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A pilonidal cyst is a sac filled with hair and skin debris that forms at the bottom of your tailbone. Infected hair follicles usually cause these cysts to develop.

Initial treatments include sitz baths, warm compresses, and antibiotics. However, if the infection is severe enough, you may need surgery.

The two surgical procedures used to treat pilonidal cysts include:

  • Incision and drainage. During this procedure, a doctor will make a cut and drain the cyst.
  • Cystectomy. During this procedure, a doctor will remove the entire cyst and the tissues around it.

Read on to learn more about how these procedures are performed, what the recovery process is like, and if a cyst is likely to return.

Your healthcare provider will likely recommend an incision and drainage procedure to treat your pilonidal cyst if:

  • this is the first time your cyst is being treated
  • your infection is minor

While an incision and drainage procedure is typically the first surgical option considered for a pilonidal cyst, your doctor may recommend a cystectomy if:

  • you’ve already had an incision and drainage procedure, but your cyst came back
  • your infection is very complex or severe

Pilonidal cyst incision and drainage is a simple procedure that’s usually done in a doctor’s office, under local anesthesia.

First, your healthcare provider will give you an injection to numb the area. Then, they’ll make a small incision in the cyst to drain the pus. This reduces pain and inflammation.

You’ll be sore after the procedure, so it’s a good idea to have someone drive you home.

Antibiotics aren’t typically required for this surgery unless the infection has spread to surrounding areas.

A pilonidal cystectomy is surgery to completely remove the cyst, along with the pilonidal sinus tracts. While this procedure is more complex than an incision and drainage, it’s also more likely to be successful.

Follow your doctor’s instructions before having a cystectomy. You may be advised to stop smoking and go off certain medications for a period of time.

Pilonidal cyst surgeries are done under general anesthesia at an outpatient surgical center. The surgery itself takes about 45 minutes to perform.

You’ll probably go home several hours after your procedure. You should arrange to have someone drive you home.

After surgery, your physician might choose to leave the wound open or close it with stitches. The use of stitches may help you heal faster, but there’s a higher chance that your cyst will recur.

The amount of time it takes for you to recover depends on how your surgery was done and if you received stitches. In general, it’ll probably take anywhere from one to three months to completely heal.

Most people can resume their regular activities two to four weeks after surgery.

You may experience some pain or tenderness during the recovery process. This can be managed by:

  • taking pain medications prescribed by your doctor
  • avoiding strenuous activities
  • using a donut cushion to sit on
  • not sitting for long periods of time on hard surfaces

Shop for donut cushions online.

Your doctor will provide you with instructions on how to keep your wound clean. Follow these directions carefully to avoid an infection or recurrence.

If your doctor prescribes antibiotics, be sure to complete the full course, even if you start to feel better before they’re finished.

Call your healthcare provider if you experience:

  • a fever
  • pus draining from your incision
  • increased pain, swelling, warmth, or redness near the incision

Unfortunately, pilonidal cysts do come back after surgery. Studies show recurrence rates are as high as 30 percent.

The cysts may return because the area gets infected again or hair grows near the incision scar.

People who have recurrent pilonidal cysts often develop chronic wounds and draining sinuses.

Here are some ways to prevent a recurrence:

  • Follow your doctor’s postsurgical instructions carefully.
  • Keep the area clean.
  • Shave the area, or use a hair removal product every two to three weeks.
  • Keep all follow-up appointments with your doctor.

Pilonidal cysts can be irritating and painful, but the good news is that there are effective removal options. Your first step should be to see a doctor.

If you need surgery, you and your healthcare provider can discuss the pros and cons of the different options. An incision and drainage procedure is typically easier and can be performed in a doctor’s office. But, the risk of recurrence is higher than it is for a cystectomy.