Pilonidal Disease/Cyst

Understanding Pilonidal Disease

Pilonidal disease is a common condition that affects the area at the top of the buttocks, near the tailbone. It usually begins when hair and skin debris become trapped beneath the skin, leading to inflammation, infection, and sometimes painful abscesses.

Although frustrating and sometimes embarrassing, pilonidal disease is highly treatable — especially when managed by a specialist.

 
Who Gets Pilonidal Disease?

Pilonidal disease most often affects teenagers and adults between the ages of 16–40 and is slightly more common in men. Risk is higher in people who:

• Sit for long periods (desk work, driving, gaming, military, etc.)
• Have thick or coarse hair
• Sweat frequently or exercise actively
• Have a deep gluteal cleft
• Have had previous infections or abscesses

Patients in the Seattle and Eastside communities often present after weeks or months of persistent drainage or repeated flare-ups.

 
Signs & Symptoms

Pain or tenderness
Redness or swelling
Drainage of pus or blood
Bad odor from drainage
Recurrent abscesses
Difficulty sitting
Chronic non-healing wounds

Symptoms may come and go or become chronic without proper treatment.

 
Acute vs Chronic Pilonidal Disease

There are two main patterns:

Acute Pilonidal Abscess
– Sudden pain
– Redness and warmth
– Often requires incision & drainage for immediate relief

Chronic Pilonidal Sinus Tracts
– Persistent drainage or openings (“pits”)
– May form multiple sinus tracts
– Sometimes requires minimally invasive procedures or surgery

 
Treatment Options in Seattle & Bellevue

Treatment depends on severity and whether disease is recurrent.

1. Incision & Drainage (I&D)- acute situation
Often used for acute abscesses. Provides fast relief but may not prevent future infections if sinus tracts remain.

2. Minimally Invasive Pilonidal Procedures
Modern approaches such as:

• Pit Picking
• Debridement / Curettage
• Phenol Injection (select cases)

Benefits include:

Less downtime
Less pain
Minimal scarring
Faster return to work or school

These approaches are increasingly preferred by active young patients in Seattle, Bellevue, and Redmond.

3. Surgical Correction
In more advanced cases, surgical options may include:

• Off-midline closure techniques
• Bascom cleft-lift procedure
• Karydakis flap
• Plastic closure
• Open healing (select cases)

Off-midline procedures offer the best long-term cure rates and reduced recurrence.

 
Recovery + Prevention

Even after treatment, reducing recurrence is important. Helpful strategies include:

Laser hair removal (preferred over shaving)
Hygiene and moisture control
Avoiding prolonged sitting
Weight optimization when indicated
Early management of minor flare-ups

Laser hair reduction significantly reduces recurrence and is commonly recommended in modern colorectal practice.

 
When to See a Specialist

You should schedule an evaluation if you experience:

Repeat flare-ups
Persistent drainage
Pain with sitting
Non-healing wounds
Failed prior treatments
Previous ER incision & drainage

Patients frequently come to us after being told it will “just keep coming back” — but that’s no longer true with modern treatments.

 
Serving Seattle, Bellevue & the Eastside
Our practice serves patients throughout the greater Seattle region including:

Bellevue • Seattle • Kirkland • Redmond • Edmonds • Shoreline • Bothell • Lynnwood

Many patients are active, working professionals or students who need fast, discreet, and durable care — and we tailor treatment to minimize downtime and disruption.

 
Frequently Asked Questions (FAQ)

Is pilonidal disease curable?
Yes. Modern surgical and minimally invasive options can eliminate chronic infections and significantly reduce recurrence.

Does it always require surgery?
Not always. Some patients respond well to minimally invasive techniques, sinus debridement, or hair reduction strategies.

How long is recovery?
Recovery depends on the procedure. Minimally invasive options may require only a few days, while surgical repairs can require several weeks.

Can it come back?
Yes, recurrence can happen, especially if hair and friction are not addressed. Laser hair reduction can dramatically reduce recurrence risk.

Can I just leave it alone?
Chronic pilonidal disease rarely resolves on its own and may worsen over time. Early management leads to better outcomes.

What if I previously had an ER incision and drainage?
ER I&D provides temporary relief but may not cure underlying tracts. Many patients seek definitive treatment afterward.

Schedule a Consultation

Living with pilonidal disease can be painful and disruptive, but you don’t have to. With the right treatment plan, most patients return to normal activity quickly and with low recurrence risk.

Schedule a consultation today to learn which treatment option is right for you.