Pilonidal Cyst

Pilonidal Cyst Overview

A pilonidal cyst is a cyst at the bottom of the tailbone (coccyx) that can become infected and filled with pus. Once infected, the technical term is pilonidal abscess. Pilonidal abscesses look like a large pimple at the bottom of the tailbone, just above the crack of the buttocks. It is more common in men than in women. It usually happens in young people up into the fourth decade of life.

Pilonidal Cyst Causes

Most doctors think that ingrown hairs cause pilonidal cysts. Pilonidal means "nest of hair." It is common to find hair follicles inside the cyst.

Another theory is that pilonidal cysts appear after trauma to the sacrococcygeal region (the region relating to both the sacrum [the lower vertebrae] and coccyx). During World War II, more than 80,000 soldiers developed pilonidal cysts that required a hospital stay. People thought the cysts were due to irritation from riding in bumpy Jeeps. For a while, the condition was actually called “Jeep disease.”

Pilonidal Cyst Symptoms

The symptoms experienced by someone with a pilonidal cyst include the following:

• Pain at the bottom of the spine
  
• Swelling at the bottom of the spine
• Redness at the bottom of the spine
• Draining pus
• Fever

When to Seek Medical Care

A pilonidal cyst is an abscess or boil. It needs to be drained, or lanced, to improve. Like other boils, it does not improve with antibiotics. If any of the following symptoms occur, consult a doctor:

• Pain at the bottom of the spine
• Swelling at the bottom of the spine
• Redness at the bottom of the spine
• Pus draining from the cyst
• Fever with any of the above symptoms

Exams and Tests

The doctor can diagnose a pilonidal cyst by taking a history (asking about the patient's history and symptoms regarding the cyst) and performing a physical exam. The doctor may find the following conditions:

• Tenderness, redness, and swelling between the cheeks of the buttocks just above the anus
• Fever
• Increased white blood cells on a blood sample (not always taken)
• Inflammation of the surrounding skin

Pilonidal Cyst Treatment Self-Care at Home

Early in an infection of a pilonidal cyst, the redness, swelling, and pain may be minimal. Sitting in a warm tub may decrease the pain and may decrease the chance that the cyst will develop to the point of requiring incision and drainage.

Medical Treatment

Antibiotics do not heal a pilonidal cyst. Doctors have any of a number of procedures available, including the following treatments.

• The preferred technique for a first pilonidal cyst is incision and drainage of the cyst, removing the hair follicles, and packing the cavity with gauze.
  
  
  • Advantage - Simple procedure done under local anesthesia
    
    
  • Disadvantage - Frequent changing of gauze packing until the cyst heals, sometimes up to 3 weeks

• Marsupialization - This procedure involves incision and draining, removal of pus and hair, and sewing of the edges of the fibrous tract to the wound edges to make a pouch.
  
  
  • Advantages - Outpatient surgery under local anesthesia, minimizes the size and depth of the wound without the need to pack gauze in the wound
    
    
  • Disadvantages - Requires about 6 weeks to heal, needs a physician trained in the technique

• Another option is incision and drainage with immediate closing of the wound.
  
  
  • Advantages - Wound completely closed immediately following surgery without need for gauze
    
    
  • Disadvantages - High rate of recurrence (It is hard to remove the entire cyst, which might come back. Typically performed in an operating room, it requires a specially trained surgeon.)