Pilonidal disease is the term used to describe recurrent cysts, abscesses, and infections on the bottom of the back close to where the tailbone is just above the gluteal ridge.

The cause of pilonidal disease is not known for certain. Some feel it is an inherited trait where people are more prone to it. Pilonidal disease tends to more likely happen to people who have more hair on their lower back. It may be a type of folliculitis where the follicle of the hairs that grow on our skin become ingrown and chronically irritated and chronic tracts, cysts, and abscesses can develop. These abscesses and cysts burrow down to the tailbone (sacrum and coccyx). The lower back becomes chronically irritated to the point that a person have repeated infections. Sometimes mild pilonidal disease can be treated with intermittent antibiotics; however, in most cases surgery is needed to remove the disease (cyst, tracts, and abscesses).

The key elements of surgery involve the patient being completely asleep and lying on the their abdomen with their lower back and buttocks clipped, prepped, and draped sterilely. An incision is made over the skin of the tailbone and all of the irritated, infected, and scarred in tissue is shelled out all the way down to the tailbone. Sometimes if there is no evidence of infection the wound can be closed in layers. Sometimes a drain is needed to help keep the wound closed. In other instances if there is too much disease or evidence of infection the wound needs to be left open to allow it to slowly granulate and close in over time. The surgery itself does not take too long. Most people can have the surgery done and leave on an outpatient basis.

A key component to avoiding recurrence is keeping hairs free from the lower back and buttocks by having this area regularly trimmed or shaved, just as most men shave their beards and most women shave their legs. The lower back would need to be free from hair at all times. Otherwise there is a risk of re-irritation and re-infection.

This surgery can be performed by any the surgeons in our office at Regional Surgical Specialists. If you have any questions or concerns please contact us at 828-252-3366.