Pilonidal cyst on the butt: Symptoms of pilonidal disease

Pilonidal cyst and tailbone fistula can occur in three different forms with correspondingly different symptoms:

asymptomatic
chronic
acute

Asymptomatic pilonidal cyst

The symptom-free tailbone fistula is characterized by the presence of one or more pits in the bottom fold. There are no signs of inflammation and no secretions. Since it does not cause any discomfort or secretion, this form of pilonidal sinus is often discovered by chance. Once the fistula is there, it does not heal spontaneously, normally it will last a lifetime.

Nartoun, SinusPilonidalis, marked as public domain

Since the spontaneous progression of the fistula disease is not inevitable, there are now two possibilities: Those affected have a fistula for a lifetime without ever developing symptoms. Or the fistula disease eventually changes into one of the following two forms and then requires treatment.

It is not possible to predict when an existing tailbone fistula will develop symptoms for the first time. Often there are several years between the occurrence of pits and the first symptoms. The MVZ St. Marien Cologne, Germany recently reported a tailbone fistula that existed for more than 30 years until it developed symptoms. The fistula was removed by minimal-invasive surgery.

Chronic pilonidal disease

Typical for the chronic pilonidal disease is the presence of pits with bloody purulent secretion. Secretion can be permanent or recurrent, i.e. occasional rest. Often a further fistula opening develops near the pits towards the buttock, the so-called secondary fistula, which indicates an inflammatory process that has existed for a long time.

GiggsHammouri, Pilonidal cyst, CC BY 3.0

Acute Pilonidal disease

This has led to the formation of an abscess in the pilonidal cyst. The abscesses almost always lie to the side of the gluteal fold, rarely in the area of the pits that are located in the gluteal fold. These abscesses are recognizable by a painful, reddened swelling that often develops within a short time. If the abscesses break open outwards (this is called spontaneous perforation) or if they are surgically opened, pus is drained.