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Pain In The Butt: Pilonidal Cysts

Have you ever devel­oped a small cyst in the crease of your but­tocks or tail­bone? It may have been a small dim­ple, or could have start­ed that way and devel­oped into a large and painful mass. This con­di­tion is caused by pilonidal dis­ease and there are more than 70,000 cas­es diag­nosed in the US each year.

About Pilonidal Disease

Pilonidal dis­ease is a chron­ic skin infec­tion in the crease of the but­tocks near the coc­cyx (tail­bone). Pilonidal dis­ease can be a one-time cyst or be a chron­ic condition.

Who Gets Pilonidal Disease?

Any­one can be impact­ed by pilonidal dis­ease. This con­di­tion is more com­mon in men than women and often occurs between puber­ty and age 40 with the aver­age age being between 20 and 35. Obe­si­ty and thick, stiff body hair can make peo­ple more prone to pilonidal dis­ease. Pilonidal dis­ease is more com­mon in peo­ple who sit often, and wear­ing tight cloth­ing can make the con­di­tion worse. If chron­ic pilonidal dis­ease is not treat­ed it can lead to abscess­es and sinus cavities.

Caus­es of Pilonidal Disease

Hairs often grow in the cleft” between the but­tocks. These hair fol­li­cles can become infect­ed. If not treat­ed, the hair can be drawn into these abscess­es cre­at­ing a pit”, inflam­ma­tion and mak­ing the prob­lem worse.

Pilonidal Dis­ease Symptoms

Symp­toms of pilonidal dis­ease can vary from mild to severe depend­ing on the sever­i­ty of the cyst. Symp­toms may include:

  • Small dim­ple
  • Large painful mass
  • Clear, cloudy or bloody drainage from the area
  • If infect­ed, the area can become red or ten­der and also foul smelling drainage (pus)
  • If infect­ed, you may devel­op a fever, nau­sea or feel sick

Treat­ments for Pilonidal Cysts

To get the right treat­ment plan, you need to have a physi­cian exam­ine your cyst. Treat­ment will depend on the dis­ease pat­tern. The pri­ma­ry treat­ment for a small abscess is to drain the cyst through an inci­sion. If more severe you may require sur­gi­cal treat­ment from a col­orec­tal sur­geon. Your col­orec­tal sur­geon will exam­ine your cyst and deter­mine if an exci­sion or cleft lift” pro­ce­dure is best for you.

  • Cleft Lift
    • In this pro­ce­dure, your sur­geon will reshape the cleft to be shal­low­er and remove infect­ed areas which allows for bet­ter heal­ing. The wound/​incision is done away from the mid­line to decrease the time it takes to heal. This pro­ce­dure is per­formed as an out­pa­tient pro­ce­dure while you are under anes­the­sia. Recov­ery takes about 2 weeks and does­n’t require and spe­cial pack­ing or wound dressing.
  • Exci­sion with Pri­ma­ry Closure
    • Tis­sue around the cyst and sinus­es are removed and the wound area is closed with stitch­es. This pro­ce­dure is per­formed as an out­pa­tient pro­ce­dure while you are under anes­the­sia. Recov­ery takes about 4 weeks. This method is faster heal­ing than the open pro­ce­dure, but has a high­er infec­tion rate. Those that have this type of pro­ce­dure need to be care­ful not to pop stitch­es since this area of the body moves in many direc­tions dur­ing your dai­ly rou­tine which can place addi­tion­al stress on stitches.
  • Exci­sion with Open Healing
    • Tis­sue around the cyst and sinus­es are com­plete­ly removed. This results in a wound that is open to heal and fill in from the bot­tom. Your wound will need to be cleaned out and re-packed with gauze at least two times a day. This pro­ce­dure is per­formed as an out­pa­tient pro­ce­dure while you are under anes­the­sia. Recov­ery takes about eight weeks. This is the slow­est heal­ing, but has a low­er rate of infec­tion com­pared to a closed wound.

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