First up, please be aware that I resisted the urge to title this article, "Pilonidal Sinus, a pain in the butt". I think I deserve some credit for that.
I don't know what it is with guys and butt jokes, but anyway, let's crack on. 😆
Seriously Andrew, stop it.
Pilonidal cyst : definition and etiology
Pilonidal cyst, a.k.a. pilonidal sinus, is a painful condition caused by rapid infection and swelling in the upper cleft of the buttocks.
'Pilonidal' literally translates to 'nest of hairs'. A sinus is a tunnel-like structure in the skin, and a cyst occurs when that tunnel becomes blocked.
While the precise etiology of pilonidal sinus remains elusive, it is commonly associated with ingrown hairs, which in turn, are caused by the inability of hairs to break through the skin due to obstruction or rubbing.
Other contributing factors include the anatomy of the buttock cleft itself, excessive body hair, and a genetic predisposition.
While pilonidal cysts can occur in anyone, the overwhelming majority of people afflicted are men aged 18 to 35 with quite dense body hair.
This period of life is when most new hairs are sprouting, and dense hair translates to more potential sites for infection.
Prevalence of pilonidal cysts
It might sound like an obscure condition, but surprisingly no. It just isn't a cute topic that pretty girls post about on Instagram. And it hurts too much to do a booty dance on TikTok. 😏
As a hair removal guru, I work on intimate body parts every day. I do come across pilonidal cysts a lot - at least, their huge post-operative scars. These cysts form so quickly and are so very painful, that they require fast surgery. For that reason, it's very rare to see one in the wild.
That said, I have identified a few over the years while they were forming, which saved the clients a lot of pain as they went straight to their GP afterwards, then into hospital.
The first symptom is usually localised redness that can be easily mistaken for a pimple or boil, however it continues to grow rapidly. Pain comes next as the swelling intensifies, and without medical intervention, that pain quickly turns to agony. If the cyst isn't drained, it can lead to blood poisoning and death.
Treatments for pilonidal cysts
If the cyst is in its earliest stages, and your GP is confident of the cause, they may attempt to lance it in their treatment rooms. Most often though, they will err on the side of caution and admit you to hospital.
Surgery involves draining the pus from the cyst and then following the sinus to the primary site of infection. The debris that caused the blockage will be removed and the sinus excised so it cannot recur, at least theoretically.
Unfortunately, rates of recurrence are quite high, most notably in people who have a genetic predisposition, or simply, dense body hair.
The first step in reducing the chance of recurrence is to ensure hygiene in the area. The second step is to permanently remove all the hair from the butt cleft.
While some types of hair removal, such as waxing, plucking, shaving, or creams, will temporarily remove the hair, they aren't a solution.
In fact, these temporary methods might actually cause an ingrown hair, which could lead to the formation of another pilonidal cyst.
For this reason, a permanent type of hair removal is the only option. Permanent methods are IPL, laser, and electrolysis.
It doesn't matter which method you elect to use, however make sure that your therapist is familiar with pilonidal cysts and experienced in providing treatments for their prevention.
