Is It a Pilonidal Cyst? Why Your Tailbone Is Inflamed & Expert Next Steps

If you're dealing with pain, swelling, or drainage near your tailbone, you might be wondering: Is this a pilonidal cyst? You're not alone. A pilonidal cyst is a common condition that affects the area at the top of the buttocks crease (also called the gluteal cleft). It can be uncomfortable, sometimes painful, and occasionally serious if not treated properly.

Let's break down what a pilonidal cyst is, why it happens, what symptoms to watch for, and what to do next.

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What Is a Pilonidal Cyst?

A pilonidal cyst is a pocket under the skin near the tailbone that usually contains hair, debris, and skin cells. The word "pilonidal" literally means "nest of hair." Over time, this pocket can become infected, leading to swelling, redness, pain, and sometimes pus drainage.

In medical terms, a chronic or recurring version is often called a pilonidal sinus. Both refer to the same underlying issue: inflammation and infection in the crease of the buttocks.

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Why Does a Pilonidal Cyst Form?

Experts believe pilonidal cysts develop when loose hairs get trapped in the skin. Friction and pressure—especially from sitting—push hair deeper into the skin. The body treats the hair like a foreign object, triggering inflammation and sometimes infection.

Risk factors include:

• Prolonged sitting (truck drivers, office workers, students)
• Thick or coarse body hair
• Being male (more common in men)
• Ages 15–40
• Overweight or obesity
• Family history of pilonidal disease
• Excess sweating
• Poor hygiene (though this is not the main cause)

It's important to understand: a pilonidal cyst is not caused by being "unclean." Hair and friction play a much bigger role.

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Common Symptoms of a Pilonidal Cyst

Symptoms can range from mild irritation to severe infection. Here's what to look for:

Early Signs

• Tenderness at the top of the buttocks crease
• Mild swelling
• Redness
• Small dimple or pit in the skin

Signs of Infection (Pilonidal Abscess)

• Increasing pain (especially when sitting)
• Swelling that feels warm or firm
• Drainage of pus or blood
• Foul odor
• Fever (in more serious cases)

If the cyst becomes infected, it can turn into a painful abscess that may need medical drainage.

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Is It Definitely a Pilonidal Cyst?

Several conditions can cause tailbone pain or swelling. These include:

• Skin abscesses
• Sebaceous cysts
• Hidradenitis suppurativa
• Infected hair follicles
• Tailbone injury (coccydynia)

The location is key. A pilonidal cyst almost always appears at the top of the buttocks crease, slightly above the anus.

If you're experiencing symptoms and want to better understand what might be causing them, you can use Ubie's free AI-powered Pilonidal Sinus symptom checker to get personalized insights based on your specific situation.

However, an online tool is not a diagnosis. A healthcare professional should examine you for confirmation.

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When Is a Pilonidal Cyst Serious?

Most pilonidal cysts are manageable, but they should not be ignored.

Seek urgent medical care if you have:

• Severe, worsening pain
• High fever
• Rapidly spreading redness
• Chills
• Difficulty sitting or walking due to pain

An untreated infection can spread into deeper tissue. While rare, severe infections can become dangerous.

If you suspect anything serious or life-threatening, speak to a doctor immediately or seek emergency care.

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How Is a Pilonidal Cyst Treated?

Treatment depends on whether the cyst is infected.

1. If It's Not Infected

For a mild, non-infected pilonidal cyst, your doctor may recommend:

• Keeping the area clean and dry
• Removing hair regularly (shaving or laser hair removal)
• Avoiding prolonged sitting
• Wearing loose-fitting clothing

Sometimes, no surgery is needed if symptoms are minimal.

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2. If It's Infected (Abscess)

An infected pilonidal cyst usually requires:

• Incision and drainage (I&D): A minor procedure where a doctor numbs the area and drains the pus.
• Antibiotics (in certain cases, especially if there's spreading infection or fever)

Drainage often brings immediate pain relief.

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3. If It Keeps Coming Back

Recurring pilonidal cysts may need surgical removal of the cyst and sinus tracts. There are several surgical approaches, including:

• Excision with open healing
• Excision with stitches
• Flap procedures to flatten the crease and reduce recurrence risk

Your surgeon will recommend the best option based on:

• Severity
• Recurrence history
• Your overall health

Recurrence can happen, but modern surgical techniques have improved outcomes significantly.

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Recovery and Prevention

Healing time depends on the treatment method. Drainage procedures may heal within a few weeks. Larger surgeries can take longer.

To reduce recurrence risk:

• Remove hair regularly around the area
• Keep the area clean and dry
• Avoid prolonged sitting
• Maintain a healthy weight
• Shower after sweating heavily

Laser hair removal may significantly reduce recurrence in people with repeated infections.

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Can You Treat a Pilonidal Cyst at Home?

You can manage mild discomfort with:

• Warm compresses
• Over-the-counter pain relievers (as directed)
• Gentle cleansing

However, do not attempt to pop or drain it yourself. This can worsen infection and lead to complications.

If the area becomes increasingly painful, swollen, or starts draining pus, you need medical evaluation.

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What Happens If You Ignore It?

A small, painless pilonidal cyst might stay stable for years. But if infected and untreated, it can:

• Form a painful abscess
• Create multiple sinus tracts under the skin
• Recur repeatedly
• Rarely, lead to widespread infection

Long-term, untreated chronic pilonidal disease can cause ongoing drainage and discomfort. While cancer from pilonidal disease is extremely rare, chronic inflammation over many years can increase risk slightly. This is uncommon but another reason not to ignore persistent symptoms.

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Who Should Definitely See a Doctor?

You should speak to a doctor if:

• You have significant pain
• There is pus or blood drainage
• You have fever
• The cyst keeps coming back
• You are unsure what the lump is

Even if it seems minor, getting an early evaluation can prevent complications and reduce long-term problems.

If you are experiencing severe symptoms or anything that could be life-threatening, seek urgent medical care immediately.

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The Bottom Line

A pilonidal cyst is a common condition that causes swelling and pain near the tailbone, usually due to trapped hair and friction. While it can be uncomfortable and sometimes serious, it is treatable—especially when addressed early.

Key points to remember:

• It usually appears at the top of the buttocks crease.
• Infection causes increased pain, swelling, and drainage.
• Drainage procedures are often simple and effective.
• Recurrence can happen but can be reduced with proper care.
• Severe symptoms require prompt medical attention.

If you're still unsure about your symptoms, taking a few minutes to complete a Pilonidal Sinus symptom assessment can help you understand whether your symptoms align with this condition and what steps to take next.

Most importantly, speak to a doctor for an accurate diagnosis and treatment plan—especially if symptoms are worsening, painful, or accompanied by fever. Early care makes a real difference.