Understanding Pilonidal Cysts: Symptoms, Causes, and Treatment

Understanding Pilonidal Cysts: Symptoms, Causes, and Treatment

Pilonidal cysts are a relatively common skin condition that affects the crease between the buttocks near the tailbone. Characterized by a bump or abscess in the sacrococcygeal region, pilonidal cysts can cause pain and discomfort when sitting. While the exact cause is unknown, they tend to affect young adults and teenagers after puberty. With proper treatment and preventative measures, pilonidal cysts can be managed effectively.

What Are Pilonidal Cysts?

Pilonidal cysts, also referred to as pilonidal abscesses or sacrococcygeal fistulae, are abnormal pockets or sacs that form under the skin between the buttocks. The word pilonidal comes from Latin and means nest of hair.

These cysts typically contain hair, skin debris, and other tissue. They start out small but can grow larger over time. A pilonidal cyst looks like a swollen bump or abscess that may be red and painful. The most common location is in the crease between the buttocks just above the anus and below the tailbone (sacrococcygeal area).

Pilonidal cysts tend to flare up and become symptomatic after irritation or infection. Smaller cysts may drain pus or other fluids on their own. Larger ones may need to be surgically drained or removed.

What Causes Pilonidal Cysts to Form?

While the exact cause is uncertain, its believed that pilonidal cysts may start when a hair follicle or pores in the skin of the buttocks area become impacted with debris like dirt, dead skin cells, or most commonly, hair. This leads to the follicle or pore becoming inflamed and dilated, gradually forming an abscess or cyst.

There are several factors that can increase the risk of developing pilonidal cysts:

• Obesity - Excess weight increases pressure in the buttocks region which can cause irritation.
• Lack of hygiene - Not properly washing the area prevents hair and debris from being cleaned out of follicles.
• Excess body hair - Having more hair around the buttocks makes it easier for hair to get embedded.
• Friction - Tight clothing, sitting for long periods, and athletic activities cause friction and shearing forces.
• Family history - Some people may be genetically prone to getting pilonidal cysts.

Males tend to be affected more often than females, likely due to having more hair around the buttocks area. Pilonidal cysts also frequently occur after puberty when hormone levels rise.

Symptoms of a Pilonidal Cyst

In many cases, a pilonidal cyst may not cause any symptoms initially. As it grows larger, common signs and symptoms include:

• A tender, swollen bump or abscess near the tailbone.
• Pain or discomfort when sitting down.
• Skin redness around the area.
• Drainage of blood, pus, or other fluid from the cyst.
• Fever, chills, and fatigue if infected.
• A foul odor from draining fluid.

The pain and external appearance often worsen when the cyst becomes infected. Signs of infection include redness, warmth, swelling, and tenderness around the area. You may also have a fever.

When to See a Doctor

Visit your doctor if you notice a bump, abscess, or any other symptoms in the buttocks crease region. Small pilonidal cysts may be monitored or treated with conservative home care if they arent causing discomfort.

See your doctor promptly if you experience signs of infection like fever, increasing pain, or redness. Infected cysts need medical drainage and treatment to prevent the infection from spreading.

Recurring pilonidal cysts will also require examination to determine appropriate management. Leaving cysts untreated allows them to enlarge and destroy more tissue while making infections more likely.

Diagnosis of Pilonidal Cysts

Pilonidal cysts are typically diagnosed through a medical history and physical exam of the affected area. Your doctor will ask about your symptoms and inspect the cyst or abscess.

Tests may include:

• Visual exam - Looking at the location, size, shape, and characteristics of the cyst.
• Palpation - Feeling the cyst to check for tenderness, swelling, and fluctuations.
• Fluid drainage - Draining fluid from the cyst with a needle to identify content.
• Imaging - MRI or CT scans to evaluate the cyst if surgery is required.

Your doctor can typically make a diagnosis simply based on the appearance and location of the cyst. Lab tests are not usually needed unless there are concerns about a different skin condition.

Home Treatment and Prevention

Small, mild pilonidal cysts may be managed conservatively at home through the following methods:

• Warm compresses - Applying a warm, moist compress to the area can encourage drainage and healing.
• Proper hygiene - Keeping the buttocks crease clean and shaved can help remove hair and debris.
• Over-the-counter pain medication - Anti-inflammatories like ibuprofen can relieve discomfort.
• Sitz baths - Soaking in a shallow bath of warm water can improve hygiene and promote healing.
• Avoid friction - Wear loose clothing and limit sitting to prevent irritation of the cyst.

Make sure to keep the area clean and dry. See your doctor if symptoms persist or worsen with home treatment. Recurring pilonidal cysts may require further intervention.

To help prevent pilonidal cysts:

• Maintain good hygiene by washing the buttocks crease daily.
• Remove hair around the area through shaving, laser hair removal, or depilatory products.
• Avoid tight clothing and Reduce sitting time, especially on hard surfaces.
• Treat constipation and diarrhea promptly to avoid excessive straining.
• Keep the area dry after bathing, exercising, or perspiring.
• Control weight to reduce pressure on the buttocks.

Medical Treatment for Pilonidal Cysts

If a pilonidal cyst becomes severely inflamed, painful, or infected, your doctor may recommend:

• Incision and drainage - Making a small cut to drain the fluid and remove debris, followed by packing the cavity to heal from the inside out.
• Antibiotics - Prescribing oral or topical antibiotics to clear any infection.
• Injecting medications - Injecting steroids into the cyst to reduce swelling and inflammation.
• Removal of cyst - Surgically excising the cyst if it continues to refill with fluid.

These medical treatments are done under sterile conditions to avoid further infection. Mild pilonidal cysts that arent causing problems can be left alone and monitored.

Surgical Removal of Pilonidal Cysts

If a pilonidal cyst keeps returning despite conservative treatments, your doctor may recommend surgical removal. Surgery is also an option if the cyst is very painful or disruptive to your daily activities.

Common surgical procedures include:

• Pilonidal cystectomy - Removing the cyst while leaving the wound open to heal gradually.
• Marsupialization - Making a small incision to drain the cyst and suturing the wound edges to the sides to keep it open for healing.
• Excision and primary closure - Cutting out the cyst and suturing the wound closed.
• Laser therapy - Using laser energy to vaporize soft tissue and hair follicles in the cyst.
• Flap procedures - Reshaping the cyst area with a flap of healthy skin to facilitate healing.

The specific surgery will depend on factors like the size of the cyst, amount of inflammation, and surgeons recommendation. Procedures are typically done under local or general anesthesia.

After pilonidal cyst surgery, youll need to keep the area clean and dry while changing dressings as directed. Avoid sitting directly on the incision site until it's fully healed.

Recovery After Pilonidal Cyst Treatment

Recovery time after pilonidal cyst treatment varies based on the procedure. Less invasive drainage and incision typically takes 1-2 weeks to heal. More extensive surgical excision may take 4-8 weeks.

During recovery:

• Get plenty of rest and avoid prolonged sitting to help the incision heal.
• Take over-the-counter pain medication as needed for discomfort.
• Keep the area covered with clean bandages that are changed regularly.
• Avoid strenuous activity that could pull at the incision site.
• Follow any instructions for caring for surgical drains.
• Watch for signs of infection like pus, redness, swelling, fever, or increased pain.
• Ask your doctor when you can resume your normal activities.

There is potential for pilonidal cysts to return after treatment. Maintaining good hygiene and avoiding irritation to the area can help prevent recurrence.

The Bottom Line

Pilonidal cysts are a common type of skin cyst that occurs in the buttocks crease near the tailbone. They typically cause symptoms like pain and swelling when infected or irritated. While the exact cause is unknown, hair and debris trapped in the skin pores and follicles can lead to the formation of cysts.

Conservative home treatment may help some small pilonidal cysts. Infected or recurrent cysts often need medical drainage or surgical removal. Recovering properly after treatment and preventing recurrence involves keeping the area clean and avoiding friction.

See your doctor if you notice any lumps, bumps, or abscesses around your tailbone. Timely diagnosis and treatment of pilonidal cysts can help relieve symptoms and avoid complications.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.