Pilonidal Cysts: What Causes Them and How They’re Treated

A painful lump near the tailbone may be more than a minor nuisance. It could be a pilonidal cyst, a condition that can become infected and cause recurring problems.

"Pilonidal cysts typically develop at the top of the crease between the buttocks," said Lisa Iucci, DO, FACS, a board-certified general surgeon with Premier Surgical Network. "It's essentially an abnormal hair follicle that can become inflamed and sometimes infected."

Pilonidal cysts are most common in teenagers and young adults. According to Dr. Iucci, some people may have an abnormal hair follicle that makes them more susceptible to developing the condition. Having more hair in the area and spending long periods sitting can also increase the likelihood of problems.

Dr. Iucci said she often sees the condition in students who spend hours sitting at a computer doing schoolwork. But prolonged sitting can be a factor for people of any age, including those who work at a desk or spend much of their day driving a truck.

"Usually, there are a few factors that come together to cause the problem," Dr. Iucci said. "You may already have the anatomy and hair follicles that make you more susceptible, and then spending long periods sitting can put additional pressure on the area."

When a Cyst Becomes Infected
Many people first seek medical attention when the area becomes painful, red or swollen or begins draining. They may initially visit their primary care physician, dermatologist, urgent care center or emergency department before being referred to a surgeon.

But having a pilonidal cyst does not automatically mean you need surgery.

When someone experiences a first episode, Dr. Iucci often recommends trying conservative measures before considering an operation. Keeping the area clean with an antibacterial cleanser may help, along with reducing prolonged sitting and becoming more active.

For patients with significant hair growth in the area, laser hair removal may also be an option. Unlike shaving, laser treatment targets the hair follicle below the skin, potentially reducing one of the factors contributing to recurring problems.

When Surgery May Be Considered
If infections continue despite these measures, surgery may become an option. The goal is to remove the affected tissue and problematic follicles that are contributing to repeated infections.

Dr. Iucci said the procedure is typically performed under general anesthesia, and patients usually return home the same day. Recovery, however, requires some patience because of the location of the incision.

Patients may need to avoid sitting directly on the area for about two weeks and limit bending, squatting and heavy lifting. Full recovery can take several weeks.

That is one reason Dr. Iucci carefully discusses the benefits and recovery with patients before recommending surgery.

"If someone has had recurrent episodes, has tried the other options and is still having problems, then we can talk about surgery," she said. "I want patients to understand what the recovery involves so they can make the right decision for themselves."

Ignoring a recurring pilonidal cyst can mean continued infections, abscesses and pain. Some infections may eventually require an incision and drainage. For anyone experiencing repeated pain, swelling or drainage near the tailbone, an evaluation can help determine the cause and the best next step.

Lisa Iucci, DO, FACS, is a board-certified general surgeon with Premier Surgical Network. Her practice includes the treatment of pilonidal cysts, abscesses and complex wounds, among other general surgical conditions.

Dr. Iucci sees patients at Premier Surgical Network, 4096 English Creek Avenue, Egg Harbor Township, NJ 08234. To request an appointment, visit PremierSurgicalNetwork.com/request-appointment or call 844-973-0002.