When one of these pockets of hair, skin and other debris becomes infected, the result is often a hot, throbbing area near the tailbone between the buttocks. They are easily treated through draining the infection or surgical removal, but — for those who are at risk of developing these infected pockets – they are likely to recur again in the future.

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Who is Most Likely to Develop These Cysts?

Age, gender and ethnicity all play a role in a person’s risk of developing a pilonidal cyst. Generally, they are most commonly seen in younger men who have a large amount of body hair. Pilonidal cysts tend to run in families, most likely because of the common factors such as ethnicity and hair texture that are passed from father to son.

While there is no definitive answer about what causes pilonidal cysts and sinuses, there is some proof that a hair growing into the skin can kick start the process. Some patients also report a trauma to the area before the cyst becomes symptomatic.

Pilonidal sinus disease almost always affects those between the age of 13 and 45. Most commonly, men in their late teens to early 20s report symptoms of this type of cyst to their doctors. These cysts rarely occur in seniors, and only occasionally in people between the ages of 45 and 65 years.

Other factors which could play a role include poor personal hygiene, obesity and occupations or hobbies where extended sitting is required. Truck drivers and cyclists often suffer from pilonidal cysts. Tight clothing such as bicycle shorts may also contribute.

How are Pilonidal Cysts Diagnosed and Treated?

Pilonidal cysts are typically diagnosed visually, in conjunction with a health history of the patient. Most experienced colon and rectal specialists will recognize the epithelial track that is characteristic of this disease, especially when it occurs in its usual place near the top of the cleft of the buttocks.

If a pilonidal cyst is infected, which is common among symptomatic cysts, the first line treatment is normally a course of broad-spectrum antibiotics. In some cases, the cyst will also require draining. This is usually done in the doctor’s office, by opening the sinus and rinsing it out. While this can be effective, surgeons often recommend excision for those with a high risk of developing pilonidal cysts.

During a pilonidal cystectomy, the surgeon removes the cyst and a small area around it. This is done in as an outpatient procedure by a colon and rectal surgeon. Depending on your particular symptoms and risk factors and your doctor’s preference, your wound may be left open and packed with gauze, or stitched closed. Each method has advantages and disadvantages, so you may want to discuss your surgery with your doctor in advance to learn which one best suits your needs.

How Likely are Pilonidal Cysts to Recur?

Some people undergo treatment for their pilonidal cysts, and never have another issue. However, as many as 20 percent of patients experience at least one recurrence. These cysts can recur within the first six months after treatment, or as many as 20 years later.

In most cases, early problems after treatment are not actually a recurrence but rather unhealed sinuses or additional cysts that were unseen by the diagnosing doctor. A true recurrence usually becomes symptomatic between six months and four years after treatment. They are typically caused by the same factors that contributed to the development of the first cyst.

Does Surgery Reduce the Recurrence of Pilonidal Cysts?

One reason a pilonidal cystectomy is preferred over simply draining the infection is because surgery does reduce the risk of pilonidal cyst recurrence. Still, statistics show that about 20 percent of people who undergo a cystectomy experience a recurrence. For some, these cysts become chronic issues and require repeated operations.

There is some difference in the risk of recurrence based on how the pilonidal cystectomy is performed. About 30 percent of patients in one study whose incision was stitched closed experienced a recurrence. The same study showed on a 17 percent recurrence rate among those whose wound was left open and allowed to heal naturally.

How Can I Reduce the Risk of Recurrence?

Some people swear by laser hair removal in order to reduce the number and coarseness of hair in the area, but there are few studies showing the effectiveness of hair removal efforts in reducing the risk of developing pilonidal cysts.In fact, shaving the area may actually increase the risk of recurrence in most patients. For this reason, it is best to always follow your surgeon’s recommendations.

The bottom line is that there are no proven ways to eliminate the risk of pilonidal cyst recurrence. The advice on how you can reduce your risk varies from doctor to doctor, but most agree that  there are few reliable ways aside from seeking proper diagnosis and treatment as soon as you begin experiencing symptoms, undergoing a pilonidal cystectomy, and following the doctor’s advice for proper healing.

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