Pilonidal Cyst: What the Heck Is That?
A pilonidal cyst forms most commonly on the tailbone area—at or near the top of the cleft of the buttocks. I don't believe I have ever seen anything quite like it. Most doctors believe that it is caused by an ingrown hair that then becomes infected. Some doctors think a pilonidal cyst is a remnant of the human tail seen during fetal development. This "tail" is supposed disappear once the spine is done developing, but sometimes, it doesn't and can develop into this painful bump. Another theory is that some sort of injury of the sacrococcygeal (tailbone) area can cause these cysts to occur. The causes are still being looked at.
Pilonidal cysts are more often seen in men than in women. Usually, they show up between the ages of 15 and 24 with very rare occurrences after the age of 40.
My son started to complain about his buttocks hurting so I told him he probably had a pimple or something, and it would go away. I hadn't looked because I don't regularly look at my 18-year-old son's buttocks—haven't seen it since he was six or so. After a week went by, he woke up with blood and pus everywhere—I had to take a look. What I saw stunned me. I don't think I can really explain my thoughts as to what I was looking at. After I got it cleaned up, I was met with the most shocking thing I do believe I have ever seen, and I don't mean in pictures. This was real life.
My son had two small holes in his skin. There was no flesh of any kind within the holes. And they were deep. My jaws dropped, and I think I muttered, "Oh my God." I was looking into darkness, which I later learned was a cavity left by the cyst. I need to say it again: "Oh my God." Many thoughts ran through my mind; among them—flesh-eating virus. Now my heart was pounding and my stomach was lurching.
If any of this is vaguely familiar to you, you may have a pilonidal cyst. Here are some more symptoms to look for:
- Localized swelling
- Reddening of the skin
- Drainage of pus and blood from an opening of the skin called a pilonidal sinus
- Hair protruding from the area
- Fever (although it's rare)
- Foul smell from the draining pus
The pilonidal sinus looks like a channel or tunnel below the surface of the skin that connects the root of the cyst to the opening on the surface of the skin.
Some doctors believe the likelihood of developing a pilonidal cyst increases with long periods of sitting or sitting improperly as well as poor hygiene.
Mayo Clinic gives these risk factors:
- Inactive lifestyle
- Occupation or sports that require sitting
- Excess body hair
- Stiff, coarse, ingrown hair
- Poor hygiene
- Excess sweating
My son had a few of these—excessive sitting, excess body hair (he is a hairy guy), and stiff or coarse hair. So do I think his human tail didn't absorb during gestation, or do I think he just plays too many video games sitting on his butt? Well, he does play and sit on his butt too much, like most teenagers these days. Do I think that's the cause? I just don't know. What I do know is that it must be fixed. My son is having pain, and I don't care for that.
The first thing to know is that antibiotics will not completely heal a pilonidal cyst—it will only treat the infection. Once a cavity is opened, it will not close again without some type of medical intervention. At least that is how I interpret the information I have been pouring over since my son saw the doctor.
One treatment option is incision and drainage. The tailbone area is numbed with a local anesthetic, and the doctor makes an incision to drain and clean the cyst. The wound is then packed with dressing so it can heal from the inside out.
Another option is surgery. This procedure is necessary if the cyst is recurring or you have one or more of the sinus passages open.
All your options should be discussed with your doctor to find out which treatment is the right one for you. Postoperative care is equally important, and you will have detailed instructions from your doctor regarding proper care.
Mayo Clinic offers these tips on helping prevent the recurrence of a pilonidal cyst.
- Remove any hair from this area on a regular basis. Shaving or depilatory creams work well in this area. Laser treatments for hair growth may also help.
- Clean the area daily with glycerin soap because it's less irritating to the skin. Rinse all soap residue off the area. Once the area is healed and no longer sore, washing the area briskly with a washcloth also helps keep the area free of hair.
- Keep the area clean and dry. Don't use powders, oils, or herbal remedies in this area.
- Avoid sitting for long periods of time.
I will certainly be hounding my kid to get off his butt more often. Although with the pain he is in, I do believe he will do anything to prevent this from happening again.
It Was Surgically Removed
My son has been on his antibiotic for a day and a half, and already, his infection looks like it's healing. He is on some strong antibiotic, taking 875 mg twice a day. When he was done with this course of antibiotics, he went into surgery to have the cyst removed. I am happy to say that after more than five years, he has not had another cyst.
I hope this has helped others who are experiencing something going on in the "behind" region. I had never heard of pilonidal cysts before and found it most interesting, so I wanted to pass it along.