How can I tell if I really have this?
Only a doctor can confirm whether you have a pilonidal cyst. Symptoms vary greatly from person to person. Some people experience mild discomfort when sitting, while others may notice drainage without pain. In severe cases, an intensely painful lump or swelling in the tailbone area requires urgent medical attention. A common first sign is discomfort around the tailbone and a lump that may feel tender or swollen. If you’re Googling "tailbone pain," there’s a good chance this could be the issue.

Why did I get this?
Pilonidal disease often starts with "follicular occlusion," where hair follicles or pores in the buttock cleft become blocked due to friction and pressure. Prolonged sitting, especially on hard surfaces, can stretch the skin, increasing irritation. While there’s a genetic component for some people, pilonidal disease is largely considered an acquired condition. Ensuring your doctor is informed about the latest research is key, as outdated beliefs about pilonidal cysts being entirely congenital can limit treatment options.

Does weight have anything to do with it?
Yes, being overweight can increase the risk of pilonidal disease. A deeper buttock cleft traps more moisture and debris, creating a favorable environment for bacteria. This, combined with the pressure from sitting, can exacerbate the condition. However, pilonidal cysts can occur in people of all body types, so weight alone is not the sole factor.

Can it be cancerous?
Pilonidal cysts are rarely cancerous. As of 1999, fewer than 50 cases of cancer related to untreated pilonidal disease have been reported, and these were typically in individuals who avoided treatment for decades. During surgery, your doctor may send tissue samples for testing, but this is precautionary and not indicative of a high cancer risk.

Can pilonidal cysts appear in other places?
Technically, pilonidal cysts are specific to the buttock cleft. However, similar abscesses can form in other areas, such as the navel, armpit, or pubic region, often linked to a condition called Hidradenitis Suppurativa. Barbers and groomers may develop a related condition known as Barber’s Pilonidal Sinus, caused by embedded hairs between their fingers.

What does the abscess or cyst feel like?
A pilonidal cyst often feels like a lump near the tailbone that can range in size from a pea to a golf ball. The lump is usually tender, movable under the skin, and painful to the touch. Some individuals experience only draining sinuses without a noticeable lump. In severe cases, the lump may cause throbbing pain and limit movement, making sitting or standing difficult.

What is this little hole in my backside?
That is likely a sinus opening, a small tunnel connecting an abscess to the surface of the skin. Sinuses allow drainage of pus or blood and are often associated with recurring infections. If you have a sinus, it is likely linked to a deeper abscess. Multiple sinuses can develop in severe cases, complicating treatment and requiring careful surgical intervention.

How do I know it’s infected?
An infected pilonidal cyst is hard to miss. Pain intensifies, making it difficult to sit, stand, or even lie down. Swelling, redness, and a foul-smelling discharge are common. The drainage may include pus or blood and vary in color. Severe infections often send people to the emergency room due to unbearable pain.

How do I sit after pilonidal cyst surgery?
Sitting after pilonidal cyst surgery requires care to avoid putting pressure on the wound. It’s best to use a donut pillow or sit at an angle to distribute your weight evenly. Frequent position changes and avoiding prolonged sitting are crucial for promoting healing.

How to poop after pilonidal cyst surgery?
Bowel movements after surgery can be challenging due to pain and wound sensitivity. A stool softener may help reduce strain. Hygiene is critical; use a peri-bottle or gentle wipes to clean the area after each bowel movement to prevent infection.

Can a pilonidal cyst come back after surgery?
Yes, pilonidal cysts can recur, especially if the original pits or sinus tracts were not fully removed or if post-surgical care was inadequate. Practicing good hygiene, removing hair in the area, and avoiding prolonged sitting can reduce the chances of recurrence.

What are the healing stages for an open wound after pilonidal cyst surgery?
Open wound healing after surgery typically occurs in stages. The first stage involves inflammation and drainage, followed by tissue granulation, where new skin begins to form. Finally, the wound closes and strengthens. Keeping the wound clean and following your doctor’s packing and dressing instructions is essential for successful healing.

What is wound packing, and why is it necessary?
Wound packing involves placing sterile gauze or dressings into the surgical site to prevent infection and promote proper healing. This process helps keep the wound open, allowing it to heal from the inside out. Regular packing changes, as directed by your doctor, are critical for avoiding complications.

Can metronidazole help with pilonidal cysts?
Metronidazole, an antibiotic, is sometimes used to treat pilonidal infections, especially when anaerobic bacteria are present. It can help reduce infection and inflammation, but it is typically part of a broader treatment plan, including drainage or surgery.

Why am I itching like crazy back there?
Itching is often a response to draining fluid or irritation around the surgical site or abscess. This is a sign of healing but can also indicate mild irritation. Keeping the area clean and using gentle, unscented products can help alleviate itching.

Can lower back pain be related?
Many people report lower back pain alongside pilonidal disease. This could be due to pressure on nerves, awkward sitting postures, or general discomfort from the abscess. Pain usually resolves after the cyst is treated and healing is complete.