How is a pilonidal cyst removed?

Pilonidal Sinus or Cyst

This is a pit or skin dimple at the base of the spine, near the upper end of the anus. It often becomes infected. It is not the human remnant of the monkey's tail, nor is it a birth defect. It is usually the result of an ingrown hair and was so common in young people in the Army that it was often referred to as jeep rider's disease. Such cysts become a surgical problem because the area can get infected and form a chronic abscess and draining dimple. Barbers are prone to the same kind of disease in the fingers, where the handle of the scissors presses on the hairy skin near the knuckle area.

My brother has the same dimple, but he is not infected.

The condition tends to run in families. The cause of the infection is not always clear, but very hairy and overweight people are especially susceptible.

Does it have to be treated if there is only a dimple; are there any special precautions to avoid trouble? 

It is only treated if it becomes infected. If you avoid bruising the area and if you keep the area especially clean, infection may be avoided. There is some advantage to shaving the hair near the dimple.

How will I know if it gets infected? 

You will have no problem knowing. The area becomes painful and tender and causes trouble in sitting. Sometimes the abscess opens by itself and starts to drain and you will feel the moisture. The odor of the pus is frequently offensive.

How is the infection treated?

Usually these abscesses can be opened in the office with local anesthesia so that you will feel no pain. The packing is then changed every few days. In some fortunate individuals the whole thing heals and never comes back. In others a draining area persists or heals for a while and then starts to drain again.

What is done if it continues to drain? 

The entire lining of the infected area must be removed to avoid its regrowth. There are many ways of doing this. Sometimes it can be done on an ambulatory basis. In other cases removal requires a general anesthesia and an excision of a large area of skin, fat, and cyst lining and its contents. Each case has to be individualized.

What are the results? Will it come back? 

If the entire lining can be removed, which is sometimes very complicated, the abscess should stay cured. Postoperative dressings in the office and care at home are particularly important in securing good healing. The patient must come regularly for dressings. Some abscesses do recur even with diligent care.

If it recurs, what's the point of doing it at all; why not just let it go? 

Let's understand first that most likely you will be cured. Second, once infected and neglected, this abscess often does not stay quiet. It burrows under the skin, comes out in new places, and can spread to invade a large part of the lower back area. Therefore, the effort to prevent this from happening is worthwhile.

Can it become a cancer? 

No, this is an infection. It is true that cancers can occur in areas of chronic inflammation and in areas that are always draining, but that is not a problem here.

How do I get about with an open wound? You say it may take six to twelve weeks to heal if left open. I have to earn a living.

You can work with the dressing on under your clothes. You wear a sort of bathing suit underpants that will absorb the moisture. When you return from work in the evening, you can apply a new external dressing and you are up and about doing everything until the next office visit. At that time the physician observes the healing progress and demonstrates the dressing method so that it can be continued at home.

Pilonidal Sinus Treatment

Are there injection treatments?

If the infected area is very small, many approaches can be used. When the abscess is the usual size, it requires an adequate incision to let all the pus out. Remember, you only see the top of the abscess cavity, which extends down to the broad, flat bony area. Hence, injection treatments are advised in only very specific and rather unusual instances.

Does the injection come from the rectum? 

Although it is a common observation that some people with this infection are sloppy about their toilet habits, the infection does not start in the rectum. However, some rectal infections can simulate pilonidal abscesses. It is important to make the distinction because the treatment is completely different.


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