Is My Pilonidal Surgery Wound Healing Normally?

Is My Pilonidal Surgery Wound Healing Normally?

Healing after pilonidal surgery takes time — and it’s not always a straight line. Some redness, drainage, or soreness can be normal. But some signs mean you should get help right away. This page will help you understand the difference and know what to do next.

What’s Normal — and What’s Not?

Symptom	✅ Normal	❌ Not Normal
Soreness	Yes, especially when sitting or moving	Increasing pain or new sharp pain
Drainage	Small amounts of clear, pink, or yellowish fluid	Thick pus, green fluid, or a bad smell
Redness	Slight redness at edges	Spreading redness or warm skin
Bleeding	Spotting from activity or dressing changes	Bleeding that won’t stop or soaks dressings
Appearance	Pink tissue, shallow base, shrinking size	Deep holes, black tissue, or wound seems to be getting larger
Healing time	Slow but steady improvement	No progress after 2–3 weeks, or looks worse

Call Your Doctor If You Notice…

Wound opens suddenly or bleeds heavily
Fever, chills, or feeling sick
Smelly or greenish drainage
Redness that spreads beyond the wound
Severe pain after it was getting better

If you’re not sure — call your doctor or wound clinic.

Common Healing Problems Explained

My wound is draining a lot (open and closed)

Some drainage is normal, especially in the first weeks. If it soaks through dressings quickly after a week or so, or if it smells bad, you may have an infection or fluid buildup. Call your doctor.

The wound looks too deep or won’t close (open healing)

Open wounds heal slowly from the bottom up over about 8 weeks. But if the base looks unhealthy (gray, white, or black) or if the hole gets bigger, call your doctor.

It hurts more now than it did before (open and closed)

It is common for surgeons to use long-acting anesthetics during surgery. Post-surgery patients may feel little pain in the first three days, then have more pain as the anesthetic wears off. By day 7 most pain should have subsided and usually gets better each week. Sudden or sharp new pain could mean the wound has reopened or become infected.

It was fine, but now it’s getting worse (open and closed)

Watch for changes — drainage, pain, swelling, or smell — even if things were improving before. Also watch for fever; all of these suggest there is an infection, and you need to call your doctor.

What If My Wound Is Infected?

Most infections are treated with antibiotics and wound cleaning
You may need to see a wound care nurse or surgeon
Early help makes a big difference — don’t wait if it looks or feels wrong
Any surgical wound infection is serious business. If you suspect an infection, see a doctor ASAP. Left untreated, wound infections can turn into Sepsis (infection moves into the blood), which will require hospitalization and can be fatal.

Common Reasons Why Pilonidal Wounds Don’t Heal

1. Lack of Oxygen

In a perfect world, your surgeon would do most of the cutting “out of the ditch” to keep the suture line or open wound in an area where it would get oxygen. The natal cleft—the area between your buttocks—doesn’t get much air, which can make it a tough spot for healing. When wounds here don’t get enough oxygen, certain bacteria that thrive without air (anaerobic bacteria) can multiply and slow down healing. The closer a surgical wound is to the bottom of the cleft, the less oxygen it gets.

Helping a wound in this area heal starts with keeping it as exposed to fresh air as possible. Ideally, surgeons try to keep the incision away from the bottom of the cleft so the wound can get better airflow. But if that wasn’t possible, you can help by gently exposing the wound to oxygen. Some people find it helps to spend a few minutes, a couple of times a day, in a “jackknife” position (lying face down with your hips slightly raised and your cheeks apart) to let air reach the area. Others have even used medical tape to keep their buttocks separated for a short time. These techniques may feel a little awkward, but getting air to the wound can really improve healing.

Dr. John Bascom created a device called a Cigar Vent for use over a non-healing wound, which can be left in place all day during normal activities. This is an easy-to-make, at-home way to provide the wound with air.

Bascom Cigar Vent Device for Healing

2. Poor Nutrition or Poor Health

Eat right and take vitamins. No Fast Food!
Make sure you are getting at least 60 grams of high-quality protein daily
Do you possibly have undetected diabetes or an immune system disorder? One symptom is slow-healing wounds. A simple fasting blood test should tell you if you are at risk.

3. Other Things That Can Go Wrong*

Hematomas: A hematoma happens when blood collects under the skin, forming a pocket or clot in the wound. This is more likely to occur in wounds closed with stitches. Hematomas usually need to be opened up and drained, because if the blood sits there, it can get infected.
Seromas: A seroma is a build-up of clear fluid in the empty space (sometimes called “dead space”) left behind after surgery. Unlike an abscess, a seroma isn’t an infection—it’s just fluid pooling under the skin. They’re more likely in closed incisions or in open wounds that seal over at the top too quickly, leaving space underneath. Some seromas can go away on their own, but most need to be drained by a doctor. To keep it from coming back, the “dead space” usually needs to be closed with stitches beneath the skin, or by opening the wound and packing it so it heals from the bottom up.
Wound Breakdown (Dehiscence): Wound breakdown (also called dehiscence) is when the tissues of the wound—either deep inside or on the surface—start to soften and come apart. In a closed incision, this means the stitches can’t hold, and the wound may open. If your doctor mentions “wound breakdown,” ask for a referral to a Wound Care Center right away. Don’t try to manage this with your regular doctor alone, even if they’re very experienced—serious wounds need a specialist’s care.

These are fairly rare occurrences, but they do happen.

What Else Can I Do To Help My Wound Heal?

RELAX! It has been proven that stress impairs your immune system and slows down healing.
CHILL OUT! Research has shown that anger slows healing. Those who control their rage heal faster than those with a low boiling point.
Avoid using antibiotic ointments (Neosporin, Bacitricin, etc.) These are proven to cause allergic reactions and contact dermatitis with frequent use.
Breathe. Deeply and slowly. Healing uses a lot of oxygen from the bloodstream. Try an exercise of deep breathing for 5 minutes, three times a day.
Try doing sitz baths with Epsom Salts.
Try some over-the-counter healing products:
- Multidex Powder has helped many people on our forums.
- Extra cleaning of the area with Hibiclens might also help lower bacterial levels.
- Try MediHoney (medical-grade Manuka Honey) as a topical wound cover; studies show it helps debride wounds and reduce bacterial loads. Do not use on a deep, open wound.

Wound Healing Centers

Once you have ruled out the above possibilities, it is time for a Wound Care Center. Most major cities have one; search for your area. Wound Care Specialists are the SWAT team of healing; all they do is treat wounds. Your surgeon has gone through extensive training in cutting and sewing; a Wound Care Specialist has gone through extensive training in wound healing. If it’s been more than 4 months since your wound healed, it’s time to bring in the wound professionals.

Consider a Wound VAC

Vacuum-assisted closure (VAC) is a non-invasive technique in which negative pressure (suction) is delivered uniformly to a wound. This improves blood flow, promotes a moist environment, and assists in the proliferation of granulation tissue. The use of the VAC system has led to progressive wound closure in cavity wounds and is now often used in both the outpatient and hospital settings.