How Are Pilonidal Cysts Treated?

Medically reviewed by: Gary H. Hoffman, MD

Pilonidal cysts are fairly common in men between the ages of 15 and 40. These cysts contain a combination of debris from the skin and hair, and are usually located near the tailbone or between the buttocks. They are typically located near the sacrum or tailbone.

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Because of their location and the moist, warm environment, these cysts often become infected. This is known as a pilonidal abscess, and requires medical or surgical treatment. Any signs of a pilonidal cyst should be evaluated by a doctor, because they commonly recur in people with certain risk factors.

What Are The Symptoms Of A Pilonidal Cyst?

Many pilonidal cysts are asymptomatic, especially if they have not yet become infected. Once bacteria begin to grow in the cyst, however, symptoms usually develop quickly. Most often, symptoms begin with discomfort or pain while sitting. Over time, the area begins to swell. Inflamed skin and elevated body temperature may point to a more advanced infection. In some cases, the cyst may rupture on it’s own, and there may be pus or bloody discharge. This can also lead to a foul odor.

What Can I Expect At The Doctor’s Office?

There are typically no tests run to determine if a pilonidal cyst exists. Many general practitioners and almost any proctologist will be able to diagnose an abscessed cyst through discussion of your symptoms and a simple visual exam. Because treating these infections early yields the best results, it is important to schedule an appointment as soon as symptoms develop.

In some cases, your doctor may refer you to a proctologist, a doctor with a specialty in colon and rectal disorders. These specialists are trained to treat pilonidal cysts with techniques that best reduce the chance of recurrence. They may also be used in cases where the cyst presents in an unusual way, and the diagnosis isn’t obvious.

Once your diagnosis is confirmed, the doctor will typically begin treatment during the same office visit. This may include draining the cyst, applying topical medications or giving you an antibiotic prescription.

How Will It Be Treated?

For most people who are suffering from their first pilonidal cyst, treatment requires little more than a quick procedure during their office visit, and following recommended hygiene and lifestyle protocols. The procedure used to drain an abscessed cyst involves simply numbing the area with topical anesthetic or a quick injection, and then making a small incision to allow the pus to drain. Antibiotics may then be prescribed to treat any remaining infection.

This treatment is enough for many, allowing the cyst to heal fully and all symptoms to disappear. Unfortunately, though, pilonidal cysts have a high recurrence rate. If the cyst returns, your doctor will most likely suggest surgical removal.

Surgery to remove a pilonidal cyst is fairly straightforward. It is almost always done as an outpatient procedure, no matter if general anesthesia or a local anesthetic is used. During the surgery, the cyst is removed using a scalpel, and the area around it is flushed with an antibiotic wash. Once this is complete, the wound can either be stitched closed or left open to heal naturally. If the wound is left open, the preferred method for many colon and rectal surgeons, it is usually packed with sterile gauze to help prevent infection.

The benefit of an open healing incision is that it heals as the body heals naturally, from the inside out. This allows for more complete healing, and a smaller chance of recurrence. If a closed incision is used, the healing time is greatly reduced, but the chance of recurrence is greatly elevated.

How Can I Prevent A Recurrence?

While what causes the cysts to develop in some people and not others has not been determined, they are closely related to hair follicles and ingrown hair. This is why men, with a much higher abundance of body hair than women, are more at risk. This is especially true of caucasian men with coarse hair. Because of the nature of their hair, they are more likely to develop pilonidal cysts than men of Asian or African descent. Removing the hair around the tailbone and intergluteal cleft can help reduce this risk. Your doctor will be able to recommend the most effective hair removal techniques.

In a study of 322 patients, other possible risk factors were found for the development of these cysts. According to the study published in the International Journal of Colorectal Disease, about half of these patients were clinically obese. Almost 45 percent had a sedentary job, and 38 percent had either a personal or a family history of the cysts. Between 30 and 35 percent had experienced irritation or trauma in the area shortly before their symptoms began.

Other factors that may play a role in the development and recurrence of pilonidal cysts include wearing tight clothing and poor personal hygiene. Washing regularly with antibacterial soap can reduce the risk. Activities that put direct pressure on the tailbone should also be minimized. This may include biking, riding a motorcycle and horseback riding.

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