Pilonidal Disease

Pilonidal disease appears in several forms. The disease is characterized by one or more pits or openings located in the midline between the buttocks. In its quiet form, it is known as a pilonidal cyst or sinus. In its active form, patients may have a pilonidal abscess, or collection of pus. In both cases, the sinuses lead deep into the midline buttock tissue, to a cavity (the pilonidal cyst) which is located next to the tail bone. The cavity may contain hairs and infected material.

It is not known if the pilonidal cyst is present at birth (congenital) or develops over time due to infected hairs. Often, tight clothing around the buttocks or physical activities, such as cycling or horse-back riding may irritate the area and lead to an infection. Most commonly, the disease is asymptomatic.

Treatment of Pilonidal Disease

In many cases pilonidal disease can be easily treated by keeping the affected area clean using antibacterial soap. Treating the irritated abscess with an alcohol swab several times a day often relieves much of the associated discomfort. Attention to personal hygiene is helpful and should focus on keeping the area shaved and free of hair. In more extensive cases, antibiotics may be used in an effort to control the early infection. In the extreme, the infected cyst must be opened to allow for drainage, or the entire area must be removed surgically.

Treatment depends on the severity of discomfort and infection. Your physician will determine the best treatment for your clinical situation. There are two types of surgical procedures available to treat pilonidal disease; incision and drainage or excision of the pilonidal cyst.

    • Incision and Drainage: An incision and drainage is performed with the use of a local anesthetic. This is often performed in a physician’s office but may also be performed in a surgical center. The wound is opened, the pus is drained, and the area is allowed to heal. This is not curative. It is symptomatic therapy that does not remove the disease.
  • Excision: With an excision, the entire area is removed. The wound is either closed with sutures, or is left to heal on its own over time, usually 4 to 6 weeks. Healing is notoriously slow, and often incomplete. Recurrences are not uncommon. Eventually however, the disease is cured.

If you are experiencing pain due to pilonidal disease, you should contact your physician to determine the best course of treatment.

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