Risk factors for developing pilonidal cysts include having thick, wiry hair on the lower back, sitting for long periods of time, and friction, such as a belt rubbing against the skin. Pilonidal cysts often become infected, leading to pilonidal sinus disease.
The sinus is a cavity below the skin that connects to the surface through your pores. The infection spreads from the cyst into the sinus tract and, over time, can lead to recurring infections that become increasingly severe and painful.
An infected pilonidal cyst is diagnosed by a visual examination by a primary care healthcare provider, dermatologist, ER healthcare provider, or colorectal surgeon. Ultrasound also may be used to determine the scope of the infection. Other treatments will likely have been tried and failed before your healthcare provider recommends pilonidal cystectomy.
The typical first-line treatment is to lance the boil. This can be done in your healthcare provider's office or emergency room using local anesthesia. Once the area is numb, the healthcare provider will make an incision into the abscess to drain the pus. Antibiotics are not usually prescribed for pilonidal infections unless an accompanying skin infection i. Lancing may work to remove the initial infection, but pilonidal cysts can be complex, and they frequently return and worsen over time. This is also done using local anesthesia and may be performed in the healthcare provider's office, an outpatient surgical center, or an emergency room setting.
This procedure involves unroofing splitting open the cyst, curetting scraping out the base, and marsupializing suturing the edges. The wound is left open to drain.
This, too, is usually a temporary fix, and the pilonidal sinus cavity experiences recurrent infections. If the cyst does not heal after draining or you continue to have problems, a pilonidal cystectomy may be needed to surgically remove the cyst and surrounding tissue. Pilonidal cystectomy is sometimes performed as an emergency procedure during an acute flare-up of pain, but it is most often a scheduled surgery that takes place at either a hospital or outpatient surgical center.
Pilonidal cystectomy does not require an overnight stay and you will be discharged following the procedure. Since the surgery is performed under anesthesia, you will be not allowed to drive afterward, so arrange transportation in advance.
Don't forget to bring your insurance documents, identification, and any additional paperwork your surgeon requires the day of the procedure. It is recommended to wear something comfortable that is easy to change out of. You will be in a hospital gown for the procedure. Do not wear any jewelry and leave anything of value at home. Your healthcare provider will instruct you on whether you will need to stop eating and drinking before the procedure.
If you are going under general anesthesia, it is typically recommended to not consume anything in the eight hours before the procedure. Your healthcare provider will advise you on whether you need to make any alterations to your current medications. Certain drugs can interfere with medical procedures and should not be taken prior to any surgery. In particular, blood thinners may cause problems with blood clotting during surgery.
Be candid about your use of any recreational drugs, marijuana, alcohol, and nicotine, as these may affect your response to sedation. Don't assume that your entire surgical team knows what medications you are taking. Repeat it to them on the day of your procedure so they are aware of what you have been on and how much time has passed since you last took it. A day or two before your scheduled pilonidal cystectomy, you will be notified when to arrive at the facility to check in.
The procedure itself should take about 45 minutes. After you check in on the day of your procedure, you'll be taken to a room to change and have a brief exam. You will review your medical history with a nurse, answer questions about the last time you ate or drank, and have your vitals checked. From there, you will be brought into the procedure room set up with a surgical table, medical equipment, and computers. You will lie face down on the table and the surgical team will prepare the skin on your lower back for surgery by shaving and disinfecting it.
The anesthesiologist will connect you to an IV to give you medicine to relax. A pilonidal cyst is a sac filled with hair and skin debris that forms at the bottom of your tailbone. Infected hair follicles usually cause these cysts to develop. Initial treatments include sitz baths , warm compresses , and antibiotics.
However, if the infection is severe enough, you may need surgery. Read on to learn more about how these procedures are performed, what the recovery process is like, and if a cyst is likely to return. Your healthcare provider will likely recommend an incision and drainage procedure to treat your pilonidal cyst if:. While an incision and drainage procedure is typically the first surgical option considered for a pilonidal cyst, your doctor may recommend a cystectomy if:. First, your healthcare provider will give you an injection to numb the area.
This reduces pain and inflammation. A pilonidal cystectomy is surgery to completely remove the cyst, along with the pilonidal sinus tracts. You may be advised to stop smoking and go off certain medications for a period of time. Pilonidal cyst surgeries are done under general anesthesia at an outpatient surgical center. The surgery itself takes about 45 minutes to perform.
You should arrange to have someone drive you home. Pune Location : Patient Testimonials. The disadvantage of wide excision is that the wound size is large and healing may take upto 3 months.
The dressing needs to be changed daily making it a tedious process. Advantages of LHP. Patient is discharged within 24 hours and can return to routine work by the 5th day. Wound healing occurs in about weeks and thus recovery is much faster as compared to conventional Wide excision. Recurrence rate is negligible. NOTE : The flap procedures are quite invasive and patients are hospitalised for a couple of days afterwards.
The post-operative recovery time is also quite long. These surgeries remove a large amount of tissue, which destabilises the area and leave few options to the patient if they fail. Causes Of Pilonidal sinus More common in males Sedentary lifestyle People who sit for long hours at a stretch eg.
Drivers Thick body hair especially those that are coarse and curly Obesity Previous injury in the area Family history of Pilonidal sinus Having a deep cleft between buttocks History of previous Pilonidal cyst. Symptoms Of Pilonidal sinus Recurring episodes of pain or swelling in the area of the tailbone. Yellowish pus-like or bloody discharge from the tailbone area which may be foul smelling Painful lump under the skin in that area Certain activities like riding a bicycle, doing sit-ups may be very uncomfortable.
A history of your symptoms followed by a visual examination of the tailbone area is enough to diagnose a Pilonidal sinus.
Frequently asked questions Pilonidal sinus can be a tricky condition. Is pilonidal sinus dangerous? Can a pilonidal sinus heal on its own?
Can females get pilonidal cysts? What is the best treatment for pilonidal sinus? Is pilonidal sinus curable? What do I feel during the surgery? How do I feel immediately after the surgery? When can I get back to my routine activities? How do I ensure appropriate wound care? We will direct you on how to do this, which may include the following guidelines: Have a bath at least once a day if you have an open wound. If your wound is closed with stitches, avoid a bath as you may be advised to keep it dry for the first few days.
Treatment The initial treatment for an infected pilonidal cyst is usually a procedure that can be performed in your doctor's office. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Cameron JL, et al. The management of pilonidal disease. In: Current Surgical Therapy. Philadelphia, Pa.
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