Pilonidal disease Mate kōpukupuku karioi ki te kiri kumu

We are not sure why pilonidal disease happens, but it may be due to:

• being born with a small dimple in the area
• damaged hair follicles that poke into your skin.

Once the hairs get stuck in your skin they irritate it, causing inflammation. A cavity can develop in this area called a pilonidal sinus. 

This can form a lump (pilonidal cyst) that is not painful or red. This is not usually a problem unless it gets infected it becomes an abscess. A pilonidal abscess is very painful and needs medical treatment.

Some things are more likely to make this happening, including:

• having curly or coarse body hair around your buttocks
• family members who have had this problem
• being an unhealthy weight 
• poor hygiene 
• sitting for a long time, or repeated friction to the area causing increased sweating 
• some other skin conditions.

When you only have a pilonidal sinus, you may not notice any symptoms, but you might have a small pit or dimple in your natal cleft. You might notice clear fluid coming from the sinus.

If you develop a cyst, you may notice a small lump, but this is not usually painful. If you have had the disease for a while, it may feel as if there is more than one lump. 

You may only notice that you have pilonidal disease if the sinus or cyst becomes infected.

Symptoms of pilonidal abscess may include:

• a painful lump or swelling near the top of your butt crack
• redness and tenderness
• a pus-filled boil or abscess
• pain when you sit down for too long or move
• a fever, if it is infected.

If you have any of these symptoms it is important to see your healthcare provider for treatment.

Your healthcare provider will ask about your symptoms and look at the area where you have pain or swelling. 

You are unlikely to need any special tests to diagnose pilonidal disease or abscess.

If you have pilonidal disease without any symptoms you may not need treatment. But it is important to reduce the chance of it getting worse.

• Keep the area clean. 
• Avoid tight clothing that increases friction or sweating. 
• Aim for a healthy weight. 
• Regularly remove hair from that area. 
• Stop smoking, if you smoke. 

If you have a pilonidal cyst without an abscess, but are having symptoms, your healthcare provider may refer you for surgical treatment. There are several types of surgery. Your surgeon will give you details about each one. 

See your healthcare provider as soon as possible if you develop an abscess with:

• pain
• swelling
• discharge
• fever (38^oC or more).

They will refer you to a surgeon straight away. They will treat the abscess by draining the area. You may be given antibiotics if you:

• are unwell
• have other risk factors like heart valve disease
• are immunosuppressed. 

It is important that you take pain relief while you are healing.

Pain relief medicine for adults

Risks of surgery

Having surgery involves some risks but these are usually outweighed by the benefits. Your surgeon will discuss the likely risks with you.