Pilonidal Disease

What is pilonidal disease?

Pilonidal disease or a pilonidal cyst is a skin infection in the crease between the buttocks near the tailbone. It usually causes an abscess, which is a pocket of infected fluid (pus) with a thick wall around it.

Many different names may be used to refer to pilonidal disease:

• pilonidal abscess
• pilonidal cyst
• pilonidal sinus
• sacrococcygeal pilonidal sinus
• sinus pilonidal disease
• perianal pilonidal disease.

How does it occur?

Pilonidal disease most often happens when hair grows under the skin. The ingrown hair becomes infected.

Pilonidal disease is more common in:

• men
• teenagers and adults up to 40 years old
• people who are overweight
• people who have thick, stiff body hair
• Caucasians (more common than in Africans or Asians).

What are the symptoms?

Common symptoms are:

• pain when you are sitting (sometimes it can be very painful)
• swelling and redness in the crease between your buttocks and tailbone
• pus oozing from the swollen area
• tenderness when the swollen area is touched
• sometimes fever, weakness, or nausea.

The size of the pilonidal cyst may range from a small tender dimple to a large painful area.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you.

How is it treated?

Your healthcare provider will probably drain the abscess. This can be done in your provider's office.

The process for draining a pilonidal abscess is:

• The area of infection is numbed with a local anesthetic.
• Your provider uses a sharp knife to make a small cut into the abscess so that the pus in the abscess can drain out of it.
• Your provider fills the abscess with sterile gauze.

A problem called a chronic pilonidal sinus can happen after an abscess has been drained. A pilonidal sinus is a space under the skin that forms where the abscess used to be. The problem with the sinus is that it can lead to repeated infections. The sinus connects to the skin with one or more small openings. In some cases the sinus may heal and close by itself, but usually the sinus has to be cut out. The sinus area may be stitched shut after the sinus is removed or it may be left open to drain and heal from the inside out. Your provider will discuss your choices for treatment.

How long will the effects last?

Most surgical wounds need 2 months to heal, but some may take up to 6 months.

A problem called complex or recurrent pilonidal disease is a complication of pilonidal disease. It may happen if:

• The area of the first abscess keeps getting infected again.
• You have hair growing in the area of the scar.
• The area gets sweaty and rubbed a lot.
• You have a sinus that was not seen in earlier treatments.

In this case your healthcare provider must cut away the old wound, scar, and other inflamed tissue. This is a more extensive surgery than simple drainage of an abscess or removal of a sinus.

How can I help take care of myself?

• Make sure that you follow all of your healthcare provider's instructions.
• Keep the area clean.
• Shave the area or use a hair removal cream every 2 to 3 weeks
• Check the area for signs of infection, such as redness, pus, or pain.

Keep all follow-up appointments with your provider for dressing changes and checks of the wound.

How can I help prevent pilonidal disease?

• Keep the area dry and clean.
• Keep hair out of the area between the buttocks and tailbone by shaving or using a hair removal cream.

For more information contact the American Society of Colon and Rectal Surgeons at 847-290-9184 or visit their Web site at http://www.fascrs.org.