saudigastro.com/patients/pilonidal-disease
Category
Common
Red flags
5
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Pilonidal disease is a problem of the skin at the very top of the cleft between the buttocks, near the tailbone, and not of the anus or bowel itself. Small pits form in the skin, hairs can become trapped there, and the body reacts as it would to a foreign object. This leads to a swollen, painful pocket of pus (abscess) or a long-lasting sinus (a small tunnel under the skin) that drains fluid or pus. It is often treated by surgeons who also treat anal conditions, which is why it is included here.
How common is it?
It is common in young adults, usually from the teenage years to the thirties, and is more frequent in men, especially those with thick body hair, and in people who sit for long periods or are overweight. It is uncommon after middle age.
Why does it happen?
The exact cause is not fully understood. The current view is that loose hairs, friction, pressure and sweat push hairs into the skin of the cleft, which becomes inflamed and infected. Risk is higher with deep buttock cleft, thick or coarse hair, prolonged sitting (such as long drives or desk work), obesity, and a family history. It is not caused by poor hygiene alone.
Symptoms
- Pain, tenderness or swelling at the top of the buttock cleft
- A red, warm lump that may become very painful when sitting
- Pus or bloody, foul-smelling fluid draining from the area
- Small pits or openings in the skin of the cleft, sometimes with hair poking out
- Fever or feeling unwell during a flare
- Some people have no symptoms until a flare-up
Red flags — seek urgent medical care
Severe, throbbing pain and a tense swelling at the top of the buttocks
Suggests an abscess, which usually needs to be drained by a doctor. See a doctor the same day or go to the emergency department.
Fever, chills, or redness spreading across the skin
The infection may be spreading. Seek urgent medical care.
Confusion, fast heartbeat or feeling faint with infection
May be a sign of a serious bloodstream infection. Call emergency services.
A sore or growth in an old, long-standing wound that does not heal
Very rarely, long-standing disease can change in the skin. Ask your doctor to examine it.
Diabetes or weakened immunity with any painful swelling here
Infection can progress faster, so be seen promptly.
How is it diagnosed?
The diagnosis is usually made from your story and by examining the skin of the cleft, where the typical pits and swelling can be seen. Scans are rarely needed. Tests are only used if the picture is unclear or other conditions, such as an anal fistula, need to be excluded.
Outlook — what to expect
Pilonidal disease is not dangerous in most people, but it can be painful and can return, especially while the underlying pits and hairs remain. Treatments differ in recovery time and chance of recurrence, so it is worth discussing the options with your surgeon.
Treatment
Habits & Lifestyle
Keeping the area clean and free of hair helps prevent flare-ups, but an abscess must be seen by a doctor.
- Do not try to squeeze or open a painful lump yourself
- Wash the cleft daily with water and mild soap, rinse well and dry thoroughly
- Keep the area free of loose hair, using hair removal as your doctor advises
- Avoid sitting for long periods; stand up and move around regularly
- Maintain a healthy weight
Diet
No food causes or cures pilonidal disease, but general health supports healing.
- Eat a balanced diet with enough protein to help wound healing
- Aim for a healthy weight, which lowers pressure and sweating in the cleft
- If you have diabetes, keep sugar levels well controlled
Medications
Medicines do not cure pilonidal disease, but they can help in specific situations.
- Simple pain relief as advised by your doctor
- Antibiotics only if there is spreading infection, a weak immune system or diabetes, as your doctor decides
- Antibiotics alone do not clear an abscess, which needs drainage
Procedures & Surgery
The right procedure depends on whether you have an abscess or a long-standing sinus, and on your preferences.
- Incision and drainage of an abscess, often under local anaesthesia
- Minimally invasive options that clean out the pits and hair through small openings
- Removal (excision) of the affected skin and sinus, with the wound left open or closed in different ways
- Flap procedures that reshape the cleft for difficult or recurring disease
- Your surgeon will explain healing time, wound care and chance of recurrence for each option
Living with the condition
- Good wound care after treatment matters; follow the dressing instructions you are given
- Keep the cleft clean and hair-free to lower the chance of returning
- Contact your doctor early if pain, swelling or discharge returns
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Do I have an abscess or a long-standing sinus?
- Which treatment do you recommend and why?
- How long will healing take and when can I return to work or exercise?
- How likely is it to come back and how can I reduce that chance?
- Should I remove the hair in this area?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide