Do I Have A Pilonidal Cyst?

Medically reviewed by: Gary H. Hoffman, MD

While most pilonidal cysts don’t have any symptoms, once they become infected they are hard to ignore. Most people get the first hint that something is wrong “back there” due to discomfort while they are sitting. This discomfort, over a few days, may become intense pain that makes them weary of sitting down. Activities such as riding a bicycle are extremely uncomfortable.

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Near the tailbone, pain and swelling often occurs as the infection builds. The skin becomes inflamed. The area may feel warm, or you may run a fever. If the cyst begins to drain on its own, you may also see pus and bloody discharge. These are all signs that you should make an appointment with your doctor. For most people, treatment for an infected pilonidal cyst is quick and effective.

What Causes Pilonidal Cysts?

Most pilonidal cysts are found near the tailbone, either at the top of the intergluteal cleft or within the cleft itself. Due to the nature of these cysts and their location, they are at a high risk of becoming infected and inflamed. This can be extremely painful. Luckily, though, they are usually fairly easy to treat if caught early.

Men, especially those who have thick, coarse body hair, are more likely to develop pilonidal cysts than women. This is because these cysts are related to problems surrounding hair follicles or ingrown hairs. While this risk factor is difficult to control, there are a number of risk factors for pilonidal cysts that can be managed with lifestyle changes. These include being sure to follow proper personal hygiene, maintaining a healthy weight, refraining from wearing tight clothing, and reducing the time spent sitting. Because of the role pressure plays in the development of pilonidal cysts, those who sit for extended periods of time at work may struggle to prevent them. This includes truck drivers and office workers. Riding a bicycle or horse frequently may also increase your risk.

How Are Pilonidal Cysts Diagnosed?

If you believe you may have a pilonidal cyst, is important to schedule an appointment with your healthcare provider. The sooner these cysts are treated, the less likely they are to develop a serious infection or to recur after the initial treatment. Because of their location, these cysts often become infected very quickly. The warm, moist environment allows bacteria to thrive, which often leads to a painful and dangerous abscess.

In most cases, your general practitioner will be able to diagnose a minor pilonidal cyst through a visual exam. If it becomes severely infected or recurs after initial treatment, though, you will most likely be referred to a colon and rectal specialist. Also known as a proctologist, these experts are specially trained in techniques that can offer you the best chance at quick healing and reduce your risk of recurrence.

How Are Pilonidal Cysts Treated?

For most people, treatment for a pilonidal cyst can be done during the office visit when the condition is diagnosed. The doctor will apply either a topical anesthetic or inject a small amount of anesthetic into the area, and then make a small incision to allow the cyst to drain. In many cases, the pain is immediately relieved. The area will then be cleaned thoroughly to prevent further infection.

Some infected cysts drain on their own, especially if treatment is delayed. A small hole known as a sinus develops between the cyst and the skin, allowing the pus and other fluids to drain from the abscess. This usually relieves pain and swelling, but it is important to still see a doctor to be sure the cyst drained completely.

How Are Pilonidal Cysts Surgically Removed?

Pilonidal cysts are notorious for recurring, despite treatment. If infections become a chronic problem, most specialists recommend surgical removal. There are several ways surgery to remove the cysts can be approached. In almost all cases, however, the surgery is done as an outpatient procedure and patients return home the same day. The time it takes to recover fully depends on how the wound is managed during the procedure, but can vary from several weeks to about eight weeks.

Some doctors prefer to perform pilonidal cyst surgery under general anesthesia, while others rely on IV sedation and local anesthetic. This decision may also be based on your particular case, such as risk factors that could cause complications when general anesthesia is used. You can discuss the benefits and possible side effects of each with your surgeon based on the specifics of your individual needs.

The way the incision is managed after surgery can also vary based on your doctor’s preference and the specific details of your case. If you are at a high risk of recurrence, your wound may be left open and be packed with sterile gauze. This will allow it to heal naturally, from the inside toward the surface of the skin. Some surgeons prefer this approach to all pilonidal cyst incisions. The healing process takes longer, but ultimately the healing may be more reliable.


If you are at a low risk of recurrence with no risk factors for wound infection, your surgeon may choose to close the incision with stitches. This will speed healing, but may have a greater risk of recurrence than a wound that is allowed to heal naturally. In addition, the incision may have to be reopened if an infection occurs. If this happens, it will be packed with a sterile dressing and allowed to heal as an open wound.

Los Angeles Colon and Rectal Surgical Associates

The board certified surgeons of Los Angeles Colon and Rectal Surgical Associates are experts on pilonidal cyst diagnosis and treatment, including surgical removal. They are specialists in all diseases of the colon, rectum and anus. By calling (310) 273-2310, you can schedule a confidential appointment and discuss any of your questions with your physician.

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