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Pilonidal Disease

Pilonidal disease can occur one time, or it may become a chronic issue. It begins with a cyst in the pilonidal area that is located in the crease of the buttocks near the tailbone. Pilonidal disease affects more men than women, from puberty to age 40.

What causes pilonidal disease?

A pilonidal cyst can be caused by friction and pressure. This can be due to skin rubbing on skin, wearing tight clothing and periods of sitting for a long time. Bicycling or similar activities may also cause a breakdown of the sensitive skin in this area. Pilonidal cysts may also form when the skin is punctured by hair and then becomes infected.

What is a Pilonidal cyst?

To start, a pilonidal cyst starts with swelling under the skin, looking much like a boil. If the cyst grows, it will become extremely painful. The cyst fills with dead skin cells, fluid, and oils. It is sac-like in appearance. When the cyst becomes inflamed it swells and makes it not only difficult to sit, but any movement worsens the pain and discomfort.

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Recurrent pilonidal disease

Suffering from one pilonidal cyst and surgery is bad enough, but having recurrent cysts are fairly common. To decrease the likelihood of a recurrence, there are a few things that you can do to decrease the chances of a repeat episode of a painful cyst.

  • Keep the area around your buttocks free of hair.
  • If you are overweight, losing weight may lower your risk
  • If it is possible, avoid sitting for long periods. This will keep pressure off of the area.
  • Make sure the buttocks are kept clean and thoroughly dry.
If the cyst does not heal, a second surgery may be needed for drainage and removal. 
Surgery for pilonidal disease

Surgery for a pilonidal cyst is performed by an experienced colorectal surgeon. The procedure will be under general or regional anesthetic. The surgeon will make a small cut in the skin near the cyst and the sac that encloses the cyst is removed. The pocket that is formed by the cyst will be cleaned and will be packed with gauze. Sutures will then be placed or the surgical area may be left open in order for the wound to drain.

Recovery from pilondial surgery

You should be able to return to work in two to four weeks, but complete healing will take several weeks.

Your doctor will give you a list of things that are safe for you to do, as well as things to avoid. You may be advised to eat a diet that is high in fiber and to take a stool softener to limit straining and hard stools.

During your recovery, you will want to sleep on your stomach or side and not on your back. This will reduce the strain put on your buttocks. If you are sleeping on your side, take care not to curl up. A soft cushion for sitting may be helpful.