Pilonidal Cyst Symptoms and Treatment Options

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
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A pilonidal cyst is a sac or lump at the crease of the buttocks that forms around hair trapped in the skin. A pilonidal cyst can become infected and develop into a chronic condition that comes and goes. Although it is not contagious, it can be quite painful, especially when sitting. The area may be swollen and look similar to a pimple or indentation in the skin. You can have more than one cyst.

A pilonidal cyst is a symptom of pilonidal disease, which is a chronic skin infection. In the United States, about 70,000 people per year develop it, according to the American Society of Colon and Rectal Surgeons (ASCRS).

Pilonidal disease occurs most often in people’s 20s and 30s, and it affects more males than females.

If you are overweight or have body hair that tends to be stiff and thicker than average, you have a higher chance of developing pilonidal disease, says the ASCRS. 

This article explores what can happen if you have a pilonidal cyst, how doctors diagnose these cysts, and the available treatment options. 

What are the symptoms of a pilonidal cyst?

young man showering
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If you have a pilonidal cyst, your symptoms can range from mild to severe. Some people do not have any symptoms at all.

When symptoms do occur, they can include:

  • irritation or pain at the site
  • a small dimple or indentation in the skin
  • a mass, which can be large and painful
  • drainage that is clear, bloody, or cloudy

Pilonidal cysts do not typically need any treatment unless they become infected.

If there is a bacterial infection, you may experience a fever, nausea, or vomiting. The area may be swollen, discolored, and tender to the touch. If you have drainage, this is most likely pus, and it can smell bad.

Call your doctor if you have symptoms of infection because you may need a prescription for antibiotics. 

How do doctors diagnose pilonidal cysts? 

To get a diagnosis, you will need to make an appointment with your healthcare professional. They will want to perform a physical exam and inspect the area, looking especially for any signs or symptoms of infection.

Your healthcare professional will also ask you some questions about your symptoms. For example, they may ask whether there have been any changes in how the cyst looks or feels. 

Rarely, small tunnels called sinus cavities form underneath the skin. Bacteria can grow in these cavities and create abscesses. To check for this, your healthcare professional may want to order additional testing, such as a CT scan. This can help them see if there is tunneling involved and, if so, how deep it goes. 

Pilonidal cyst surgery and other treatments 

If the pilonidal cyst is not causing any symptoms, you may not need treatment. If there is an infection, an abscess, or a sinus cavity, however, you will need treatment. 

Antibiotics

Severe pain and symptoms of inflammation, such as swelling and discoloration, could mean that you have a bacterial infection at the site. Your healthcare professional may prescribe an antibiotic that treats a variety of bacteria to get rid of any infection that might be present. 

Medical procedures

The following are some medical procedures that doctors can perform for pilonidal cysts: 

  • Lancing: Also known as incision and drainage, a healthcare professional will cut a small opening in the skin to remove any pus or blood that is inside. They will inject a local anesthetic to numb the area before the procedure.
  • Phenol injection: This procedure is not common. If your healthcare professional does choose to perform it, they will give you a local anesthetic and then inject a substance called phenol into the cyst. This is an antiseptic that cleans out the infection. With this treatment approach, you may need more than one injection. 
  • Surgery with wound closure: You may need surgery if pilonidal cysts continue to come back or if you have chronic inflammation and infection with a sinus cavity. With this approach, you may receive a local, general, or spinal anesthetic. A surgeon will then open the sinus cavity, remove the pus and other substances from the cavity and abscess, and stitch the area closed. In some cases, they may remove the entire sinus cavity. This procedure flattens the buttock crease. You will need to keep the dressing clean and dry when you return home.

Home remedies

If your infection or symptoms are mild, you may be able to treat the cyst at home. To do this, use warm compresses on the area several times per day.

You can also take a sitz bath, which involves running warm water in the bath and sitting in the shallow water. A sitz bath can clean the perineal space between the vulva or scrotum and the rectum. 

Causes of pilonidal cyst

Doctors are not sure exactly why some people get pilonidal cysts. However, in most cases, they develop when the hairs surrounding the crease of the buttock grow into the skin. When this happens, the pressure and rubbing can catch the hair and push it down into the skin.

Your body treats this hair as a foreign substance and creates a cyst around the hair. This is similar to how your body reacts when you get a cut or have a splinter. It can cause irritation and infection. 

The following factors increase the likelihood of developing pilonidal cysts:

  • sitting for long periods of time
  • having a family history of cysts or pilonidal disease
  • having an excessive growth of thick, coarse hair in the buttock region
  • not keeping the area clean
  • experiencing trauma or irritation

Pilonidal cyst recovery time

Exactly when a pilonidal cyst will clear up depends on how extensive it is. If there is an abscess, it will take longer to heal. If there are sinus cavities present, it can also be more severe, with a longer recovery period to be expected after treatment.

For a simple lancing technique, it can take 4–6 weeks to heal completely. For more extensive surgery with open wound healing, the recovery time can be 6–12 weeks.

Prevention

To help prevent pilonidal cysts from occurring, it is important to maintain a moderate weight and take frequent breaks during the day if you sit a lot. Also, keep the area as clean as possible by washing it with mild soap and drying it completely. 

If you have thicker hair that grows near the crease of the buttocks, you might want to consider shaving the area regularly to prevent hair from growing into the skin. 

Summary

A pilonidal cyst is a skin condition that can cause pain, inflammation, and swelling near the tailbone. In some cases, this cyst can become infected, forming an abscess. Sometimes, after the infection clears, a sinus cavity develops, which can also become infected and involve abscess formation. 

Pilonidal cysts do not always require treatment, but if they do, it is important to start treatment right away — especially if the cyst is infected. Cysts can go away on their own, but they can be chronic for some people. 

Because of the location of these cysts, it might feel embarrassing to discuss your symptoms with your healthcare professional. However, pilonidal cysts can cause further issues, so do talk with your healthcare professional promptly if you are having symptoms or suspect that you have a cyst. They can determine if treatment is necessary.  

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 Apr 7
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