Pilonidal Cyst/Sinus

A pilonidal cyst/sinus can be diagnosed during an exam. If your child has a pilonidal cyst/sinus, the doctor will see a dimple, or an opening in the skin (sinus tract) near the tailbone. The cyst/sinus is harmless unless it becomes infected. Your child will only need surgery if it becomes infected. Signs of an infection are:

• Pain or tenderness in the lower spine
• Redness, warmth, swelling or drainage from the site
• Fever (this is uncommon)

If the cyst/sinus is not infected, it may be treated with hair removal and good hygiene such as showering and changing clothes after sport activities and keeping the area clean and dry as much as possible. This may help it go away or prevent it from getting infected.

If the cyst/sinus becomes infected, it may be treated with antibiotics. Sometimes antibiotics are not enough to treat the infection.

In some cases, the infection turns into an abscess. An abscess is a painful collection of pus and other infected material underneath the skin. If the pus and infected material can’t drain out, the area will get more swollen and painful. An abscess may need to be drained to heal. To do this, a doctor will numb the area first. A cut (incision) will be made to drain the pus and infected material.

Your child may need surgery if they have an infected cyst/sinus or it keeps coming back.

There are several types of surgeries. Your surgeon will discuss which they feel is best for your child. Your child will be given general anesthesia for any type of surgery. This means your child will be given medicine to make them sleep without pain during the surgery. They might need to stay overnight in the hospital after surgery.

During an open wound surgery, sinus tracts are removed with a very small skin punch (a circular tool that cuts and removes tissue). Then the wound is left open. This decreases the risk of wound infections and heals within 1-2 weeks.

Your child may need a closed wound surgery if they have a certain type of abscess. If your child has a closed wound surgery to remove the pilonidal cyst, their wound is closed after the cyst or sinus tracts is removed. This surgery is less commonly done now because there is a chance of getting a wound infection because bacteria (germs) are more likely to grow in the area. A closed wound can also re-open after the surgery.

An infected cyst/sinus can be very painful, until it is drained. Because the cyst is located near the tailbone, sitting for long periods of time can cause pain. After the infection is drained, we may give your child a prescription for pain medicine.

We partner with you and your child to prevent and relieve pain as completely as possible. You know your child best. No matter the level of your child’s pain, believe they are hurting and respond right away. After a surgery your child is likely to have some pain and discomfort. In addition to medicine prescribed for pain, we will work with you to create a plan that encourages coping activities to treat pain and provide support. Good pain treatment will help your child get better, faster.

It can take several weeks for the wound to heal. After drainage of an infected cyst/sinus, the chance it will become reinfected, if your child has good hygiene and hair removal, is low. Follow-up care is very important to help the wound heal and to stop the cyst from coming back. Follow these care steps:

• Keep the area free of hair. You can do this by shaving, waxing, or using hair removal creams. Do not use hair removal creams if your child has an open wound. Another option is laser hair removal, but this can cost a lot and is not covered by insurance.
• Keep the area clean and dry. Avoid synthetic fabrics and tight-fitting underwear.
• Have your child bathe or shower often, especially after activities that make them sweat. Use antibacterial or glycerin soap.
• Avoid having your child sit for long periods of time. You may need special clearance at school so they can get up for breaks.
• Consider weight management, if needed. Being overweight can increase the chance of having the cyst come back.
• If the cyst/sinus keeps getting infected, your child may need surgery to remove the cyst/sinus.