Patients with pilonidal disease may present with open wounds, draining sinus tracts, or a pilonidal abscess. Patients usually present in two common ways: acute pilonidal abscess or chronic pilonidal abscess.

How do I know if I have an Acute Pilonidal Abscess?

Some patients present with an acute pilonidal abscess as the very first sign of pilonidal disease. Many people in their teens and twenties will experience what they think is a bruised tailbone but is actually the early signs of an acute pilonidal abscess. Symptoms usually start as a dull ache that gets worse and worse over a period of about 2 days. Often, patients with a pilonidal abscess have a hard time sitting due to pain in the area. Some patients will notice a firm lump that has grown near the tailbone. Eventually, if left untreated, patients develop fevers, chills, and generalized malaise, almost like they are suffering from the flu. By this point, many have an abscess that needs to be drained.

When a clinician examines the area near the tailbone, they usually notice a swollen area that is often hard, red, and painful. Sometimes, there is a softer area in the middle or even pus already draining out of the middle. Typically, an acute pilonidal abscess can be drained by an ER doctor, a primary care doctor, or a pilonidal specialist by creating an opening slightly bigger than the size of a pencil eraser. This opening allows the pus to drain and almost immediately relieves the significant pain many people feel. In some cases, the abscess is quite deep and has not reached the surface of the skin yet. In these situations a surgeon, a surgical nurse practitioner, or surgical physician assistant is often the most qualified person to drain the abscess. A member of our care team is typically able to see a patient in the metropolitan Boston area within 24- 48 hours in order to assess and treat the pilonidal abscess.

What is a Chronic Pilonidal Abscess?

Some patients present with a chronic pilonidal abscess. In these cases, most patients present with swelling or a lump above the tailbone which can be uncomfortable at times but usually not nearly as painful as an acute pilonidal abscess.  Chronic pilonidal abscesses do not require immediate drainage. In our experience, a patient with a chronic abscess does not typically respond to medical treatment and would benefit from cleft lift surgery. Sometimes a course of antibiotics can improve symptoms, but often surgery is the definitive treatment.

When should I be seen by a pilonidal expert?

Anyone who has pain that interferes with daily life should come in for an appointment.  If the pain is making it difficult to sit and sleep, you should be seen in an urgent care center, ED or pilonidal clinic within a day or two.  In our pilonidal clinic, we focus on taking care of patients with pilonidal disease. Contact us today to schedule a consultation with an expert.