Pilonidal cyst symptoms, causes and treatment

A pilonidal cyst is an extremely unpleasant disease which is happening in the gluteal region (gluteal fold), which is why no one likes talking about it. However, the persons involved should be ashamed of themselves, but not necessarily a proctologist to confide in. Other names for this disease, pilonidal sinus, sinus pilonidalis, pilonidal cyst or pilonidal are abscess.

Table of contents

  • Pit-Picking and sinus discectomy
  • Cut out the fistula, followed by open wound treatment
  • Cut out the fistula system with wound closure

What is a fistula?

A fistula is an unnatural passage, a tubular connection, the body itself forms, or to be laid off for medical reasons, for example during an Operation (for example, a gastric fistula for the purpose of artificial nutrition).

The body itself thus forms an unnatural tube, this is what happens in connection with inflammation, so that pus and other secretions can be transported away.

Causes, formation of the fistula

The trigger for the disease, ingrown hair, where the skin of the germs and callused skin. As a result, small nodules, which can ignite due to immersion in bacteria. May wrinkle disturbed the hair development is in the area of the buttocks: a hair that grows a new one it is not pushed correctly from the root of the hair and the Keratin binds to the hair roots. Nevertheless, the risk to formation of a pilonidal cyst, also in the case of normal hair formation. This usually happens when the hairs to break, and in the wall of the hair follicle into the skewer and fill with the broken hair. In addition, loose hair can be amongst the sources, if you get a fold by the movement of the buttocks in the buttocks.

That under the skin resulting nodule, foreign body granuloma, can become infected, and develop an abscess. Of Fistula tracts, which can go in depth or on the surface of the skin to spread form.

Excessive sweating, mostly sedentary activities, Overweight as well as a present „Acne inversa“ encourage the creation of such a fistula. In the Latter, it is a chronic skin disease in which painful inflammation of the nodes, abscesses, and fistulas develop. In General, the disease occurs more frequently in men than in women, which are mostly between 20 and 30 years old.


Even if no complaints are present, in the area of the gluteal fold discover a pore opening, perhaps a small black point. In General, this is a very long time unnoticed.

Other symptoms include oozing, swelling, redness, sensitivity to pressure while Sitting and Lying, pus formation, pain, itching, bleeding and possibly even fever.

Acute Form chronic Form

A pilonidal cyst can occur in acute or chronic Form. The acute Form can manifest itself in massive complaints, since the persons Affected suffer from pain when you sit or lie on your back. A swelling is palpable and painful to pressure, and the affected area is reddened in the rule and überwärmt. May be pus and/or blood, fever is also possible. By now the visit to the proctologist is inevitable.

The chronic Form differs in the fact that an abscess is present, however, pain and swelling are absent. Of the fistula with a purulent or bloody-purulent discharge occurs continuously or repeatedly. Eventually, the patients feel a pressure sensation in the area of the Coccyx.


No complaints and comes to no Secretions, there is no need for therapy. In both the acute and the chronic Form is, however, operated normally, wherein different procedures are used.

Pit-Picking and sinus discectomy

Both procedures are minimally invasive and are applied especially in the case of smaller Findings. The Whole takes place under local anesthesia. After the Operation the wound, which must several times a day and taking a shower is not sutured. On top of that, sitz baths and Ointment dressings.

Cut out the fistula, followed by open wound treatment

This is a frequently used method, which is applied especially in the case of larger Findings. Here, the entire fistula system is cut generously. Of course, the procedure is performed under General anesthesia and stationary. The Fistula tracts will be highlighted during an Operation with a dye solution and then removed completely. The wounds are not sutured, but with Tampons, and pressure associations, and also need to have to be on the day in the shower. Particularly the beginning of it for an auxiliary person. The lengthy treatment of wounds is Concerned is a challenge, due to the unpleasant place. The entire healing process can take up to three months, with the ability to work are also suffering for several weeks including.

Cut out the fistula system with wound closure

The method applied in the method according to Karydakis and Limberg. In the case of the Operation according to Karydakis, the skin of the buttocks on the cut side fold. The wound is sutured, the surgeon the skin from the opposite Buttock to the wound, which should improve the wound healing. Normally, the wound healed after about a week. The stitches will be removed, if necessary, after 14 days. Disorders of wound healing are very rare.

The Operation according to Limberg is as follows: the surgeon cuts out the pilonidal cyst and uncovers a diamond-shaped flap of skin located on the side of the wound. This is then covered the wound. After this Operation, the Sit is a bit difficult. The stitches will be removed after approximately 14 days.


As previously mentioned, the result is steinbeiß fistulas crease in the buttocks. This region of the body favors the accumulation of bacteria and the emergence of infections. This place is inadequately ventilated and sweat accumulates there. The opposite areas of the skin can RUB against each other, causing a mechanical irritation. The vicinity of the gluteal fold the Anus favors the formation of inflammation, which is why Hygiene is especially important. Regular Washing and good Drying, of course. It should come to minor injuries, these must be disinfected and supplies.

Since hairs are often the cause of the fistulas, they should be removed if necessary. Is shaved normal, a grow, this may still be easier. Who fistulae, abscesses, or the Like tends to leave the hair permanently, for example by a laser treatment, remove. An Alternative the regular use of a depilatory cream.

Who sits predominantly, the it is more likely to get inflammation in the area of the Coccyx. Just by Sitting in the sweat, which makes for a humid climate accumulates in the gluteal fold. Therefore, it is recommended occasionally to get up and walk a few steps to changing the Seating position.

Another contributing factor is Obesity. Blame the permanent mechanical pressure and the close contact of opposite areas of skin with the buttocks is here. Since being Overweight is generally not healthy, it is recommended a gradual reduction of the weight.

Bland Fistulas

In the case of Bland fistulas are existing fistulas, which cause no symptoms. One should observe, however, you do not need to be removed. It should come to an inflammation and/or pain, you should consult a doctor. It is a bland, pilonidal cyst, so the above-mentioned preventive measures recommended.


By a recurrence to the speech is, if a pilonidal cyst, which has already been operated on, again. This is fortunately rarely the case, however, further surgery may be necessary. To prevent this, carry out the above-mentioned preventive measures. A 100% protection however, there is not unfortunately. (sw)