A pilonidal cyst is a small pocket that forms near the top of the buttocks, where the cheeks meet. It can sit quietly for years or flare into a painful, infected lump almost overnight. Here is what causes them, how they are treated, and when surgery is the right call.
What is a pilonidal cyst?
A pilonidal cyst forms in the cleft at the top of the buttocks, near the tailbone. It often contains hair and skin debris, which is where the name comes from. Pilonidal means “nest of hair.” When the cyst becomes infected it turns into a pilonidal abscess, which is painful and may drain foul-smelling fluid or pus.
Symptoms
- A lump or swelling near the top of the buttock crease
- Pain, especially when sitting
- Redness and warmth over the area
- Drainage of pus or blood, sometimes with an odor
- One or more small openings, called “pits,” in the skin
Some people have a single mild episode. Others deal with infections that keep coming back.
Who gets pilonidal cysts
They are most common in:
- Young adults, especially men, between puberty and around age 40
- People who sit for long periods
- Those with thick or coarse body hair
- People who are overweight
- Anyone with a deep natal cleft or a family history of the condition
How pilonidal cysts are treated
Treatment depends on whether the cyst is infected and whether it keeps returning.
For an acute infection (abscess)
The first step is usually a simple in-office procedure to drain the abscess and relieve the pain. It is done under local anesthetic and brings fast relief, though drainage alone does not always prevent the abscess from returning.
For recurring or chronic disease
When cysts keep coming back, surgery to remove the cyst and the affected tissue is the definitive treatment.
Techniques range from excision with the wound left open to heal, to flap procedures that move the closure off to the side of the cleft to lower the chance of recurrence. A colorectal surgeon recommends the approach based on the size, location, and how many times it has returned.
Recovery
Recovery depends on the procedure. A simple drainage of an abscess heals in a few weeks with regular dressing changes. Surgical excision takes longer, and keeping the area clean and hair-free during healing is important. It is also important to keep up with hair removal after any procedure in order to prevent recurrence. Your surgeon will give you specific wound-care instructions to follow.
How to lower your risk of recurrence
- Keep the area clean and dry
- Remove or manage hair in the area as advised
- Avoid prolonged sitting where you can
- Maintain a healthy weight
🩺 Pilonidal disease is common in young healthy people. Treatment is tailored to each patient and outpatient surgery can offer a lasting fix for recurrent cases.
When to see a colorectal surgeon
See a specialist if you have a painful lump near your tailbone, drainage, or repeated infections. Recurrent pilonidal disease rarely resolves on its own, and a colorectal surgeon can relieve the immediate problem and prevent it from coming back.
Frequently asked questions
What kind of doctor treats a pilonidal cyst?
A colorectal surgeon. They handle both the drainage of an acute infection and the definitive surgery for recurrent disease.
Will a pilonidal cyst go away on its own?
A mild infection can self-resolve, but cysts that become severely infected or keep returning usually need surgical treatment.
Is pilonidal surgery painful?
Surgery is done under anesthesia, so it is not painful at the time of the procedure. There is soreness during healing, which is managed with oral pain medications and good wound care.
How do I stop pilonidal cysts from coming back?
Keep the area clean and hair-free, avoid long periods of sitting, and follow your surgeon’s wound-care plan after any procedure.
Get relief
If you are dealing with a painful lump near your tailbone or repeated infections, you do not have to keep cycling through flare-ups. Request a pilonidal evaluation with Colon Rectal Specialists or call (248) 852-8020.
