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Pilonidal cyst

What is a pilonidal cyst?

A pilonidal (pi-lo-ni-dal) cyst is a collection of hair, skin debris, and other tissue. It is almost always located near the tailbone (bottom of spine) in the buttock crease.

What causes pilonidal cysts?

Pilonidal cysts usually occur when hair cuts the skin and then becomes trapped. The cyst can sometimes drain blood or fluid. If it becomes infected it can be extremely painful.

How is it diagnosed?

A pilonidal cyst can be diagnosed during an exam. If your child has a pilonidal cyst, the provider will see a dimple, or an opening in the skin near the tailbone. The cyst will not hurt your child unless it becomes infected. Signs of an infected cyst are:

  • Pain or tenderness in the lower spine
  • Redness, warmth, swelling or drainage from the site
  • Fever, this is uncommon

How are pilonidal cysts treated?

If the cyst is not infected, it may be treated with hair removal and good hygiene. This may help it go away or prevent it from getting infected.

If the cyst becomes infected it may be treated with antibiotics. Sometimes antibiotics are not enough to treat the infection. In some cases, the infection turns into an abscess. An abscess is a painful collection of pus and other infected material underneath the skin. If the pus and infected material can’t drain out the area will get more swollen and painful. An abscess may need to be drained in order to heal. To do this, a provider will numb the area first. A cut (incision) will be made to drain the pus and infected material.

When is surgery needed?

There are many treatments available for pilonidal cysts. Your child may need surgery if they have an infected cyst or it keeps coming back.

If your child needs surgery

What happens during surgery?

There are several types of surgeries. Your surgeon will discuss which they feel is best for your child. Your child will be given general anesthesia for any of these surgeries. This means they will be given medicine to make them sleep without pain during the surgery. They might need to stay overnight in the hospital after surgery.

Closed wound surgery

For some operations the wound is closed after the cyst is removed. There may be a quicker recovery from this surgery but there is a chance of getting a wound infection because bacteria (germs) are more likely to grow in the area. Also, a closed wound could re-open after the operation.

Open wound surgery

During an open wound surgery, the cyst is removed. Then the wound is left open so it can heal from the inside out. Since bacteria need a closed space to grow it is important to keep it open so it can heal. This type of wound will take several weeks to close.

Will my child be in pain?

An infected cyst can be very painful until it is drained. Because the cyst is located near the tailbone, sitting for long periods of time can cause pain. After the infection is drained, your provider may give your child a prescription for pain medicine.

What can I expect after the surgery?

  • Diet: Most patients are able to eat a normal diet.
  • Activity: There are no specific activity restrictions after the surgery. Your child may return to normal activities as they tolerate. However, they might want to avoid sitting for long periods of time. Let your provider know if you child needs a letter for school so they can get up for breaks.
  • Wound care: Your child’s surgeon will give you specific instructions for wound care following the surgery. Here are some things you and your child can do as well:
    • Keep the area free of hair. You can do this by shaving, waxing or using hair removal creams. Do not use hair removal creams if your child has an open wound. Another option is laser hair removal but this can cost a lot of money and is not covered by insurance.
    • Keep the area clean and dry. Avoid fabrics not made out of cotton/wool and tight-fitting underwear.
    • Have your child bathe or shower often. Especially after activities that make them sweat. Use antibacterial or glycerin soap.
  • Medicines: Medication for pain such as acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®) or something like a narcotic may be needed to help with pain for a few days after surgery.
  • Return to school/daycare: Your child may return to school or daycare when you feel it is appropriate.

When do I call the surgeon?

  • If your child had surgery, call if your child has:
    • Fevers over 101 °F
    • Wound redness
    • Increasing pain and/or
    • Worsening drainage that might indicate an infection
  • Follow-up with your child's surgeon as directed following the surgery. You can call 612-813-8000 to schedule an appointment.

When do I call the primary care provider?

  • If your child did not have surgery, call if your child has:
    • Redness, swelling or pain around the cyst
    • Pus or blood draining from the cyst
    • Other new symptoms

Questions?

This information is not specific to your child but provides general information. If you have any questions, please call your clinic.

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

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