Pilonidal disease: painful, inconvenient and embarrassing

November 3, 2016 Richy Tai On Lee, MD FACS

teenage boy looking out bedroom window


In this article:

  • Pilonidal disease is a skin infection near the tailbone that commonly occurs in teenage boys and young men.

  • Its symptoms and location can make it an embarrassing condition.

  • A Swedish physician explains risk factors and treatment options as well as prevention tips.

Imagine you’re a teenager and your world revolves around trying to be cool. Then you get pilonidal disease, a skin infection near the tailbone that can cause severe pain, foul-smelling discharge and deep embarrassment.

Teens, mainly boys, and young men are more prone to getting pilonidal disease. But kids in particular may be so distressed by this condition that they don’t know who to turn to.

Parents might not be their first choice, but parents who are aware of the disease can help a suffering child.

What is pilonidal disease?

Pilonidal disease occurs when hair and debris become embedded in skin at the top of the buttocks, usually close to the tailbone. Over time, a significant amount of hair and debris can accumulate, causing a cavity to develop under the skin. These cavities can be much larger than they seem on the surface.

A perfect storm of repeated skin irritation, a moist and warm environment, the collection of hair or debris, and bacteria can lead to an infection. When this happens, a painful abscess can develop in the cavity and pus may start draining from the area.

Who gets pilonidal disease?

While anyone can get pilonidal disease, boys and men are most affected, likely because girls and women tend to have less and finer body hair.

People who sit for prolonged periods of time, such as professional drivers, are at higher risk of pilonidal disease. Other risk factors include:

  • Obesity
  • An inactive lifestyle
  • A lot of body hair
  • Stiff or coarse body hair
  • Poor hygiene

What are the symptoms?

If the cavity with embedded hair and debris isn’t infected, there may be no symptoms, or at most some minor discomfort when sitting. If an infection does develop, these symptoms may occur:

  • Pain or discomfort that intensifies when sitting and/or lying on the tailbone area
  • Palpable swelling under the skin
  • Redness of the skin surrounding the area
  • Drainage of foul-smelling pus

How is pilonidal disease diagnosed?

A teen’s symptoms, plus an examination of the area, are usually all we need to diagnose the problem. Blood work and imaging studies are usually not necessary, although sometimes we may decide to order these tests to gain more information.

How is this condition treated?

If there is an abscess, our priority is to drain it as much as possible and get the infection under control. We can either drain the abscess in the clinic setting with a local anesthetic, or in the operating room with full anesthesia or sedation. Treatment will depend partly on the seriousness of the infection and how well your child can tolerate the procedure.

Often, we put a small plastic tube in the cavity to allow for continued drainage over the next several days. Antibiotics are usually prescribed to help control the infection.

At home, your child will need to have the dressing changed and soak frequently in a warm bath or shower to help the area heal. About a week after the cavity is drained, we will remove the plastic tube and check on how the area is healing. Depending on the extent of the infection, we may require more follow-up visits and monitoring.

If the cavity doesn’t fully heal and there’s a recurrent infection, surgery may be necessary to remove the diseased tissue altogether and promote better healing. But surgery should not be the first line of treatment.

How can we minimize the possibility of recurring pilonidal disease?

The key to avoiding repeat infections is breaking up the perfect storm of conditions that lead to the disease.

Good hygiene with a daily bath or shower is essential. When in the shower, the gluteal cleft should be rinsed right before getting out to be sure hair from another part of the body does not get lodged in this area.

Some studies have found that hair removal in this area can help reduce the recurrence of pilonidal disease. This includes shaving, electrolysis, laser removal and using depilatory creams.

Aside from good hygiene and hair removal, it’s important to avoid excessive pressure in the area. Your child should:

  • Avoid sitting for long periods.
  • Use good posture to keep direct pressure off the tailbone.
  • Lose excessive weight to prevent added pressure on the area.

Find a doctor

If you have questions about pilonidal disease, contact Pediatric Primary Care at Swedish. We can accommodate both in-person and virtual visits.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.

Join our Patient and Family Advisory Council.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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