What is a Pilonidal Cyst?
A pilonidal cyst is a sac filled with debris and hair that occurs in the area at the top of the crease of the buttocks overlying the tailbone (sacrum). If a pilonidal cyst becomes infected, the resulting abscess is often extremely painful.
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Before Pilonidal Cyst Surgery
What are pilonidal cyst symptoms and signs?
If a pilonidal cyst is not infected, there may be no symptoms. When a cyst is infected, signs and symptoms include:
. Pain to the top of the buttocks
. Low back pain
. Discharge of blood or pus (if abscess ruptures or “pops”)
. Foul-smelling odor.
When to see a doctor
If you notice any signs or symptoms of a pilonidal cyst, see your doctor. He or she can diagnose the condition by examining the lesion.
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How do doctors diagnose a pilonidal cyst?
A doctor will diagnose a pilonidal cyst by first doing a physical examination. A pilonidal cyst looks like a lump, swelling, or abscess at the cleft of the buttock with tenderness, and possibly a draining or bleeding area (sinus). The location of the cyst at the top of the buttocks makes it characteristic for a pilonidal cyst.
If infection is severe, blood tests may be performed for diagnosis. There is usually no need for imaging tests in cases of pilonidal cysts.
The exact cause of pilonidal cysts isn’t clear. But most pilonidal cysts appear to be caused by loose hairs that penetrate the skin. Friction and pressure — skin rubbing against skin, tight clothing, bicycling, long periods of sitting or similar factors — force the hair down into skin. Responding to the hair as a foreign substance, the body creates a cyst around the hair.
This explanation accounts for rare cases of pilonidal cysts that occur in parts of the body other than near the tailbone. For example, barbers, dog groomers and sheep shearers have developed pilonidal cysts in the skin between fingers.
Certain factors can make you more susceptible to developing pilonidal cysts, such as:
. Male sex
. Younger age (pilonidal cysts are most common in people in their 20s)
. Inactive lifestyle
. Occupation requiring prolonged sitting
. Excess body hair
. Stiff or coarse hair
. Family history
. Previous pilonidal cyst
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If a chronically infected pilonidal cyst isn’t treated properly, you may be at slightly increased risk of developing a type of skin cancer called squamous cell carcinoma.
To help prevent pilonidal cysts, try to:
. Keep the area clean
. Lose weight if needed
. Avoid prolonged sitting
If you’ve had pilonidal cysts in the past, you might want to regularly shave the area or use hair removal products to reduce the risk of recurrence.
Who’s a good candidate for pilonidal cyst incision and drainage?
Your healthcare provider will likely recommend an incision and drainage procedure to treat your pilonidal cyst if:
. This is the first time your cyst is being treated
. Your infection is minor
Who’s a good candidate for a pilonidal cystectomy?
While an incision and drainage procedure is typically the first surgical option considered for a pilonidal cyst, your doctor may recommend a cystectomy if:
. You’ve already had an incision and drainage procedure, but your cyst came back.
. Your infection is very complex or severe
During Pilonidal Cyst Surgery
Home remedies are aimed at relieving pain and swelling. These home treatments include the following:
. Sitz baths: Sitting in a tub of warm water up to the hips can relieve pain and may reduce the chances the cyst will worsen.
. Vitamin C and zinc supplements can help in the healing process. Vitamin A also helps with tissue repair. Consult a doctor for the right dose of these supplements.
. Essential oils, such as tea tree oil and sage oil, may help soothe the cyst and may even help fight infection.
. A product called No Bump Rx helps prevent ingrown hairs.
. Castor oil applied to the cyst may help reduce inflammation.
. A coccyx cushion or pillow can provide support and comfort while sitting.
. Regular exercise helps improve blood flow, which can aid in healing.
It has been suggested that raw garlic applied directly to the cyst may help with infection, however, it can be extremely irritating to the skin and the open wound. Talk to your doctor before using any herbal supplement or natural remedy as some may interact with medications you are on. In addition, if your cyst has been drained and is open, you need to follow your doctor’s instructions.
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The two surgical procedures used to treat pilonidal cysts include:
. Incision and drainage. During this procedure, a doctor will make a cut and drain the cyst.
. Cystectomy. During this procedure, a doctor will remove the entire cyst and the tissues around it.
What to expect from a pilonidal cyst incision and drainage surgery
Pilonidal cyst incision and drainage is a simple procedure that’s usually done in a doctor’s office, under local anesthesia.
First, your healthcare provider will give you an injection to numb the area. Then, they’ll make a small incision in the cyst to drain the pus. This reduces pain and inflammation.
You’ll be sore after the procedure, so it’s a good idea to have someone drive you home.
Antibiotics aren’t typically required for this surgery unless the infection has spread to surrounding areas.
What to expect from pilonidal cystectomy surgery
A pilonidal cystectomy is surgery to completely remove the cyst, along with the pilonidal sinus tracts. While this procedure is more complex than an incision and drainage, it’s also more likely to be successful.
Follow your doctor’s instructions before having a cystectomy. You may be advised to stop smoking and go off certain medications for a period of time.
Pilonidal cyst surgeries are done under general anesthesia at an outpatient surgical center. The surgery itself takes about 45 minutes to perform.
You’ll probably go home several hours after your procedure. You should arrange to have someone drive you home.
After Pilonidal Cyst Surgery
How long does it take to recover from pilonidal cyst surgery?
After surgery, your physician might choose to leave the wound open or close it with stitches. The use of stitches may help you heal faster, but there’s a higher chance that your cyst will recur.
The amount of time it takes for you to recover depends on how your surgery was done and if you received stitches. In general, it’ll probably take anywhere from one to three months to completely heal.
Most people can resume their regular activities two to four weeks after surgery.
You may experience some pain or tenderness during the recovery process. This can be managed by:
. Taking pain medications prescribed by your doctor
. Avoiding strenuous activities
. Using a donut cushion to sit on
. Not sitting for long periods of time on hard surfaces
Your doctor will provide you with instructions on how to keep your wound clean. Follow these directions carefully to avoid an infection or recurrence.
If your doctor prescribes antibiotics, be sure to complete the full course, even if you start to feel better before they’re finished.
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Call your healthcare provider if you experience:
. A fever
. Pus draining from your incision
. Increased pain, swelling, warmth, or redness near the incision
What are the chances the cyst will come back?
Unfortunately, pilonidal cysts do come back after surgery. Studies show recurrence rates are as high as 30 percent.
The cysts may return because the area gets infected again or hair grows near the incision scar.
People who have recurrent pilonidal cysts often develop chronic wounds and draining sinuses.
Here are some ways to prevent a recurrence:
. Follow your doctor’s postsurgical instructions carefully.
. Keep the area clean.
. Shave the area, or use a hair removal product every two to three weeks.
. Keep all follow-up appointments with your doctor.