Believe it or not, what you wear does make a difference in developing pilonidal problems and in recovering from surgery. Keep in mind that this is a disease based on the skin of the gluteal cleft being excessively folded, such that the skin of the cleft is almost always pressed against the skin from the opposite side. In some people this folding happens no matter what they are wearing, but in others wearing the wrong clothing can tip the balance such that problems develop. This seems to be a more significant issue with some body shapes than others, but being overweight does accentuate this problem.
So, it is important to wear loose fitting clothing that allows air circulation and, even more importantly, does not exert pressure on the buttocks which will accentuate the tightness and depth of the gluteal fold. You want clothes that are loose enough so that when you sit, the buttocks can change shape the same way they would if you were not wearing anything. Although there seems to be “internet knowledge” that thong underwear is not recommended, I have not seen any evidence that thong underwear is a problem at all, since it does not compress the buttocks from the side.
In our practice, we have found that Spandex is one of the worst problems because if you’re wearing Spandex, you are probably wearing it so that it is pretty tight, but any brand of tight elastic clothing can be a problem if purchased too small.
I can’t list every type of problematic garment, but I think you get the idea- it is the tightness. If it is tight across the hips, and pushes the two sides of the buttocks together, it can be a problem. The issue is the SIZE of the garment more than the particular kind of garment or fabric. If you are a patient with pilonidal disease, and have had successful surgery, unsuccessful surgery, a cleft-lift, or no surgery at all – my recommendation is that you avoid these kinds of clothing – or if you do, that you wear it for limited amounts of time and make sure the size is not too small. It might make sense to make this a permanent lifestyle change.