When a Pilonidal Cyst Won’t Leave You Alone: Your Treatment Options

A pilonidal cyst can start out as a tiny bump or tender area on the top of the buttock crease, which is relatively easy to ignore. Then sitting gets uncomfortable and the area starts to swell or drainage comes. For some people the problem settles down and returns weeks or months later. That cycle can get incredibly frustrating for pilonidal disease. Pilonidal cysts are treated with conservative treatment for mild symptoms, and recurrent or more serious diseases. The pilonidal cyst treatments are based on the type of infection and how serious the disease is and other treatments that have been tried and whether or not it is on track.

Pilonidal disease is most commonly formed in the crease between the buttocks in the area around the tailbone. Small openings or pits can form in the skin and loose hairs can be buried under the skin. Friction, pressure and moisture as well as long sitting can cause irritation in the area.

The cyst or sinus can be very quiet. Infection or inflammation can cause problems to become much worse. An infected pilonidal cyst will swell up, turn red and hurt. An abscess can also form under the skin and eventually begin to drain pus or blood as well.

Some people have one episode and never have another, while others develop chronic disease with ongoing drainage, inflammation or multiple sinus openings. This is why there is no treatment that is appropriate for every patient.

Not every pilonidal cyst needs surgery immediately. If there’s no active abscess or serious infection, a doctor will recommend conservative management. Keeping the area clean and dry may be more important and patients may be instructed on how to control hair in the area.

The pressure on the area may be relieved, and it can help with irritation but lifestyle changes can’t always eradicate sinus tracts.

Conservative care is more about managing risk and symptoms and not assuming that every pilonidal cyst must be surgically removed as soon as it is discovered.

Patients need to know that they are being looked after. Pain, swelling, redness or drainage can signify that the disease is growing and needs medical treatment.

A painful pilonidal abscess is different from a small cyst without any infection. If pus is being collected under the skin, incision and drainage may be necessary.

In this procedure, the doctor leaves an opening which allows for the infected material to drain from the skin. The pressure can relieve the pain of an abscess.

However, draining an abscess and treating the underlying pilonidal disease are not always the same thing. Drainage is the immediate collection of the infected material, but there may be pits or sinus tracts that remain.

That means some patients might develop another episode later on. Follow-up is critical when infections occur repeatedly.

Recurring disease can change the conversation about pilonidal cyst treatments.

If someone is suffering repetitive abscesses, drainage or inflammation, a doctor might suggest a treatment approach that is specifically aimed at the sinus tracts rather than treating each infection as it is happening.

The extent of the disease can determine treatment. A patient with a relatively limited sinus may have different options compared to a patient with multiple openings, branching tracts or a history of past surgery.

That’s why examination is so important. What looks like a small opening on the surface does not always mean what is going on underneath the skin.

Some patients may be better suited for less invasive treatment. Minimally invasive measures can remove or treat the pits, trapped hair and affected sinus tissue while keeping the wound small.

The advantage to patients is that a smaller procedure may mean a less lengthy recovery for appropriately selected patients. But minimally invasive treatment is not the best treatment for every case.

The number and location of sinus openings, prior infections and extent of disease will all matter in determining if a technique is suitable.

Patients involved with these treatments should ask what the procedure is intended to do and what happens if the disease occurs again.

Surgery may also be considered when pilonidal disease is extensive, chronic, or recurrent.

There are several surgical methods. Some surgical methods remove the affected tissue and allow the wound to heal gradually. Other surgical procedures close the surgical site and the position of the closure is also important.

More complex pilonidal disease can be treated with surgery that flattens or shifts the buttock cleft while moving the incision away from the deepest areas.