Pain, swelling or drainage near your tailbone may seem like a small issue at first. Many people call this a pilonidal cyst, but it is often part of a broader condition known as pilonidal disease.
In some cases, a cyst may heal and not return. In others, it becomes a chronic or recurring infection that requires ongoing care or surgery.
At Banner Health, you receive expert care from experienced specialists who treat pilonidal disease every day. Your care team will guide you through your treatment options and create a plan that fits your needs, whether you need in-office treatment or surgery.
Pilonidal disease is a chronic skin condition that affects the area near the tailbone, at the top of the crease between the buttocks.
It can include:
Many people use the term “pilonidal cyst,” but this is just one form of pilonidal disease.
A pilonidal cyst is one type of pilonidal disease. It is a small pocket under the skin near your tailbone, at the top of the crease between your buttocks (gluteal cleft). It may contain hair, fluid and debris.
The word “pilonidal” means “nest of hair,” which helps explain how this condition develops.
At first, a pilonidal cyst may not cause symptoms. But when bacteria enter the cyst, it can become infected. If left untreated, it can form a pilonidal abscess (a swollen pocket of infection). If the infection does not fully heal or keeps returning, small tunnels can form under the skin. These tunnels are called sinus tracts. When this cycle continues, it becomes pilonidal disease.
Other names for pilonidal cyst disease include intergluteal pilonidal disease and sacrococcygeal disease.
Pilonidal disease is most common in teenagers and young adults. Men are more likely than women to develop pilonidal disease.
Most cases of pilonidal disease develop when loose hairs press into your skin. Friction and pressure make this more likely. When hair pushes into the skin, your body treats it as a foreign object. This can cause inflammation and infection.
You may be at higher risk of developing pilonidal disease if you:
Symptoms can range from mild to severe. They depend on whether you have a simple cyst, an abscess or chronic pilonidal disease.
You may notice:
Pain from an infected pilonidal cyst can start suddenly and become intense within a day or two. Sitting, bending or lying on your back may make it worse.
Get medical attention right away if you have nausea, fever, chills or worsening pain. These symptoms may mean the infection is spreading.
Your health care provider can usually diagnose pilonidal disease with a physical exam. They will look for:
Imaging tests are rarely needed. If the condition appears complex or deep, your provider may order a CT scan or MRI to check for sinus tracts beneath the skin.
Treatment depends on how severe the condition is and whether it is infected. Your provider will recommend the least invasive options that treat the problem and lower your risk of recurrence.
If your cyst is small and not infected, your provider may recommend:
These steps reduce irritation and may help prevent infection.
If you develop an abscess, you may need a procedure called incision and drainage.
During this in-office procedure:
This treatment relieves pressure and pain quickly. You may need antibiotics if the infection has spread.
Incision and drainage treat the active infection but they do not always prevent the condition from coming back.
If your pilonidal disease keeps returning or doesn’t heal, surgery may be the best long-term treatment. There are several surgical approaches. Your surgeon will choose the method that works best for you.
The goal of surgery is to:
For some people with limited but chronic disease, a procedure called unroofing may be an option.
During this procedure:
Instead of removing large amounts of tissue, this approach targets the tunnels causing the problem. Healing occurs gradually from the inside out. This method may shorten recovery time and preserve more healthy tissue.
In more advanced cases, the surgeon may perform an excision, which removes the cyst, abscess and sinus tracts completely.
After excision, there are two main healing approaches:
Your surgeon will explain the risks and benefits of each option.
If pilonidal disease is complex or recurrent, flattening the deep buttock crease can reduce friction, moisture and hair buildup.
During a flap procedure:
Flattening the area lowers the chance of future infections.
One of the most effective surgical treatments for chronic or recurrent pilonidal disease is the cleft lift procedure, also called the Bascom cleft lift.
This specialized flap procedure is designed to:
Moving the incision off the midline and reshaping the cleft helps prevent future hair and moisture buildup. This can greatly reduce the risk of recurrence.
Recovery depends on the type of treatment you receive. After incision and drainage, you may return to normal activities within a few days. After surgery, healing may take several weeks. If the wound is left open, full healing may take longer.
Your care team will give you detailed instructions for wound care, hygiene and activity. Following these instructions lowers the risk of infection and speeds healing.
Yes, pilonidal disease can return, especially if hair, friction and moisture continue in the area.
You can lower your risk of recurrence by:
Some people need additional treatment if a cyst returns. Working closely with your provider helps you manage the condition long term.
When you choose Banner Health, you receive care from experienced, board-certified general surgeons and specialists who regularly treat pilonidal disease. We focus on accurate diagnosis, evidence-based treatment options, minimally invasive surgical techniques and clear recovery instructions. We offer convenient locations and coordinate follow-up care to support your recovery and reduce the risk of recurrence.
If you are experiencing pain, swelling or drainage near your tailbone, don’t wait. A Banner Health specialist can evaluate your symptoms and recommend the right treatment, from simple procedures to advanced surgical options.
Schedule an appointment today to get relief and prevent the condition from getting worse.
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