Pilonidal FAQ

Pilonidal disease occurs in the natal cleft as a result of midline openings or pits. Hair and bacteria can get inside the pits, and lead to infections, cysts and fistula tracts. This can become a chronic problem. Some patients have a cyst only, some have a cyst and sinus tract, others can develop an abscess which can lead to a lot of pain and drainage. The cyst or sinus are areas of chronic infection and inflammation.  Many patients may have a cyst or sinus for years before they notice a serious infection and most patients “outgrow” their disease.  A small percentage of people require a surgical procedure to drain an abscess or remove their disease

Usually patients present with bloody drainage on their underwear. This can be painful at times, but is often just a nuisance. Some patients, however, present with quite a bit of pain and sometimes with a fever. This is a sign of an abscess, which needs to be taken care of by a physician.

There are both surgical and nonsurgical options for treating pilonidal disease. Patients with a lot of symptoms that are resistant to conservative treatment will require surgery. In the past, surgery involved removing the infected area and either leaving the hole open or closing the incision. More recently, the cleft lift procedure for pilonidal disease was developed by Dr. John Bascom, and is now considered the gold standard of treatment. Dr. Reinhorn is currently the only surgeon to perform this surgery on adult patient in New England.

Please see Cleft Lift Procedure for more information on the surgery.

In recent years, several researchers have described using a laser to remove the hair in the area. This procedure allows the body to heal surgical incisions, without hair as a foreign body that can get into the wound. Lasers are believed to stimulate healing as well. Laser treatment is still considered experimental, and I am currently conducting my own research on this. For now, I generally recommend laser for patients who have already had surgery and are back with recurrent disease or a have difficult-to-heal wound.

Generally I recommend people shave the area around the cleft with a clipper once per week if they are not undergoing laser therapy. I highly recommend all pilonidal patients wash with Hibiclens® antimicrobial soap daily during the time they have a pilonidal cyst or sinus and for a year after they have been medically “cured.”

This is a decision to make with your physician. Not every patient who has pilonidal disease needs surgery. Some people may outgrow their disease, or may have such infrequent episodes that they choose not to have surgery. Generally, people who have frequent episodes of infection or abscess benefit from surgery to improve their quality of life.

If you have an active infection with drainage, typically I will treat you with an antibiotic before and after surgery. This will allow for your body to be in the best shape possible before the surgery as well as continue to fight the infection after surgery.

Typically, I see patients 3-5 days after surgery to remove the drain and two weeks after surgery to remove the ends of a dissolvable stitch. After that I see most patients at 1 month, 3 months, 6 months and 12 months after surgery. Patients that have a wound issue may need to be seen more frequently.

Please see What to Expect From Surgery for more information on the day of surgery and the following few weeks.

Pilonidal.org offers general information, a forum to ask your questions, and an updated list of surgeons who perform the cleft lift procedure in every state. Click here to get to pilonidal.org.