Pilonidal is pronounced "pie-low-NAI-dul" and is a medical term that means "nest of hair". In most cases, physicians find hair inside cysts. In the case of pilonidal cysts, they are located at the sacrum and coccyx (tailbone to anus region). A pilonidal cyst or sinus is a growth filled with air or liquid in the gluteal crease.
What Is a Pilonidal Cyst?
The gluteal crease is commonly called the crease of the buttocks and is the site of the pilonidal cysts. These cysts are usually caused by friction, pressure, or an infection. Most physicians have argued that it is caused by ingrown hairs, which curl and grow back into the skin, puncturing and embedding themselves into it. When these ingrown hairs get trapped, it irritates the skin, and the body creates cysts and accumulates pus around the foreign object.
Patients usually complain of a bump or lump near the tailbone that hurts when sitting, standing, or bending. When a pilonidal cyst can become infected, it is called a pilonidal abscess and can be extremely discomforting and painful. It's not fatal but can lead to complications or pose a risk factor for other lethal diseases like cancer.
Can Pilonidal Cysts Go Away on Their Own?
Although a pilonidal cyst isn't fatal, it can be pretty tough to get rid of as it doesn't just go away. If untreated, these cysts could compromise the skin surrounding that region leading to a squamous cell carcinoma or a full-body infection. People tend to treat themselves at home by changing their lifestyle, employing better hygiene practices, and keeping the gluteal area dry.
Home remedies might be able to soothe the pain. Still, a long-term solution is needed, especially when the cysts are chronic. As these cysts won't go away on their own, proper treatment will prevent the recurrence of the pilonidal cysts from tracts or sinus cavities that can get pus-filled and infected again. If your pilonidal cysts keep recurring after home treatments, it's time to look into more effective and permanent treatments.
What Causes a Pilonidal Cyst to Flare Up?
A pilonidal cyst can be acute (temporary) or chronic (recurring). In cases where the cysts are recurring, certain triggers make the cyst flare up:
- A sedentary lifestyle increases the irritation as the pain is worse when sitting. This includes jobs that require long hours of sitting, like truck driving, office workers, and pro cyclists
- Being overweight puts more pressure on the gluteal area when sitting, thereby increasing the chances of irritation
- Poor hygiene around the gluteal area and increased wetness can breed bacteria that infect the cyst leading to a pilonidal abscess
- Poor shaving habits and dense hairs increase the risks of having ingrown hairs
- Having folliculitis and body acne
- Having single or multiple tailbone injuries
- Wearing skin-tight clothing
How Can I Differentiate Between Coccyx Pain and Pilonidal Cyst?
As both conditions are painful, occur at the lower tip of the spine, and can be present with or without trauma, it's quite difficult to tell the difference between them. However, one major difference between coccyx pain and a pilonidal cyst is that the pilonidal cyst doesn't occur at the bony level of the sacrum/coccyx. The pilonidal cyst doesn't cause pain with pressure on the bone but rather on the soft tissue. The cyst feels like a bulge beneath the skin and may look like a pimple at some point.
Signs and Symptoms
- Pain and tenderness
- Redness
- Swelling or bump in the crease of your buttocks
- Rash around the surrounding skin surfaces
- Draining of pus or blood
- Itching and odor in cases of infection
- Fever, nausea, and fatigue in severe cases
Diagnostic Tests
- Your physician usually carries out a physical assessment of the gluteal area. The physician palpates the area to detect the cyst or signs of it
- MRI or CT scan to detect a pilonidal sinus
If your physician notices a pilonidal cyst, they might want to know how long it's been there, if the cyst has started draining fluid, if there have been changes in the appearance, and if you've experienced any other symptoms following the cyst's appearance.
Treatments
For recurring cysts, a permanent treatment is necessary. The same goes if the cyst gets infected and begins draining a foul-smelling fluid. The treatment chosen depends on the severity of the case, but here are some of the popular ones:
Cream
Topical treatment is an effective method to soothe the pain. It uses creams, ointments, or balms with active natural ingredients possessing anti-inflammatory and antiseptic properties that combat swelling and infection.
Surgery
This common procedure is called a pilonidal cystectomy, where a surgeon removes a cyst on a patient's tailbone. It removes the entire cyst and reduces the chances of a recurring infection. The surgery may take longer to heal as the incision may be deep and need a draining tube and a change of dressings.
An incision and drainage is a same-day surgery that can be performed in a clinic. It involves numbing the location with local anesthesia and making a small incision to allow drainage of the cyst. After this procedure, you will be placed on antibiotics to prevent the spread of infection.
Injections
Injections like the compound phenol are used to treat or prevent mild and moderate pilonidal cysts. After removing hair and debris from the cyst, the compound is injected and left for about a minute before removal.
Laser Therapy
Laser therapy is used in the treatment of cysts with two approaches: laser hair removal to remove ingrown hairs and laser ablation to collapse pilonidal sinuses after the removal of abscesses.
How Can Pilonidal Cysts Be Prevented?
To prevent pilonidal cysts or reduce the recurrence and improve health, you should avoid the causes and risk factors, and these steps include:
- Proper hygiene, including washing and drying the gluteal area (buttocks)
- Losing weight
- Reducing sitting time by being more active
- Shaving or waxing the hairs around the buttocks to prevent ingrown hairs
Conclusion
Although having a pilonidal cyst isn't a life-threatening issue living with it can be very uncomfortable, and proper management is necessary to prevent reoccurrence or complications later in life.