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Pilonidal Sinus – Causes, Symptoms & Remedies

By Dr. Raj Kumar Singh +2 more

Pilonidal Sinus is a skin abnormality that can occur near the tailbone, at the top of the buttocks. It usually forms a tunnel or a sac-like depression in the region. Pilonidal sinus is also known as a pilonidal cyst or pilonidal disease and is usually not a concern unless it gets infected. Infected pilonidal cysts are called abscesses and can cause pain and discomfort, apart from other symptoms. The precise cause of pilonidal sinus is unknown, but it is thought to be associated with hair growing into the skin, as well as skin-to-skin friction. 

People who sit for long periods for work (such as drivers, office workers, etc) may experience pilonidal sinus more often than others. Additionally, men are more likely to experience this condition than women, possibly due to males being hairier than women in general. If you suspect that you may have pilonidal sinus, you must speak with your doctor and get it checked. Only a doctor will be able to diagnose and treat this condition. 

What causes Pilonidal Sinus?

The exact cause of pilonidal sinus is unknown, but the presence of hair within the shallow depression near the tailbone area can indicate a possible link. It is thought that excessive sitting along with ingrown hair (when the hair grows back into the skin) may be causing the development of pilonidal sinus.

Excessive sweating may also cause pilonidal sinus since this can encourage the growth of certain bacteria. Bacteria can cause an infection within the hole, this may lead to various symptoms and require medical intervention. Here are some risk factors for pilonidal sinus:

  • Gender – Males are 3-4 times more likely to develop this condition than females.
  • Age – People younger than 40 have a higher risk than older adults.
  • Job Type – Jobs that involve a lot of sitting such as driving and transportation jobs as well as office work.
  • Weight – Obese and overweight people are more likely to develop pilonidal sinus, possibly due to increased friction.
  • Hair – Hairier individuals with thick or rough hair may have a higher risk.
  • Clothing – Tight clothing may increase your risk of this condition.

Pilonidal Sinus Types

There are two main types of pilonidal sinus – Infected pilonidal sinus and non-infected pilonidal sinus. Additionally, the severity of the condition may differ based on the size of the cyst or sinus as well as the symptoms associated with it.

Symptoms Of Pilonidal Sinus

Pilonidal sinus typically only causes symptoms when it becomes infected. Although not all of these tunnels will become infected, once you develop an infection in this hole or cyst, the following symptoms may appear-

  • Pain in the upper buttocks area, it may get worse when you sit down.
  • A hole, dimple, sunken area of skin at the top of the area between your buttocks.
  • Swollen, reddened skin that is tender to the touch near the top of your buttocks.
  • An infected abscess that drains fluid or pus.
  • In rare cases, the above symptoms may be accompanied by a fever and chills
  • In other rare cases, the infected cyst may occur in other body parts (such as the armpits).

Usually, pilonidal sinus will be detected by a doctor when he/she visibly examines the area and know about complaints of pain and tenderness in the region.

Home Remedies for Pilonidal Sinus

Pilonidal sinus can usually only be permanently fixed through surgery, but there are plenty of self-care methods you can do to ease your symptoms. Here are some basic activities and solutions for lowering your risk of pilonidal sinus as well as decreasing your discomfort if you already have it:

1. Hot compress

Using a hot wet compress can heat the region and provide some mild temporary relief. A hot compress may also allow the pus to drain from the sinus which could ease the pain and itchiness associated with this condition. Use a hot water bag or heated wet cloth to gently place it on the region for several minutes. Repeat the process as needed.

2. Sitz bath

Although a Sitz bath is usually recommended for fistulas, it may also give some relief to those with pilonidal sinus. In a shallow tub, add warm water and soak the region for several minutes. Repeat this procedure multiple times a day if it brings relief from the pain. 

3. Hygiene

Ensure that the region between your buttocks is always clean and dry. Be gentle when cleaning the area and always pat yourself down with a dry towel. Moisture may increase the risk of bacterial growth so it is essential to maintain proper hygiene. 

4. Hair removal

Since ingrown hair is thought to play a major role in the development of infection in the pilonidal sinus, you can lower your risk by removing hair from the area. Laser hair removal as well as traditional methods like shaving and hair removal creams may decrease your risk. Be sure to clean the area thoroughly after shaving since loose hair can also poke the skin and cause a cyst to form. 

5. Clothing

Avoid tight-fitting clothes as these may allow moisture and sweat to collect between your buttocks. If you have a history of pilonidal sinus or you are at a higher risk of developing one, you should consider cotton-only clothing options. 

6. Weight management

The increased weight comes with a higher risk of developing a pilonidal cyst, you can avoid this by lowering your weight. If you already have a healthy BMI (Body Mass Index) then this may not be an option for you. However, if you are overweight or obese, speak with your doctor about a healthy weight loss plan. 

7. Exercise

Simple, light exercises like regular walks may allow you to deal with the issue of sitting for hours at your job. Sitting for long periods is linked with a higher risk of pilonidal sinus. Any quick, short and easy physical activity you can get during the day for a few minutes may lower your risk of this condition. 

When to seek professional help for Pilonidal Sinus

The pilonidal sinus will usually require medical attention when it gets infected and causes symptoms. The infection will usually not go away on its own, hence various minor surgical procedures may be required. Here are a few signs that you need to contact your doctor at the earliest: 

  • Any signs of growth, lesion, or cyst in the upper buttocks region 
  • Bleeding, pus drainage from the area
  • Pain, and discomfort due to the growth 
  • Swelling, tenderness, and reddened skin 
  • You have had pilonidal sinus before and notice that it has returned 

Your doctor will make a decision based on your medical condition and recommend some of the following options:

  • Cyst drainage (using very small incisions) 
  • Injections (for minor cysts) 
  • Antibiotics (a temporary measure only)
  • Hair removal (LASER procedures or others, to lower the risk of pilonidal sinus developing)
  • Open surgery (to remove the infected sinus or cysts)


Pilonidal sinus can be a painful condition to live with. Fortunately, there are a variety of self-care options to manage the symptoms at home as well as effective surgical options to choose from. Your doctor will observe and diagnose your condition before suggesting the best surgical procedure for your case. Surgical intervention is usually the only method to permanently get rid of the pilonidal sinus. Speak with your doctor to find out what your options are.  

Frequently Asked Questions (FAQs)

Q1. Is pilonidal sinus a serious condition?

Pilonidal sinus is not a serious medical issue until it gets infected. Infected pilonidal sinuses will require some kind of medical intervention.

Q2. Can pilonidal sinus disappear on its own?

In some cases the swelling and pus leakage may temporarily decrease, however, it usually returns. For most infected pilonidal sinus cases the issue will not get fixed by itself. 

Q3. How do I know if I have a pilonidal sinus?

You will notice pain, tenderness, swelling and redness in the area between your buttocks at the top. Pus may leak out of the cyst and you may notice more pain when you sit down. Hair may also be noticed from the pilonidal sinus. 

Q4. Is Pilonidal sinus surgery painful?

No, pilonidal sinus surgery typically involves less pain than other procedures such as surgeries for fistulas and fissures. During the operation, local anesthesia will ensure that you feel no pain while pain after the procedure will be minimal. 

Disclaimer: The information included on this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.


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