I recently saw a patient who reminded me of a common association between pregnancy and pilonidal abscesses. (Patients usually call this a “pilonidal cyst,” although when it suddenly becomes swollen and painful, what they actually have is a pilonidal abscess.)
I first treated this patient for a pilonidal abscess at a time when she was not pregnant. At that time we discussed the option of a cleft lift, but she decided not to proceed. Since then, I have seen her during two separate pregnancies—and each time she developed another abscess late in the pregnancy. This was painful and disruptive at a time when she had other things going on!
Pregnancy does not actually cause pilonidal disease to start; in a patient like this the pits and underlying sinus are already there. But the later stages of pregnancy bring changes in weight, posture, sitting position, and pressure on the buttocks. It is theorized that these changes can irritate or obstruct a pilonidal pit that had previously been draining adequately, resulting in trapped bacteria under the skin which turn into an infected abscess. Hormonal changes may also play a role, but we really don’t know.
What should be done with a pilonidal abscess during pregnancy?
If there is a painful abscess, it usually should be drained. Pregnancy is not a reason to leave a painful abscess untreated, and antibiotics alone are usually not the answer.
Drainage can usually be done with local anesthetic and does not require definitive pilonidal surgery at that time. So, I recommend going to an ER, urgent care, or a trusted physician to have this evaluated before it gets too painful. Sometimes these will drain on their own, but it is hard to predict, so it is a good idea to have it checked.
However, once the abscess has resolved, consideration should be given to having a procedure to prevent this from becoming a recurring problem, because recurrence is very common. If the abscess has been adequately drained this is not an emergency, further surgery can usually be delayed for several months. We perform surgery under general anesthesia, but it is not necessary to wait until breastfeeding has stopped. In our clinic we recommend the cleft lift procedure as the option with the highest success rate.
I think it makes sense to consider treating the underlying pilonidal disease to prevent going through the same thing again, but that is a patient’s choice.
Bottom Line
Pregnancy does not cause pilonidal disease, but it can make a pre-existing pilonidal cyst become acutely infected. The treatment is usually drainage of the abscess. Once the pregnancy is over, it makes sense to consider a cleft lift procedure to prevent this from being a recurring problem.
