Discharge Instructions - Pilonidal Abscess

As discussed in the Emergency Department prior to discharge, your child has been diagnosed with a pilonidal cyst or abscess.  A pilonidal cyst is a fluid-filled sac that forms just above the crease where the buttocks come together.  This cyst can become red, inflamed, and infected.  This infection can result in an abscess.  It can also cause pain and make it uncomfortable to sit or lie back.  Pilonidal cysts are thought to be related to hair in the area.

If the cyst is not infected, it might not cause symptoms.  But if the cyst is infected, it can cause pain, redness, and swelling in the area above the crease where the buttocks come together.  In some cases, the cyst might burst and drain fluid, blood, or pus (a milky yellow or green fluid).  In other cases, a procedure called an incision and drainage (or I&D) is performed to drain pus and infected material and relieve pain.

If you have a pilonidal cyst without any symptoms, it probably does not need treatment.  If the cyst is causing symptoms, treatment usually involves either draining the cyst or removing it with surgery.

Draining a cyst can usually be done at your primary care provider's office or in the Emergency Department.  To drain a cyst, a doctor or nurse will first numb the area.  Then he or she can cut open the cyst, drain it, and wash it out.  In some cases, the doctor or nurse might also pack the empty cyst with gauze, or leave a drain in place.  After the cut has healed, you should regularly remove the hair from the area.  You can do this by shaving carefully or using a hair-removal product such as Nair.  This might help prevent the pilonidal cyst from causing symptoms again.

Removing a cyst involves surgery, so it is done in an operating room at the hospital.  Right before the surgery, people having the surgery either get a shot to numb the area, or a shot to numb the area plus some medicine to make them drowsy.  People having the surgery can usually go home the same day.  The wound might be closed or left open.  You will need to see your doctor regularly after surgery to check how the area is healing.

If you had an incision and drainage procedure done in the Emergency Department and packing material was placed, remove the packing in 48 hours.  You should note blood from the wound, which is a good sign that an abscess is not reforming.  If you were directed to follow up with your primary care provider for a pilonidal cyst, arrange an appointment as soon as possible to discuss options for treatment.

You can take Acetaminophen (also known as Tylenol), Ibuprofen (also known as Advil or Motrin), or Naproxen (also known as Aleve) for the pain.

Return to the Emergency Department for persistent or worsening pain, development of fever (≥38.0 °C or 100.4 °F), worsening redness or a red streak to the back or buttocks, or any new or concerning symptoms.