Frequently Asked Questions About Diagnosing Pilonidal

Pronounce it: Pie-Low-Nye-Dal.

“How can I tell if I really have this?”

Only a doctor can tell you for sure since Pilonidals take different courses in different people. Some people may just experience a bit of a pain when sitting, others may only have some drainage and no pain, still others will be making a trip to the ER or surgeon because they are in excruciating pain. The usual signs of an acute infection are swelling and pain in the tailbone region. Most people end up at this site by Googling tailbone pain. The most singular common symptom is discomfort in the area around the tailbone and a swelling lump.

“Why did I get this?”

The primary prevailing opinion is based on the over 600 Pilonidal surgeries performed by late Dr. John Bascom, who is regarded as the top expert in the world. Bascom’s theory on Pilonidal Disease involves “follicular occlusion” which is the blocking and inflammation of pores in the mid-line of the buttocks caused by pores in the midline that have become stretched. This tends to occur in the tailbone area because of the friction and pressure on the area that stretches the pores when the person is sitting. We caution people everywhere in this site to make sure your doctor has the latest info on Pilonidal Disease. There are still some “old school” doctors out there who still think that Pilonidal is completely congenital and there is no way to get rid of it. You can usually spot these doctors by their use of the phrase “the cure is worse than the disease.”

“Does weight have anything to do with it?”

It is generally suggested that being overweight does encourage Pilonidal Disease but is not a sole cause. Pilonidal Disease occurs most frequently in those with deep natal cleft (aka: your crack), as most of us gain weight, out butts get bigger and the cleft gets deeper. The deeper the cleft, the more moisture and debris that gets trapped in it and the more pressure created when sitting/standing. Plumper buttocks also create a greater seal that keeps out oxygen and provides a happy living accommodation for anaerobic bacteria to thrive.

“Can it be cancerous?”

Very rarely. As of 1999, fewer than 50 cases have been reported and those were mostly in people who had refused treatment for many, many years. When you undergo surgery, your doctor will probably send the tissue to the lab for testing just to be sure.

“Can you get Pilonidal Cysts in other places?”

You may run across references to Pilonidals in other body regions, but technically a Pilonidal occurs in the natal cleft area only. There are similar type cysts that have been reported in the Umbilicus (Navel), on the breast, in the pubic region and in the armpit…these locations suggest Hidradenitis Supperativa, rather than Pilonidal Disease. There is a similar disease called Barbers Pilonidal Sinus that is caused by hair digging into the soft tissues between the fingers that tends to occur on animal groomers and barbers.

“What does the abscess/cyst feel like?”

In most cases (but not all), you can feel a lump in your tailbone area. The lump can be as small as a pea or as large as a golf ball. The lump moves when you press on it – bone feels like bone and doesn’t move. Usually, the lump will hurt when you press on it. Not every case of Pilonidal Disease involves an obvious lump (abscess), some people just have draining sinuses and abscess is buried too deep to be felt from the top skin.

“What is this little hole in my backside?”

That is a sinus opening. A sinus is a tract that links your abscess to the top of the skin. It is probable that the sinus opening is the site of the original infection/exploded pit and the abscess formed deep in the tissues as infection took hold. Not everyone who has a Pilonidal abscess has an obvious sinus. If you have a sinus, you can be assured there is an abscess to go with it somewhere or one will likely form in the future. It is possible to have multiple sinuses. Some doctors speculate that sinus openings only form in response to flare-ups, but I can tell you that I noticed my sinus hole a good 12 years before my first real flare-up, so the jury is out on this one. There is good reason to suspect that sinus openings that are right in the center of the buttock midline are, in fact, pits (exploded follicles) which are the cause of a Pilonidal.

“How do I know it’s infected?”

It hurts. It really, really hurts. If there is a sinus, there may also be a foul smelling drainage that can be a variety of colors from clear, brownish, white pus or mixed with blood. For a lot of people, the first time they hear the word Pilonidal is in the emergency room where they had to be carried, screaming in pain the whole way. When a Pilonidal abscess is infected (inflamed, acute, “flaring up”) it will swell and make it almost impossible to sit, stand or lie down, since any movement seems to make the pain worse. Several women have posted that the pain of an acutely infected Pilonidal abscess is worse than childbirth. So, men, now you know!

“Why am I itching like crazy back there?”

Itching is your skin’s response to the infected fluid draining from the abscess. If you are itching, you have an infection.

“My lower back has been hurting like crazy, it is related?”

Possibly. A significant number of people report this symptom and the pain usually goes away after healing from surgery. There are no notes in the medical literature on the relationship of lower back pain and Pilonidals but the theories of those of us who suffer are as follows:

• It might be that the abscess is pressing on some of the Sciatic nerves;
• It might be because we tend to sit in funky positions due to pain/discomfort, which throws the back out of alignment;
• It might be from the stress that medical problems bring on.

“Are there any tests to diagnose it?”

Not really. Usually, one isn’t needed since the person is in pain and has an obvious lump/draining sinus. In some cases, Pilonidals are visible on a very high resolution MRI with contrast. Pilonidals are also reportedly visible through Ultrasound, although we have never actually seen any pictures.

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This page last updated: January 17, 2016