A pilonidal cyst typically occurs in the crease between the buttocks. It most often occurs in older teens and young men, but can also be seen in female teens and young women.

Initially it may present with swelling, blood stains on underwear or discomfort with sitting or activities.

If it becomes infected, then it is called an abscess. This is characterized by worsening pain, swelling, redness of the area, and sometimes a fever.

Ingrown hairs in a deeper cleft between the buttocks, trauma associated with sports or activities (called “Jeep drivers disease” in World War II), a hairy bottom, or increased BMI.

A pilonidal cyst may be diagnosed by your family doctor or dermatologist. A referral to a pilonidal specialist would be the next best step.

If an abscess has developed, then urgent care is required for relief, which usually requires surgical drainage. Calling a pilonidal specialist directly would be the next best step for urgent attention.

Antibiotics are sometimes given to treat the surrounding infection, but rarely would be given as the sole treatment, as they are not likely to help long term.

Unfortunately, not likely. Once the cyst has developed, it probably requires cleaning out at a minimum. Sometimes this will prevent recurrence. More often than not, surgery is required to remove the cyst.

The best operation is one that removes the inflamed tissue, has minimal post-operative pain, doesn’t require significant wound care or packing, can be performed as an outpatient procedure, has high success rate, and a minimal chance of recurrence.

This can be accomplished with the cleft lift procedure.

Many non-specialist surgeons are removing more tissue than necessary, leaving the wounds open after surgery and post-operative care that requires wound care and packing.

With more modern surgical techniques by a pilonidal specialist, many of these things are no longer necessary.

After care generally requires a period of limited activities for the first 10–14 days. Day to day activities can then resume.

I usually recommend 4 weeks before returning to full activities, such as exercise.

With a well-planned cleft lift procedure, which eliminates the cyst and elevates the midline buttock crease, there is a very low incidence of recurrence.

There will be an incision a few inches long to the side of the midline crease. After a few months, this will fade and be hardly noticeable.

There will be softer, gentler rolling hills between the buttocks, instead of a deep valley. The final results will be esthetically pleasing.