A pilonidal cyst is a lump under the skin that is located in the crease between the buttocks. It may cause an infection or abscess under the skin, near or above the tailbone, and may cause pain and swelling in the area. Sometimes, like a large pimple, the infection either bursts through the skin by itself or may need to be lanced or drained to let the infected fluid out. A pilonidal cyst may become infected only once or may repeatedly come back in the same place.
Some people are born with a small abnormal area under the skin which later can develop into a pilonidal cyst. In other cases, the cyst may develop from ingrown hairs between the buttocks. In most people, there is no definite way to tell whether the cyst has been present from birth or has developed from ingrown hairs.
If an abscess is present containing infected material or pus
It is important to release the fluid by making a small opening in the cyst. This is done after first making the area numb using Novocain-type local anesthesia. Once the fluid is released, the pain rapidly disappears. Antibiotics usually are unnecessary after the fluid is drained. In many cases, this is all that is necessary, and the problem does not recur.
If the cyst becomes infected over and over, and does not go away on its own
Surgery may be advisable to remove the cyst. Such surgery must be done in an operating room but can usually be done as outpatient surgery, allowing the patient to return home an hour or two after the procedure is completed. There usually is little post-operative pain, and most people can return to work within the next day or two.
Most people are free of further problems with pilonidal cysts after drainage alone or after surgical removal of the cyst. However, in some cases, even after surgery, the cyst can come back. The reasons for this are not known; a new cyst can form from an ingrown hair, or it is possible to have another congenital cyst flare up at a later time. When this happens, surgery can again be done, again as an outpatient, with the exact nature of the procedure dictated by the nature of the recurrence.
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