A pilonidal cyst is a painful skin cyst that develops near the tailbone, often containing hair and debris. If left untreated, it can become infected, forming an abscess that requires medical intervention. At ColoWell America, we offer comprehensive treatment solutions, from conservative management to advanced surgical techniques, ensuring long-term relief and minimizing recurrence.
Symptoms
A pilonidal cyst often starts as a small, painless lump near the tailbone, but it can become infected and inflamed, leading to painful abscess formation. Symptoms can vary depending on whether the cyst is infected or non-infected.
Common Symptoms:
- Pain or tenderness near the tailbone, especially when sitting.
- Swelling or a lump in the upper buttock area.
- Redness and warmth over the affected area.
- Pus or blood drainage from a small opening in the skin, sometimes with a foul odor.
- Itching or irritation in the affected region.
- Fever and chills (if the infection is severe).
Diagnosis of Pilonidal Cyst
A pilonidal cyst is diagnosed primarily through a physical examination by a healthcare provider. In some cases, imaging tests may be needed to assess the severity and rule out complications.
Physical Exam:
A doctor will check for tenderness, swelling, redness, and drainage near the tailbone.
Imaging Tests (For Severe Cases):
🔹 Ultrasound – Helps determine the extent of infection and whether abscesses are present.
🔹 MRI or CT Scan – Used in complex or recurrent cases to detect deep tissue involvement or sinus tracts.
When to See a Doctor?
Seek medical attention if you experience:
⚠ Severe pain or swelling that worsens over time.
⚠ Recurring drainage of pus or blood from the cyst.
⚠ Fever, chills, or nausea, indicating a spreading infection.
⚠ Multiple abscess formations or signs of a chronic pilonidal disease.
Treatment Options for Pilonidal Cyst
Treatment for pilonidal cysts depends on severity, frequency of recurrence, and presence of infection. At ColoWell America, we provide a range of treatment options tailored to each patient’s condition. The goal is to eliminate infection, prevent recurrence, and promote long-term healing while minimizing discomfort.
Conservative Treatment For Mild Cases or Early-Stage Cysts
If the cyst is small, not infected, or minimally symptomatic, conservative management may be recommended:
✔ Antibiotics – Prescribed if an infection is present but the cyst is not severely abscessed.
✔ Pain Management – Over-the-counter pain relievers (ibuprofen, acetaminophen) can help relieve discomfort.
✔ Hygiene & Preventive Measures – Keeping the area clean and dry, avoiding prolonged sitting, and hair removal (shaving or laser therapy) may prevent worsening.
✔ Warm Compresses – Can help encourage drainage in some cases.
Best For: First-time, mildly symptomatic cases without significant infection.
Incision & Drainage (I&D) – Immediate Relief for Acute Abscesses
For painful, infected pilonidal cysts, an incision and drainage (I&D) procedure is often the first-line surgical treatment.
Procedure:
- A small incision is made over the cyst.
- The abscess is drained, relieving pressure and pain.
- The area is cleaned and packed with sterile gauze.
Recovery & Post-Op Care:
- The wound is left open to heal naturally (often over 1-2 weeks).
- Daily dressing changes to prevent infection.
- Patients can return to normal activities quickly, but must avoid prolonged sitting.
Best For: Acute, painful, or infected cysts that require immediate relief.
💡 Note: While I&D provides temporary relief, it does not remove the cyst and has a high recurrence rate, requiring further treatment in many cases.
Excision – Complete Removal for Chronic or Recurrent Cysts
For patients with recurring pilonidal cysts, surgical excision is recommended to completely remove the cyst and affected tissue, reducing the chance of recurrence.
Procedure:
- The entire cyst, abscess, and surrounding infected tissue are removed.
- The wound can be left open (for natural healing) or closed with stitches (primary closure).
- The choice of healing approach depends on cyst size, infection status, and recurrence history.
Types of Excision Healing:
- Open Healing (Secondary Intention) – The wound is left open to heal gradually from the inside out, reducing recurrence risk but requiring daily wound care for several weeks.
- Primary Closure (Stitches) – The wound is sutured closed for faster healing (2-4 weeks), but has a higher risk of infection and recurrence.
Recovery & Post-Op Care:
- Open healing requires daily wound packing and dressing changes.
- Closed excision requires suture removal in 10-14 days.
- Patients should avoid prolonged sitting and heavy activity during recovery.
Best For: Patients with chronic, recurrent, or complex pilonidal disease.
Flap Surgery For Severe or Recurrent Cases Requiring Reconstruction
For extensive or recurrent cysts, especially when prior treatments have failed, flap surgery provides a long-term solution with a lower recurrence rate.
Procedure:
- The cyst and surrounding diseased tissue are completely removed.
- A flap of healthy skin is rotated or advanced to cover the wound, ensuring better healing and preventing further cyst formation.
- A JP (Jackson-Pratt) drain may be placed temporarily to prevent fluid buildup.
Recovery & Post-Op Care:
- Hospital stay of 1-2 days (for complex cases).
- Sutures and drains removed in follow-up visits.
- Limited physical activity for several weeks to allow proper healing.
- Lowest recurrence rate among all surgical options.
Best For: Patients with multiple recurrent cysts, extensive disease, or failed previous surgeries.
