A pilonidal cyst is a common skin condition that typically forms a small pocket near the tailbone, just above the crease of the buttocks. This sac often becomes filled with hair, skin debris, and other foreign materials, which can lead to inflammation. When bacteria infect this pocket, it forms a painful, swollen abscess that requires attention. This situation often leads people to consider draining the cyst themselves for immediate relief, but this action carries significant risks.
Why Self-Draining Is Dangerous
Attempting to drain a pilonidal cyst at home is strongly advised against by medical professionals. The temptation to “pop” the cyst ignores the complex, deep nature of this condition. A pilonidal abscess can have deep, branching tracts that extend well beneath the skin’s surface, making complete drainage impossible without specialized medical tools and expertise.
Incomplete drainage leaves infected material, allowing bacteria to multiply rapidly. Using non-sterile tools introduces dangerous bacteria, such as Staphylococcus aureus, dramatically increasing the risk of severe secondary infection. This self-lancing can lead to cellulitis, a rapidly spreading skin infection, or even sepsis, a life-threatening systemic infection.
The area overlies a venous plexus, meaning that attempting to cut or puncture the cyst can result in excessive bleeding that is difficult to control at home. Squeezing the cyst can also be dangerous, as it can push bacteria and debris deeper into the surrounding tissue, worsening the infection and causing more tissue damage and scarring. Professional drainage procedures are performed under local anesthesia to ensure pain management, which is impossible to replicate safely at home.
Immediate Home Comfort Measures
While self-draining is unsafe, there are several non-invasive steps you can take to manage pain and discomfort while you arrange a doctor’s visit. Applying a warm, moist compress to the affected area several times a day can help soothe inflammation and may encourage superficial drainage. Warm sitz baths, often with Epsom salt, can also help ease pressure and discomfort.
Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be taken as directed to help reduce localized pain and inflammation. It is important to maintain strict hygiene by gently cleaning the area with warm water and unscented soap, then patting the skin completely dry. Sitting for long periods places direct pressure on the tailbone area and can aggravate the cyst, so using a coccyx or donut cushion may help, and taking frequent breaks to stand and walk is recommended. These home measures are only temporary solutions and cannot eliminate the underlying cyst, which still requires a medical consultation for definitive treatment.
Professional Treatment and Next Steps
Once you seek medical help, a healthcare professional will examine the cyst and determine the appropriate course of treatment based on its severity. For an acute, infected pilonidal abscess, the initial treatment is an Incision and Drainage (I&D) procedure. This minor procedure is typically performed in an office setting using a local anesthetic.
The doctor makes a small incision to fully drain the pus, clean out any embedded hair and debris, and then irrigates the cavity to reduce the bacterial load. The resulting wound is usually not stitched closed but is instead packed with gauze and allowed to heal from the inside out, a process that can take up to four weeks. While I&D offers immediate pain relief, it does not remove the entire cyst tract, and recurrence rates are estimated to be as high as 40 to 60 percent.
Pilonidal Cystectomy
If the disease is chronic, recurrent, or involves multiple sinus tracts, the doctor may recommend a definitive surgical option, such as a pilonidal cystectomy. This procedure involves surgically removing the entire cyst and the surrounding tissue that contains the hair follicles and sinus tracts. The surgeon may choose to leave the wound open to heal, or perform a primary closure, where the wound is stitched closed, sometimes off-midline to reduce tension and recurrence. Post-procedure care involves diligent wound management, potentially including daily packing changes, and follow-up appointments to monitor healing.