Expert treatment for pilonidal disease
A pilonidal sinus is a small tunnel or cavity under the skin near the top of the buttock crease, usually containing hair and debris. It commonly causes recurrent infections, and surgery is the definitive treatment for persistent or recurrent disease.
Pilonidal disease most often affects teenagers and young adults, particularly men and people with coarse body hair or sedentary lifestyles. It can develop into a painful abscess, a draining wound or repeated infections. Dr Goutham offers treatment tailored to your condition, from minimally invasive procedures to flap repair.
What causes pilonidal disease?
- Trapped hair — loose hairs work into the skin of the natal cleft, triggering inflammation and infection.
- Prolonged sitting — increases pressure and friction over the area.
- Coarse or dense body hair — more likely to become embedded.
- Moisture and friction — weaken the skin barrier, making infection more likely.
- Excess weight and deep skin folds — create a favourable environment.
- Hormonal changes in adolescence — increase oil and hair growth.
Signs and symptoms
- Pain and tenderness in the buttock crease, especially when sitting
- A small pit, lump or swelling near the tailbone
- Redness and warmth over the area
- Pus or bloody discharge from a skin opening
- Foul-smelling drainage if an abscess forms
- Fever and feeling unwell in more severe infections
How pilonidal disease is diagnosed
Pilonidal disease is usually diagnosed by examination — Dr Goutham looks for the characteristic midline pits and any swelling, tenderness or discharge. Imaging is rarely needed, but in complex or recurrent cases an MRI may be used to map the extent of the sinus tracts before surgery.
Treatment options
Treatment is matched to the severity of the disease, from simple drainage of an acute abscess to definitive surgery for recurrent disease:
Abscess drainage (I&D)
A small incision releases the infection, easing pain and swelling. Modern approaches often need no packing, and the area heals over a few weeks.
Pit-picking
Pit-picking uses tiny incisions to remove hair and debris from the sinus tracts. It may suit selected limited disease; the extent of the disease helps determine whether it is appropriate and what recovery will involve.
Excision ± closure
The affected tissue is removed; the wound is either left to heal naturally or closed, depending on the case.
Flap repair (Karydakis / cleft-lift)
A flap technique flattens the cleft and moves the scar off the midline. Off-midline closure may reduce recurrence and wound complications compared with conventional midline closure. The choice depends on your disease and individual risks.
Recovery and wound care
Recovery depends on the procedure and how your wound heals. An open wound may need regular dressings and ongoing care. Your aftercare instructions cover keeping the area clean and dry, dressing reviews, sitting and hair care. Dr Goutham provides a personalised aftercare plan and follow-up.
Preventing recurrence
Pilonidal disease can return after treatment. Measures that may help include keeping the area clean and dry, hair removal where advised, avoiding long periods of unbroken sitting and maintaining a healthy weight. Follow the wound-care and hygiene instructions for your procedure. Recurrence risk depends on the disease, the procedure and healing.
Care during treatment and recovery
- ✓Treatment options — minimally invasive and flap repair.
- ✓Tailored treatment — matched to your disease and lifestyle.
- ✓Follow-up care — practical advice about wound care and when to seek review.
- ✓Recovery planning — activity and wound care advice matched to your procedure.
- ✓Care close to home — Brisbane, Redland, Moreton Bay and Logan.
Pilonidal disease FAQs
Will my pilonidal disease come back after surgery?+
Pilonidal disease can return after any operation. Off-midline closure may reduce recurrence compared with conventional midline closure. The choice of repair takes account of your disease and the benefits and risks of each technique.
Is pit-picking better than excision?+
Pit-picking may suit selected limited disease. Excision or flap repair may be considered for more extensive or recurrent disease. The choice depends on the disease, previous treatment and the benefits and risks of each option.
How long is recovery?+
Recovery depends on the procedure, how the wound heals and the activities you need to return to. An open wound may need regular dressings and ongoing care. Dr Goutham will explain the recovery plan for your procedure.
Does a pilonidal abscess always need surgery?+
An acute abscess is first treated with incision and drainage. If you have had repeated abscesses, definitive surgery is then recommended for a long-term solution.
Can I sit normally after surgery?+
Prolonged sitting is limited early in recovery to protect the wound. Most people gradually return to normal sitting over a few weeks as healing progresses.
How do I stop it coming back?+
Keep the area clean and dry, reduce hair in the cleft as advised, avoid long unbroken periods of sitting, and maintain a healthy weight.
Is the surgery painful?+
The procedure is done under anaesthetic so it is not painful at the time. Afterwards, discomfort is usually well managed with simple pain relief.
Will I need time off work?+
Most people need some time off depending on their job and the procedure — desk-based workers usually return sooner than those whose work involves prolonged sitting or physical activity.
Caring for South-East Queensland
Dr Goutham consults and operates across Brisbane, Redland, Moreton Bay and Logan — care close to home, wherever you are in South-East Queensland.
Trusted resources
- HealthDirect — Pilonidal sinus
- Healthdirect — Pilonidal disease
- Cleveland Clinic — Pilonidal cyst
Last medically reviewed by Dr Goutham Sivasuthan, Specialist Surgeon — June 2026.