Pilonidal Cyst: Symptoms, Causes & Treatment
Everything you need to know about pilonidal disease — from the first symptoms to the advanced flap-based treatment that stops it from coming back.
What is a Pilonidal Cyst?
A pilonidal cyst (sacrococcygeal fistula) is an abnormal pocket in the skin that usually locates itself above the buttocks near the tailbone. The cyst looks much like a pimple and commonly contains hair and skin debris. If the cyst becomes infected it can result in a really painful abscess that requires clinical attention. Even the pressure from sitting can become uncomfortable, and an infected pilonidal cyst is known for causing fever, nausea, and vomiting.
Pilonidal cysts were first described in 1833 by Herbert Mayo. The term pilonidal is derived from the Latin words “pilus” (hair) and “nidus” (nest). They occur more frequently in men than in women, and are more common among young adults in their late teens, 20s and 30s.
Without proper treatment, a pilonidal cyst can become seriously infected and make you quite ill — early treatment matters.
Symptoms of a Pilonidal Cyst
Pilonidal cysts often start out symptomless — but once infected, watch for these signs:
Causes & Risk Factors
What causes a pilonidal cyst?
A chronic skin infection that forms near your tailbone in the top crease of your buttocks, a pilonidal cyst develops when hairs in the cleft of your buttocks grow into your skin and become infected — and it is known for causing excruciating pain.
Risk factors include:
Being overweight · A sedentary lifestyle · Sitting for long periods · Naturally stiff, coarse hair. Though anyone can suffer from a painful, inflamed pilonidal cyst, this condition affects men more commonly than women.
How Pilonidal Disease Is Treated
Pilonidal Abscess
The main technique for treating an infected pilonidal abscess is lancing the cyst and draining the pus within it — typically a simple in-office procedure under local anesthetic. Should an excision be necessary, the area is surgically opened and completely debrided, leaving the wound open to heal with a decreased risk of wound complications.
Pilonidal Cyst & Sinus
Complex or recurrent pilonidal disease is best treated by an operation that removes the entire bed of disease — the sinus tracts and cyst down to healthy tissue over the tailbone. The wound is then reconstructed and closed with flaps, mobilizing healthy tissue for a tension-free closure with a small chance of coming open.
What Pilonidal Pain Really Feels Like — And How We End It
Patients describe it as sitting on a bruise that never heals — a boil-like swelling at the tailbone that makes desks, car seats, and long flights unbearable. When it becomes infected, the pain can be excruciating, with drainage, odor, and fever that disrupt work, school, and sleep.
The pain of a pilonidal flare-up is unlike anything else — a deep, throbbing pressure at the tailbone that turns everyday life into a series of calculations. How long is the drive? How hard is the chair? Will sitting through a meeting, a class, or a flight make it worse? Many of our patients tell us they quietly rearranged their whole lives around their cyst — skipping the gym, avoiding travel, sleeping on their side, dreading every recurrence.
And because of where pilonidal disease occurs, too many people suffer in silence — embarrassed to talk about it, hoping it will go away on its own. It rarely does. Flare-ups tend to return, each one more disruptive than the last.
You don’t have to live this way. Pilonidal disease is completely treatable — and with the right surgical technique, it almost never comes back.
How the Pilonidal Institute Can Help
- ✓Immediate relief — infected abscesses are drained in-office, under local anesthetic, often the same week you call
- ✓A permanent solution — our published flap-based technique removes the disease completely, with a near-zero recurrence rate
- ✓Outpatient & quick recovery — home the same day, minimal pain, and back to your life fast
- ✓Discreet, judgment-free care — two board-certified colorectal surgeons who treat this condition every week and understand exactly what you’re going through
Cutting-Edge Flap-Based Outpatient Treatment
Dr. Nasseri and Dr. Barnajian perfected a unique flap operation — bilateral fasciocutaneous gluteal flaps with tie-over sutures and incorporation of extracellular matrix — refined over decades and published in peer-reviewed journals.
- ✓Outpatient — you go home shortly after the procedure
- ✓Most patients experience minimal pain afterward
- ✓Cosmetic midline scar that aligns with the natural crease
- ✓Minimal rate of complications
- ✓Near-zero recurrence rate
Have These Symptoms? Don’t Wait.
Book an appointment with the Pilonidal Institute right away — our doctors can evaluate your cyst, treat it, and help stop it from ever recurring.
Schedule an Appointment