What a pilonidal wound is

Pilonidal disease starts in the crease at the top of the buttocks, close to the tailbone. Hair and skin debris collect in small pits in the skin, and the area can become infected and form an abscess. Some of the procedures surgeons use leave a wound that is meant to stay open while it heals.

Pilonidal wound care is the follow-up an open wound needs after one of those procedures. It applies to wounds left open on purpose, to an abscess that was drained, and to a stitched incision that later comes apart.

Gateway arranges care for this kind of wound across the region. See wound care in St. Louis for how visits at home and in facilities are set up.

Why healing takes so long

An open pilonidal wound closes from the bottom up and from the edges in. New tissue has to fill the space before skin can grow across it, which is slower than healing along a stitched line.

The location adds its own problems:

  • The crease is deep, warm and damp, and the two sides rub against each other
  • Sitting, bending and walking pull on the wound edges
  • Loose hair from the head and back, and hair growing nearby, can work into the wound
  • The wound sits close to the anus, so keeping it clean takes attention
  • You cannot see it, so changes are easy to miss

A pilonidal wound can stall for a while, or look closed at the skin while a pocket remains underneath. The page on tunneling and undermining explains why that hidden space matters.

What the treating clinician checks at each visit

The treating clinician measures length, width and depth, looks at the tissue at the base, and checks the edges, the drainage and the surrounding skin. They also look for loose hair in the wound and for skin that has closed over a gap.

From there, the clinician decides what goes in or on the wound and how often it is changed. Gateway’s page on dressing selection and changes describes how those decisions are made. Your surgeon stays in charge of surgical questions, including whether another procedure is needed, and the wound care team shares what it finds.

Sitting, work and activity

Sitting puts pressure and friction on this wound, so ask for specific instructions instead of guessing:

  • How long can I sit at one stretch, and how should I position myself?
  • Should I use a cushion, and which kind? (Ask before buying a ring-shaped one.)
  • When can I drive, and how far?
  • When can I go back to work, school, exercise or lifting?

If your job involves long hours in a chair or a vehicle, say so. The guide on returning to work with a wound lists more points to raise.

Hygiene and hair questions

Washing instructions differ from surgeon to surgeon and can change as the wound fills in. Ask whether you may shower, whether the dressing stays on or comes off, and how to clean up after a bowel movement. Our guide to showering and bathing with a wound covers the general questions.

Hair matters with pilonidal disease. Many surgeons want the skin around the crease kept free of hair during healing and afterward, but the method and timing are their call. Ask who should do it and how often.

Changes to report and when to call 911

Call the treating clinician or your surgeon if you notice:

  • Pain that is getting worse instead of slowly easing
  • Redness, warmth or swelling spreading out from the wound
  • Thick, green or foul-smelling drainage, or much more drainage than before
  • Fever or chills
  • A new lump, pit or draining spot near the crease
  • Skin closing over the top while the area beneath still feels hollow or full

The guide to signs of wound infection has more detail. Call 911 for bleeding that soaks through dressings and does not stop with firm pressure, or for confusion, fainting, a racing heartbeat or trouble breathing.

How Gateway arranges pilonidal wound follow-up

Gateway arranges wound care visits with partner clinicians in homes and other care settings across Greater St. Louis and the Metro East. We coordinate the request, scheduling, records from your surgeon, clinician orders, supplies and follow-up. The treating clinician makes every clinical decision.

Patients and family members can call 314-325-0126 or request care online, with or without a referral. Visit availability is confirmed by location and care setting. Read how mobile wound care in St. Louis works if you want care at home.

Common questions

How long does an open pilonidal wound take to heal?

There is no single answer. It depends on the size and depth of the wound, the procedure, your general health and how well the area is protected from pressure, moisture and hair. Nobody can give you an exact date. Ask your surgeon what is typical for a wound like yours and what would count as slower than expected.

Is drainage from a pilonidal wound normal?

Some drainage is expected while an open wound fills in. It is often thin and clear, pale yellow or lightly blood-tinged, and it tends to lessen over time. Tell the clinician if the amount goes up, if it turns thick, green or cloudy, or if a new odor appears. Our guide on what wound drainage means explains more.

Can a family member change the dressing between visits?

Often, yes, because most people cannot reach or see this area. The treating clinician decides whether home dressing changes are appropriate and shows the helper what to do for your wound. Ask for a demonstration, written steps and a number to call. A helper who is unsure about something they see should call instead of improvising.

Can pilonidal disease come back after the wound closes?

It can. New pits or a new abscess sometimes form in the same crease, even after a wound has fully closed. Surgeons often give long-term advice about hair control and skin care in that area, so ask what they recommend for you. Report a new lump, tenderness or drainage near the old site early.

Related pages

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.