Pilonidal Cyst Removal

A pilonidal cyst is a fluid-filled sac like a pimple at the coccyx, or tailbone, just below the crack of the buttocks. Pilonidal cysts are prone to infection. If one becomes infected, filling with pus, it is technically called a pilonidal abscess. Pilonidal cysts are always treated through excision and drainage. It is important to treat these cysts because left untreated the infection may become systemic.

Causes of Pilonidal Cyst

Pilonidal cysts are thought to be caused by ingrown hairs or other trauma to the region. Found to be very common in soldiers of World War II who spent a great deal of time riding in jeeps, they were nick named "Jeep disease." Pilonidal cysts are most common in individuals between 15 and 24 years of age and rarely occur in people over 40. Individuals whose family members have had the problem are more likely to develop pilonidal cysts.

Risk Factors for Pilonidal Cyst

Certain individuals with one or more of the following risk factors are more prone to develop pilonidal cysts.

  • Obesity
  • Inactive lifestyle or occupation
  • Trauma at the site
  • Excess body hair
  • Stiff or coarse hair
  • Poor hygiene
  • Deep cleft between the buttocks

Symptoms of Pilonidal Cyst

The symptoms of pilonidal cyst are difficult to ignore. They include:

  • Pain and pressure at the bottom of the spine
  • Swelling at the bottom of the spine
  • Redness at the bottom of the spine
  • Draining pus, particularly if malodorous
  • Fever

Diagnosis of Pilonidal Cyst

While patient history regarding development of symptoms may cause the physician to suspect a pilonidal cyst, physical examination is much more definitive. The doctor will be able to observe redness and swelling just above the anus. Inflammation of the surrounding skin and a high white blood cell count will confirm the diagnosis.

Treatment of Pilonidal Cyst

The first common remedy for a pilonidal cyst is usually soaking in a hot tub. While this will not eliminate the problem, it will facilitate the cyst's coming to a head so that it can be more easily lanced.

Like other boils, pilonidal cysts are usually infected with Staphylococcus aureus and will not heal on their own or with the administration of antibiotics alone. It is necessary that these cysts be surgically drained. There are several ways to do this.

Incision and Drainage With Packing

During this procedure, the surgeon makes an incision and drains the cyst, removing hair follicles and packing the cavity with gauze. While incision and drainage is a simple procedure that can be performed under local anesthesia, it requires packing and frequent changes of gauze for up to 3 weeks.


In this outpatient procedure the surgeon creates a pouch which will heal without packing. Marsupialization requires a surgeon familiar with the technique. While packing is not necessary, healing may take as long as 6 weeks.

Incision and Drainage With Immediate Closure of the Wound

During this procedure the surgeon drains and cleans the wound and sutures it closed. While there is no need for packing with this method and the wound heals more quickly, there is more danger of the cyst recurring.

Recovery from Pilonidal Cyst Removal

Pilonidal cyst removal is usually an outpatient procedure. Painkillers and anti-inflammatory medication are usually prescribed to prevent further infection and keep the patient as comfortable as possible during healing.

Full recovery may take from one week to several weeks, depending on the size of the cyst and the method of removal. It is important that the patient keep the wound clean until it heals and that the patient practice careful hygiene of the area to prevent recurrence.

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