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We understand that the Pilonidal disease can be intimidating, painful and sometimes confusing. That why we are here to help you in every way possible with any questions or concerns.
Only a doctor can tell you for sure since Pilonidals take different courses in different people. Some people may just experience a bit of a pain when sitting, others may only have some drainage and no pain, still others will be making a trip to the ER or surgeon because they are in excruciating pain. The usual signs of an acute infection are swelling and pain in the tailbone region. Most people end up at this site by Googling "tailbone pain". The most singular common symptom is discomfort in the area around the tailbone.
Even the doctors don't agree on this issue but we can give you the primary prevailing opinion:
Without getting too technical, the primary theory on Pilonidal Disease involves "follicular occlusion" which is the blocking and inflammation of pores in the midline of the buttocks. This tends to occur in the tailbone area because of the friction and pressure on the area that stretches the pores when the person is sitting. We caution people to make sure your doctor has the latest info on Pilonidal Disease. There are an appalling number of "old school" doctors out there who still think that Pilonidal is completely congenital and there is no way to get rid of it. You can usually spot these doctors by their use of the phrase "the cure is worse than the disease."
Somewhat. There are plenty of instances where multiple family members have Pilonidal Disease. Doctors speculate that this is due to the inherited shape of the buttocks and natal cleft, type of hair and predisposition to blocked follicles/pores.
It is generally suggested that being overweight does encourage Pilonidal Disease but is not a sole cause. Pilonidal Disease occurs most frequently in those with deep natal cleft (aka: your crack), as most of us gain weight, out butts get bigger and the cleft gets deeper. The deeper the cleft, the more moisture and debris that gets trapped in it and the more pressure created when sitting/standing. Plumper buttocks also create a greater seal that keeps out oxygen and provides a happy living accommodation for anaerobic bacteria to thrive.
Very rarely. As of 1999, fewer than 50 cases have been reported and those were mostly in people who had refused treatment for many, many years. When you undergo surgery, your doctor will probably send the tissue to the lab for testing just to be sure.
You may run across references to Pilonidals in other body regions, but technically a Pilonidal occurs in the natal cleft area only. There are similar type cysts that have been reported in the Umbilicus (Navel), on the breast, in the pubic region and in the armpit...these locations suggest Hidradenitis Supperativa, rather than Pilonidal Disease. There is a similar disease called Barbers Pilonidal Sinus that is caused by hair digging into the soft tissues between the fingers. It tends to occur on animal groomers and barbers.
In most cases (but not all), you can feel a lump in your tailbone area. The lump can be as small as a pea or as large as a golf ball. The lump moves when you press on it - bone feels like bone and doesn't move. Usually, the lump will hurt when you press on it. Not every case of Pilonidal Disease involves an obvious lump (abscess), some people just have draining sinuses and abscess is buried too deep to be felt from the top skin.
That is a sinus opening. A sinus is a tract that links your abscess to the top of the skin. Not everyone who has a Pilonidal Abscess has a sinus. If you have a sinus, you can be assured there is an abscess to go with it somewhere or one will likely form in the future. It is possible to have multiple sinuses. Some doctors speculate that sinus openings only form in response to flare-ups, but I can tell you that I noticed my sinus hole a good 12 years before my first real flare-up, so the jury is out on this one. There is good reason to suspect that sinus openings that are right in the center of the buttock midline are, in fact, pits (exploded follicles) which are the cause of a Pilonidal.
It hurts. It really, really hurts. If there is a sinus, there may also be a foul smelling drainage that can be a variety of colors from clear, brownish, white pus or mixed with blood. For a lot of people, the first time they hear the word Pilonidal is in the emergency room where they had to be carried, screaming in pain the whole way. When a Pilonidal Abscess is infected (inflamed, acute, "flaring up") it will swell and make it almost impossible to sit, stand or lie down, since any movement seems to make the pain worse. Several women have posted that the pain of an acutely infected Pilonidal Abscess is worse than childbirth. So, men, now you know!
Itching is your skin's response to the infected fluid draining from the abscess. If you are itching, you have an infection.
Not really. Usually, one isn't needed since the person is in pain and has an obvious lump/draining sinus. In some cases, Pilonidals are visible on a very high resolution MRI with contrast. Pilonidals are also reportedly visible through Ultrasound, although we have actually seen one ourselves, so this may be just a rumor.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”