Pilonidal Disease

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Pilonidal Disease

Topic Overview

What is pilonidal disease?

Pilonidal disease is a chronic infection in the skin slightly above the crease between the buttocks. It develops in a cyst (pilonidal cyst) at the top of or next to the crease between the buttocks (overlying the sacrum). The cyst may look like a small dimple (called a "pit" or "sinus"). Hair may protrude from the pit, and several pits may be seen.

See a picture of a pilonidal cyst.

A pilonidal cyst can be painful enough to make sitting or walking difficult, and in some cases pus or blood may drain from the pit.

What causes a pilonidal cyst?

In the past, most experts believed pilonidal cysts were present at birth (congenital). But now experts think a pilonidal cyst may form in three ways. Some are probably present at birth. But most experts now believe that the cysts develop later in life in one of two ways, or a combination of the two:

  • A pilonidal cyst may form when a hair follicle (the sac from which a hair grows) in the skin becomes irritated or stretched. This may be due to exercise that affects the buttocks area (such as horseback riding or cycling), tight clothing around the buttocks, heat, or extensive sweating. The hair follicle becomes blocked and infected and then swells and ruptures into the surrounding tissue, forming an abscess. Continued exercise or walking often pulls hair into the abscess.
  • In some people, particularly those with coarse or stiff hair, a loose hair may become trapped in the crease of the buttocks. The hair can poke into the skin, especially if there is already a stretched or irritated hair follicle. Walking and exercise can pull the hair further into the skin. A cyst then forms around the hair and can become infected.

What are the symptoms?

Pilonidal disease often has no symptoms. If the cyst becomes infected (an infected cyst is called an abscess), you may have redness or swelling near the top of the crease of your buttocks, cloudy fluid or blood draining from the abscess, and sometimes difficulty walking or sitting because of pain from the area of the abscess.

How is pilonidal disease diagnosed?

Pilonidal disease is diagnosed by your doctor after visually examining and gently feeling the area around the crease in the buttocks to check for redness, warmth, and swelling. No other tests are usually needed.

How it is treated?

Treatment for pilonidal disease can include keeping the area around the crease of the buttocks clean with antibacterial soap and possibly taking antibiotics to control the infection. Using an alcohol swab 2 to 3 times a day when the pilonidal area begins to get irritated can help manage the infection. Treatment also may involve draining the cyst, and sometimes surgery to either open or remove the cyst.

Frequently Asked Questions

Learning about pilonidal disease:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Symptoms

Pilonidal disease is often first recognized as a small dimple (called a "pit" or "sinus") at the top of or next to the crease of the buttocks. Hair may protrude from the pit, and several pits may be seen. Pilonidal disease often has no symptoms. But when infection in the cyst flares up, you may have:

  • Discomfort, redness, or swelling at the top of or next to the crease of the buttocks. The cyst can be so uncomfortable that sitting or walking is difficult.
  • Cloudy fluid or blood draining from the pits.
  • Fever over 38°C (100.5°F) . But fever is not common.

Although pilonidal disease occurs more in males, it does develop in females. Because of its location, a pilonidal cyst can also cause embarrassment and hinder social interaction. The location of the cyst should not keep you from seeking treatment, though, because help is available.

Because of similar symptoms, a pilonidal cyst is sometimes confused with Crohn's disease or a fistula or abscess next to the rectum.

Examinations and Tests

Usually no medical tests are necessary to diagnose pilonidal disease. Your doctor can detect this condition by a visual examination of the area around the crease in the buttocks.

A skin and wound culture of the infected pilonidal cyst (abscess) may be done if it does not heal after treatment.

A pilonidal cyst is sometimes mistaken for Crohn's disease or a fistula or abscess next to the rectum (perirectal abscess). If the doctor suspects another condition, more tests may be done.

Treatment Overview

No medical treatment is needed for pilonidal disease that is not causing symptoms. If you have been diagnosed with a pilonidal cyst or pilonidal disease, keep the area around the cyst clean and dry. Use an antibacterial soap to wash the area. And wipe with an alcohol swab 2 to 3 times a day when the pilonidal area begins to get irritated. Your doctor may tell you to keep the area cleared of hair by shaving, using a hair-removing lotion (depilatory), or having electrolysis. This reduces the chance of hair entering the cyst and contributing to infection.

If a pilonidal cyst is infected, your doctor will usually prescribe an antibiotic unless the cyst needs to be drained right away. If antibiotics do not clear up the symptoms, you may need another treatment, such as the following:

  • The cyst is cut open and drained (incision and drainage).
  • The cyst is removed (excision).

An incision and drainage is sometimes the first option chosen, especially if the cyst is infected. If the pilonidal cyst does not heal, or if it returns, the doctor will perform an excision. To limit the possibility of the infection spreading, incision and drainage may be used instead of excision to reduce the infection. But the treatment chosen depends on how bad the infection is.

Whether you have incision and drainage or excision, it is difficult to heal the wound that is left after the procedure. It is also not uncommon to develop another pilonidal cyst. Be sure to follow your doctor's instructions for caring for the wound and the surrounding skin.

Incision and drainage

During incision and drainage, the hair and pus are removed. The sac that forms the cyst is not removed. The wound is packed with gauze and in general takes at least a month to heal. This procedure can be done in the doctor's office under local anesthesia. The doctor may prescribe antibiotics to help fight the infection.

Excision

In an excision, the infected material is drained and the entire pilonidal cyst is removed. Because an excision is a complex procedure that requires a deeper cut than an incision and drainage, it is usually done at an outpatient surgical centre or hospital under general anesthesia.

After the cyst and infected tissue are removed, the wound may be closed with stitches or sutures (closed method) or left open and packed with surgical gauze (open method). If the wound is packed with gauze, the gauze is changed daily until the wound heals.

Excision of the cyst heals within 10 days to 6 weeks or more, depending on the type of surgery.1

See pictures of an incision and drainage and an excision.

Home Treatment

Home treatment for pilonidal disease focuses on keeping the area clean and, if you have surgery, following instructions on taking care of the area.

If you have a pilonidal cyst and no symptoms of infection or discomfort:

  • Keep the area dry and clean.
  • Wear cotton underwear and clothing.
  • Shave the area or use a hair-removing lotion (depilatory) to remove hair if your doctor advises you to. Some people choose to keep hair away longer by having electrolysis in the area. Electrolysis uses a low-voltage electric current to remove hair. Talk with your doctor about the best method of hair removal for you.
  • Avoid sitting on hard surfaces for long periods of time.
  • Watch the area for signs of infection, such as discomfort, redness, swelling, pain, a cloudy or bloody discharge, or a fever over 38°C (100.5°F).

If you have a pilonidal cyst with symptoms of infection:

  • Contact your doctor.
  • Keep the area dry and clean.
  • Shave the area if your doctor advises you to.
  • Soak in a warm tub several times a day.
  • Take non-prescription pain medicine if needed.

If you have had surgery (excision or incision and drainage) for a pilonidal cyst:

  • Your doctor will teach you how to treat the area and give you guidelines on physical activity.
  • You will typically have to stay at home and limit physical activity for at least one week.
  • The healing process can be painful, so prescription or non-prescription pain medicine may be needed.

Other Places To Get Help

Organization

American Society of Colon and Rectal Surgeons
85 West Algonquin Road
Suite 550
Arlington Heights, IL  60005
Phone: (847) 290-9184
Fax: (847) 290-9203
Email: ascrs@fascrs.org
Web Address: www.fascrs.org
 

The American Society of Colon and Rectal Surgeons is the leading professional society representing more than 1,000 board-certified colon and rectal surgeons and other surgeons dedicated to treating people with diseases and disorders affecting the colon, rectum, and anus.


References

Citations

  1. Hull TL, Wu J (2002). Pilonidal disease. Surgical Clinics of North America, 82: 1169–1185.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer C. Dale Mercer, MD, FRCSC, FACS - General Surgery
Last Revised June 8, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.