Top of the buttock crease · Near the tailbone
A pilonidal cyst is a cavity that forms in the upper crease of the buttocks, usually with hair inside. It is not at the anus — it sits higher, near the tailbone — and it is frequently mistaken for an anal abscess.
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It appears mostly in younger people, more often men, and is associated with long hours sitting — drivers, desk work, long flights — and with heavy hair growth in the area.
It may show only as a small pit or lump that does not bother anyone, or it can flare: pain, swelling, redness and pus with an odour. Many describe it as a boil that comes and goes.
When only the flare is drained, the episode settles but the cavity and the hair are still there, so it is normal for it to return months later. That is why so many people carry this for years as «that thing that flares up now and then».
Resolving it properly means removing the cavity and its tracts, not just emptying the pus.
If it is acutely infected, it is drained first to relieve pain. Definitive surgery is scheduled afterwards, once the area is free of active infection.
There are several excision and closure techniques, and the choice depends on size, how many tracts there are, and whether it has been operated before. Recovery and wound care differ quite a bit between them, so they are explained before deciding.
Hair care in the area after surgery is part of the treatment, not a detail: it affects whether it returns.
No, though they are confused. The pilonidal sits at the top of the buttock crease near the tailbone; a perianal abscess sits beside the anus. Location is what tells them apart, and treatment differs.
Because drainage settles the infection but leaves the cavity. That is the typical course when only drainage is done: to stop it returning, the cavity and its tracts have to be removed.
It depends on the technique and on your work, especially how much sitting it involves. That is worth raising at the consultation before scheduling, so the date is chosen with it in mind.
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