Treatment for Pilonidal Disease

What is this condition?

Pilonidal disease is an infected cyst over the small triangular bone at the bottom of the spine. It usually contains hair and becomes an abscess, a draining sinus (channel), or a fistula (abnormal tubelike passage). The people who most often get pilonidal disease are hairy men ages 18 to 30.

What causes it?

Pilonidal disease may be linked to a person's tendency to be hairy, or it may be caused by stretching or irritating the base of the spine (intergluteal fold) with rough exercise (such as horseback riding), heat, excessive perspiration, or constricting clothing.

What are its symptoms?

Generally, a pilonidal cyst produces no symptoms until it becomes infected, causing local pain, tenderness, swelling, or heat. The cyst may drain and the person may have chills, fever, headache, and general discomfort.

How is it diagnosed?

The doctor can see the cyst and may find a series of openings along the midline, with thin, brown, foul-smelling drainage or a protruding tuft of hair. Pressure may produce pus, but there is no perforation to the intestines (a common concern).

How is it treated?

The doctor may take a conservative approach by making an incision to drain the abscesses and suggesting regular extraction of protruding hairs and sitz baths (four to six times daily). However, persistent infections may require surgery to remove the entire affected area. After removal of a pilonidal abscess, the person requires regular follow-up visits to check on the healing wound.

The surgeon may periodically probe the wound during healing with a cotton-tipped applicator, wipe away excess scabbing, and extract loose hairs to promote healing from the inside out and to prevent dead cells from collecting in the wound. Complete healing may take several months.

What can a person with pilonidal disease do?

If you have surgery, you'll be encouraged to walk within 24 hours and follow these guidelines to care for your incision:

. Wear a gauze sponge over the wound site after the dressing is removed, to allow ventilation and prevent friction from clothing.

. Take sitz baths. After your bath, air-dry the area instead of using a towel.

. After the wound is healed, you should briskly wash the area daily with a washcloth to remove loose hairs.