Pilonidal Sinus Disease: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 2, 2026.
What kind of doctor treats Pilonidal Sinus Disease?
Most people start with a primary care doctor, who can often diagnose the condition and drain a simple abscess. When surgery is needed, the patient is referred to a general surgeon or a colon and rectal surgeon. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What it is
A pilonidal sinus is a small tunnel or hole in the skin near the tailbone, at the bottom of the spine. The word pilonidal means "nest of hair," because hair often grows inside these tunnels. When the hole gets infected and fills with pus, it is called a pilonidal abscess. Some people have no symptoms for years; others have repeated infections causing pain and swelling.
Symptoms
Many people have no symptoms. When the area becomes infected, symptoms appear near the tailbone. Common signs include pain when sitting, swelling, redness, and warmth. There may be drainage of pus or blood, sometimes with a bad smell, and some people develop a fever.
Causes and who gets it
Doctors believe loose hairs are pushed into the skin by pressure and friction. The body reacts to the hair as a foreign object, and the tunnel forms and sometimes becomes infected. It is most common in young men between the teens and thirties, especially those who sit a lot, have coarse body hair, or are overweight.
How doctors diagnose it
Doctors usually diagnose a pilonidal sinus by looking at the area near the tailbone and asking about symptoms. No special tests are needed in most cases. If the infection seems severe or is spreading, the doctor may order blood tests or imaging.
Treatment
An infected abscess usually needs to be drained. A doctor can often do this in the office by numbing the area and making a small cut to let the pus out. For sinuses that keep coming back, surgery may be recommended. Keeping the area clean and free of hair afterward lowers the chance of return.
When to see a doctor
See a doctor if you have pain, swelling, or drainage near your tailbone. Get care quickly if you also have fever, spreading redness, or worsening pain, which can signal a spreading infection. Early treatment often means simpler care.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance for visits. A concierge doctor usually charges more and often works alongside insurance. These doctors often have longer appointments. Many can drain a simple abscess in the office and will refer to a surgeon if needed.
Common questions
Is pilonidal sinus disease caused by poor hygiene?
No. It is not caused by being unclean. It happens when hair pushes into the skin, often because of pressure, friction, and body hair type.
Can it go away on its own?
A sinus without symptoms may stay quiet for a long time. An infected abscess usually needs to be drained by a doctor. It often will not fully heal without care.
Will it come back after treatment?
It can come back in some people, even after surgery. Keeping the area clean and free of hair may lower the chance of return. Results differ from person to person.
Can I still exercise?
Light activity is usually fine. Activities that put pressure on the tailbone, like sitting for long periods or cycling, may be uncomfortable during a flare-up. Ask your doctor what is safe for you.
Sources
- MedlinePlus - Pilonidal sinus disease
- MedlinePlus - Surgery for pilonidal cyst: MedlinePlus Medical Encyclopedia
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
