Pilonidal Cyst – Diagnosis and Treatment

Diagnosis

A doctor checks for a pilonidal cyst by looking at the skin near the tailbone. They ask about pain, swelling, drainage, or odor.

The doctor may also ask if you have had similar cysts, abscesses, or infections in the buttock crease. This process usually involves a simple physical exam and a few questions about your symptoms.

In most cases, no lab tests or imaging are needed. However, if the area is severely swollen, recurrent, or suspected to involve deeper infection, the doctor may order an ultrasound to see if an abscess is forming under the skin.

In rare situations, imaging like an MRI may be used if the cyst returns often or causes complications, especially when surgery is being considered.

Treatment

The treatment depends on the size of the cyst and if it has come back. A healthcare provider often starts with incision and drainage.

They numb the area and cut into the cyst to let the fluid or pus out. This procedure usually happens in the doctor’s office.

If the cyst returns or causes more problems, surgery may be necessary. There are a few types of surgery:

• Open Wound Care: The provider leaves the wound open and fills it with dressing. This method takes longer to heal but lowers the chance of the cyst returning.
• Primary Closure: The provider closes the wound with stitches. Healing is faster, but the cyst may come back.

You may need hair removal around the area, either by shaving or laser epilation. Removing hair helps prevent infection.

Some people get special treatments like fibrin glue to close the area or wide excision to remove all affected tissue.

Proper wound care is important. Providers give instructions about changing dressings and keeping the area clean. You should watch for signs of infection and know when to seek more help.

Getting Ready for Your Visit

Steps to Take Before Your Appointment

Write down important information:

• When symptoms started
• Any previous episodes or similar issues
• Things that make your symptoms better or worse
• Medications, vitamins, and supplements you use

If you are overweight, sit for long periods, or have problems with ingrown hairs, include these details. If you shave the area around the cyst, mention this as it can affect your treatment.

Tip: Bring your notes to help you remember key details.

Questions the Doctor May Ask

Doctors ask questions to understand your symptoms and daily habits.

Examples include:

Question	Purpose
Have you had a fever?	Check for infection
Does pain disturb your sleep?	Measure severity
What type of work do you do?	See if you sit for long times

Doctors may also ask about past treatments. They might ask how much time you spend sitting each day.