Pilonidal Cysts: Symptoms and Treatment

Medically Reviewed by Zilpah Sheikh, MD on March 22, 2024
Written by Amy Gopal, Shelly Shepard, WebMD Editorial Contributor
7 min read

There’s a type of cyst you can get at the bottom of your tailbone, or coccyx. It’s called a pilonidal cyst, and it can become infected and filled with pus.

The cyst looks like a large pimple at the bottom of your tailbone. It's more common in men than in women, and it affects younger people more often. More than 70,000 people get a pilonidal cyst in the U.S. each year.

People who sit a lot, such as truck drivers, have a higher chance of getting one.

Pilonidal cysts can be treated. If your cyst becomes a problem, your doctor can drain it or take it out through surgery.

Pilonidal cyst risk factors

Certain people have a higher chance of getting a pilonidal cyst, including people who:

  • Sit most of the day at work
  • Are severely overweight
  • Have body hair that is coarse or thick
  • Are male (men are three to four times more likely to get a pilonidal cyst than women)
  • Are aged 20-35 years

Researchers think that ingrown hairs cause pilonidal cysts. Pilonidal means "nest of hair," and doctors sometimes find hair  follicles inside the cyst.

Other causes

During World War II, more than 80,000 soldiers got pilonidal cysts that put them in the hospital. People thought they were because of irritation from riding in bumpy Jeeps. For a while, the condition was called "Jeep disease."

You might be more likely to get one if you were born with a small dimple in the skin between your buttocks, called a sacral dimple. This harmless dimple could get infected and result in a pilonidal cyst, though doctors aren’t exactly sure why. If you have a sacral dimple, you don't have to be overly concerned you'll get a cyst, but stay aware of signs of infection and talk to your doctor if you have symptoms.

Is a pilonidal cyst hereditary? 

It's possible to inherit a pilonidal cyst from a relative. For example, if thick, coarse body hair runs in your family, you are more likely to get a cyst.

Can a pilonidal cyst cause bowel problems?

Pilonidal cysts are not known to cause problems with your bowels. But since bleeding is a symptom of pilonidal cysts, you may see blood on the toilet paper after a bowel movement because you have wiped over the bleeding cyst.

The symptoms of a pilonidal cyst include:

  • Pain, redness, and swelling at the bottom of the spine
  • Pus or blood draining out of it
  • Bad smell from the pus if it’s infected
  • The affected area feels tender when touched
  • Fever or nausea if the cyst is infected

The cysts can vary in size. Yours may be a small dimple or cover a large, painful area.

You should call your doctor if you have any of these symptoms:

  • Pain that increases after sitting for a long time
  • Swelling along your butt crease or a dimple, and it is red or sore
  • Leakage of pus or blood from the abscess
  • Fever, nausea, or extreme tiredness

Your doctor will examine you and look at the crease of your buttocks to check for signs of a pilonidal cyst. If they see a pimple or dimple there, or a bump that is oozing fluid, they may ask you:

  • Does the cyst look different than when you first noticed it?
  • Is there liquid leaking from the cyst?
  • Do you have other symptoms?

Early in the infection of a pilonidal cyst, the redness, swelling, and pain may not be too bad. Some things you can try:

  • To ease any pain, soak in a tub of warm water.
  • Take nonprescription pain medicine, but follow the dosing instructions.
  • Keep the cyst and the area around it clean and dry.

Can a pilonidal cyst go away on its own?

Sometimes, your cyst may open and drain on its own. If it does drain on its own, be sure to keep the area around it dry and clean.

Pilonidal cyst antibiotics

Your doctor may prescribe antibiotics if the skin around your pilonidal cyst is inflamed, but antibiotics will not heal the cyst or make it go away.

Laser therapy

Laser therapy won’t cure your current pilonidal cyst, but it can remove hair to prevent it from becoming ingrown. This could help keep further cysts from developing.

Draining

This is the preferred method for your first pilonidal cyst. Your doctor makes a cut into the cyst and drains it. They remove any hair follicles and leave the wound open, packing the space with gauze.

It’s a simple procedure done under local anesthesia, meaning the doctor numbs just the area around the cyst. You have to change the gauze often until the cyst heals, which may take up to 3 weeks.

Pilonidal cyst surgery

If your pilonidal cyst is chronic or keeps returning, you may need surgery. You also may need surgery if the cyst worsens and creates a hole under your skin. Some forms of surgery include:

Marsupialization. In this procedure, your doctor makes a cut and drains the cyst, removing pus and any hair inside. Then, they sew the edges of the cut to the wound edges to make a pouch.

  • Advantages -- This is outpatient surgery under local anesthesia. It also lets your doctor make a smaller, shallower cut so that you don’t need to repack gauze daily.
  • Disadvantages -- It takes about 6 weeks to heal, and you need a doctor specially trained in the technique.

Incision, drainage, closing of wound. In this technique, the doctor drains the cyst, but it’s not left open.

  • Advantage -- You don’t need to pack gauze because your doctor fully closes the wound after surgery.
  • Disadvantages -- You’re more likely to have problems with the cyst in the future. It’s harder to remove the entire cyst with this method. It’s usually done in an operating room with a specially trained surgeon.

Follow all of your doctor’s instructions about at-home care, especially if you need to remove and pack gauze. Other tips:

  • Keep the area clean.
  • Check for any signs of a new infection, such as redness, pus, or pain.
  • Keep your follow-up appointments with your doctor so they can see how your cyst is healing.

A complete cure is possible, but remember that a pilonidal cyst may come back even if you had one surgically removed.

If your pilonidal cyst is not treated or keeps returning, you could develop what’s called sinus cavities (empty spaces under the skin) and pockets of infection.

Infected pilonidal cyst

An infected pilonidal cyst can be painful and is referred to as an abscess.

If your cyst is infected, the pus may smell bad, and you may get a fever and feel nauseated.

If your infected cyst worsens, the infection could spread throughout your body, which might be life-threatening.

Pilonidal cyst recurrence

Even with medical treatment, you may develop chronic pilonidal disease, which means your cysts keep coming back.

You can try to prevent pilonidal cysts by:

  • Standing up or walking around to avoid sitting for too long.
  • Washing regularly to keep the area around your buttocks clean.
  • Maintaining a healthy weight.

Pilonidal cysts are small fluid-filled sacs or bumps that appear along the crease or top of your buttocks. If the cyst isn’t painful, you can try treating it yourself. However, if the pain worsens or appears to get infected, you should see your doctor. Your doctor can treat the pilonidal cyst or surgically remove it. It’s important to know the signs of pilonidal cysts since they can come back after treatment.

What can trigger a pilonidal cyst?

Researchers don't know every cause of a pilonidal cyst, but often it happens when an ingrown hair causes a skin infection and cyst to form. If you are a man, are 20-35 years old, or have thick and coarse hair, you are at increased risk of a pilonidal cyst. Also, if you sit a great deal for work or are overweight, you have a greater risk of developing a cyst.

Will a pilonidal cyst go away by itself?

Yes, sometimes your cyst may open and drain on its own. If it does drain on its own, be sure to keep the area around it dry and clean.

Is it OK to squeeze a pilonidal cyst?

No, you shouldn't squeeze your pilonidal cyst. Doing so could further irritate the cyst, make the infection worse, or make the cyst bleed. You also aren’t likely to remove all the pus by squeezing, so it’s best to have your doctor clear the cyst for you.

What is the best way to get rid of a pilonidal cyst?

Draining is the preferred method for a first pilonidal cyst. Your doctor makes a cut into the cyst and drains it. They remove any hair follicles and leave the wound open, packing the space with gauze.

The procedure is done under local anesthesia, meaning the doctor numbs just the area around the cyst. You have to change the gauze until the cyst heals, which may take up to 3 weeks.