A pilonidal cyst is a sac filled with hair and skin debris that forms at the bottom of your tailbone. The recovery time after surgery depends on the procedure type and if you need stitches. In some cases, it could a few months.

Researchers used to think of pilonidal cysts as a congenital disease (formed in utero).

However, it’s now thought that they are acquired from hair from surrounding soft tissue and skin that grows inward and forms a foreign body reaction and thickened tissue.

They are 2.2 times more common in men than in women, and most commonly occur in men in their 20s and 30s.

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

The two primary procedures used to treat pilonidal cysts include:

  • Incision and drainage. During this procedure, a doctor will make a cut and drain the cyst.
  • Surgical cyst removal. During this procedure, also called a cystectomy, 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.

Incision and drainage

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

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

An incision and drainage procedure is successful at treating a pilonidal cyst about 60 percent of the time. To maintain results, doctors often recommend that people who have the procedure try to prevent another infection with hair removal procedures, such as shaving, waxing, or laser hair removal.

Surgical pilonidal cyst removal

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

  • you’ve already had an incision and drainage procedure but your cyst came back
  • your infection is severe
  • you have multiple cysts with sinus tracts

Newer procedures to treat pilonidal cysts

Newer minimally invasive surgical treatments are showing promising results in treating pilonidal cysts. These include:

  • video-assisted ablation of pilonidal sinus (VAAPS)
  • endoscopic pilonidal sinus treatment (EPiST)

Incision and drainage is a common procedure for treating cysts and rarely causes serious complications. Pain is the most common complication.

Pilonidal cyst surgical removal generally causes scarring. The scar will become less noticeable over time.

Like all surgical procedures, incision and drainage and pilonidal cyst surgical removal can lead to infection. Signs of an infection include:

  • redness
  • oozing pus
  • fever or chills
  • heat coming from wound (warm to the touch)
  • tenderness

Other potentional complications include:

  • seroma (fluid buildup)
  • hematoma (bruise)
  • poor healing
  • recurrent pilonidal cyst

Pilonidal cysts also have a high risk of reoccurrence after treatment. More than one procedure may be needed to remove your cyst.

Here’s a look at how you can prepare for each procedure:

Incision and drainage

No special preparation is usually needed before an incision and drainage procedure. It’s a good idea to wear something that allows your doctor to easily access the pilonidal cyst.

Surgical cyst removal

It’s important to arrange a ride before your procedure since you won’t be able to drive after receiving pain medication and general anesthesia. You’ll leave the hospital or surgical center the same day as your operation.

It’s critical to follow your doctor’s presurgical instructions to minimize your risk of complications. Your doctor may tell you to stop taking certain medications or herbal supplements as well as to stop smoking.

They may also give you particular instructions about how soon before your procedure you can bathe and eat. Typically, doctors instruct you to stop eating 8 hours before any procedure that requires general anesthesia.

Bring a photo ID with you to the surgery center as well any insurance documents and other paperwork you may need.

Incision and drainage

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

First, the healthcare professional 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 procedure unless the infection has spread to surrounding areas.

Surgical cyst removal

This entails a complete surgical removal of 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.

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

There are several types of pilonidal cyst removal surgeries:

  • Wide local excision. The area removed goes down to the fascia of the sacrum (the tissue overlying the muscles). The wound is packed with medicated packaging and left to heal from the bottom up.
  • Excision with marsupialization. The excision is performed and then the roof of the cyst is removed. The fibrous tissue is sutured.
  • Excision with closure. The cysts and sinus tracts are removed and the area surgically closed.
  • Excision with complex closure. The cysts and sinus tracts are removed, and a flap technique is used to surgically close the wound. The flap is sutured to the underside of the skin bridge formed between the incision and the midline, which aids in faster healing and less likelihood of recurrence.

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 amount of time it takes for you to recover depends on your surgical procedure and whether you received stitches. In general, it’ll probably take anywhere from 1 to 3 months to completely heal.

Most people can resume their regular activities within a month of surgery. You’ll likely have a follow-up appointment with your doctor about 6 weeks after your procedure. The follow-up appointments depend on whether the wound packing materials need to be changed or if sutures need to be removed.

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
  • sitting on a doughnut cushion
  • not sitting for long periods of time on hard surfaces

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 doctor if you experience:

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

Unfortunately, pilonidal cysts can come back after surgery. Within five years of a procedure, recurrence rates ranged from 13.8 percent to 32 percent, depending on the type of surgical removal.
The reccurrence rate after incision and drainage is about 40 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 post-surgical instructions carefully.
  • Keep the area clean.
  • Shave the area, or use a hair removal product every 2 to 3 weeks.
  • Keep all follow-up appointments with your doctor.
  • Shave or wax hair in the area, or consider laser hair removal, to prevent the cyst from recurring.

Pilonidal cysts can be irritating and painful, and impact affect interpersonal relationships and social activity. 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 a healthcare professional 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 surgical cyst removal.

It’s best to seek care early on.