Definition

A pilonidal cyst is a cavity underneath the skin over the tailbone. Pilonidal translate to “nest of hair” because the cavity is often found to contain hair. Literature shows that it is an acquired disease, though there may be some genetic link in some patients.

Causes

This problem is more common in young adults and teenagers. This condition is rare in patients over 40 years of age. It is three times more common in men than women.

Symptoms

Many people have no symptoms, or their symptoms burn out over time. Occasionally, the hair becomes ingrown, pus accumulates in the cyst, causing an abscess to form, at which point a patient may experience fever or pain and swelling in the tailbone area. Others will develop low-grade infections periodically; these patients experience milder, recurring episodes of pain and swelling.

Diagnosis & Treatment

Patients with an acute abscess can generally be treated in the doctor’s office. The doctor uses local anesthesia to numb the area and a small incision is made to allow for drainage of pus. This immediately relieves pressure and decreases pain. Daily cleansing of the area in the bathtub or shower is important to keep hair and other debris out of the wound. The patient should return for follow up until the wound is healed. Healing occurs rapidly, and usually the wounds are completely closed in three weeks. To help prevent reoccurrences and to aid healing, patients are often urged to keep the skin around the gluteal cleft free from hair either by shaving the area weekly or by use of a depilatory (substance that removes body hair) for at least three months.

For patients with repeated episodes of abscess or chronic drainage and skin irritation, surgery may be required. This is done as an outpatient procedure in our Ambulatory Surgery Center. A variety of surgical techniques are utilized in our practice to remove the cyst.  Most commonly, the cyst is opened (cystotomy), cleaned, and allowed to heal from the inside out. Some of the surgeons prefer the approach described by Dr. Bascom in which an incision is made off the midline to open and empty the cyst, which some believe to result in quicker healing and lower recurrence.

After surgery, it is important to keep gauze in the wound in order to keep the skin edges separated and shaved, until the wound fills in from the bottom. The patient will need to shower the wound frequently and repack it.  This often takes the assistance of a family member. The patient will be seen back in the office for follow up until the wound is healed. In some instances, a more complex procedure may be necessary to rearrange tissue.

After surgery, approximately 10 percent of patients will develop another cyst.

Visit the American Society of Colon & Rectal Surgeons website for more information