What Does a Pilonidal Cyst Feel Like?

A pilonidal cyst is a condition that is often perplexing but common, and a pilonidal cyst starts at the top of the buttock crease, causing pain, swelling and tenderness that can ruin everyday activities. Many patients report to the doctors or at the doctor’s office that they first feel a cyst in butt crack or a lump in the buttock crack, and then they do not know what a pilonidal cyst is until they see a painful lump. You usually call that pain a pilonidal cyst. Acknowledging how it’s feeling — when it starts and during a flare-up — can help you see symptoms sooner and get the right treatment. 

Initially, a pilonidal cyst will seem to be mild pain or a thin and sore area under the skin. It’s often called a bruise-like ache, or a mild pressure spot you feel from a seat. During this time, cysts form when hair and skin get trapped under tension or over sitting. It can be subtle — tender when you lean back, sore after a lengthy drive or similar to a small knot at the very top of your buttock crease — but very apparent. The feeling of a growing lump. And as the cyst grows, that feeling gets clearer. It is likely to be firm, round and increasingly sensitive. Some patients describe how it feels like “a marble under the skin,” others say it looks like an ingrown hair, multiplied by ten. That’s usually when someone first discovers that there’s more going on than even the basics: they can feel a painful lump in buttock crack that wasn’t before. Roughness is sharp or hurtful to touch or press; skin may feel warm or red. Pain with Sitting or Motion. Pain from pressure is one of the greatest typical feeling of pilonidal cyst. Sitting — especially on hard or firm surfaces — can be painful or overpowering. Stretching the skin — moving into a straight-backed posture, leaning against a chair, leaning against the car seat — can give the clinician a feeling of pull or stabbing. Patients can unknowingly do this, altering their posture when they sit, aiming at not putting any weight on the field. Such pressure sensitivity is an important characteristic of pilonidal cysts and is not the same as plain skin irritation. 

Once infected they rapidly change the sensation inside a pilonidal cyst generally means it becomes warmer, swollen and much more painful. The cyst often feels deep and throbbing — like some sort of dental abscess but located around the tailbone. Many patients complain of a throbbing pain that worsens with daily activity. The skin may appear to be red, stretched or shiny, and the pain may extend to the lower back or buttocks. This increased inflammation is a sign that the cyst has turned into an abscess. The Feel of Pressure: “Something Is About to Burst”. The characteristic sign of an abscessed pilonidal cyst is sudden pressure from within. It is because the pressure is too high, especially once one begins to feel like an inside-out attack. Patients often describe feeling as if the area is “about to pop” or “filled with something tight under the skin.” Even light touch can produce sharp discomfort. The swelling can make it almost impossible to sit. This feeling of pressure is the most evident indicator that the cyst is accumulating pus internally and might need drainage. 

If the cyst ruptures or begins to drain, the sensations recede again. Sudden relief for many is felt as the internal pressure drops. They could experience some warmth or moisture in the space and decreased throbbing hurt. The fluid includes blood, pus or clear discharge. Although drainage may alleviate pain temporarily—there’s still the cause; the cyst often refills or flares back up until the right medicine is used. 

Pilonidal cysts do not always turn into severe problems. Others adhere to a chronic pattern: mild discomfort, transient swelling, and sudden drainage. They may feel like repetitive knots or irritated bumps that flare up after prolonged periods of sitting, exercise or sweating. Some patients will observe tiny pits or dimples in the skin that are tender feeling to them. A persistent cyst in the butt crack, even if the pain is mild, suggests a chronic condition that does not usually go away without medical help. 

As important is the recognition of what a pilonidal cyst does not feel like. Almost always, the pilonidal cyst sits at the midline, or very top of the buttock crease. Lumps in a lower position or farther off toward the side are more likely to be boils, abscesses, hemorrhoids or gland infection. Pilonidal cyst pain is also differently affected by sitting; because sitting simply doesn’t make your pain worse, what it’s causing might not be a pilonidal cyst. Emotional discomfort: That section you may not speak to Patients about. People feel embarrassed or anxious about symptoms in this region of the body. That discomfort can cause treatment delays, even when the pain becomes intense. Pilonidal disease; this is one of the most common diseases and not primarily due to personal or hygiene reasons. Understanding the symptoms early — seeking care without shame — can prevent complications and ongoing infection. 

Any persistent painful lump in the buttock crack, increasing swelling, drainage, or severe pain when sitting should be checked with a provider experienced with pilonidal disease. Early treatment can help you to prevent the growth of abscess and make the potential for it to recur less likely. Contemporary surgeries are much less invasive than previous widespread excision methods and may even provide faster recovery with less downtime. 

A pilonidal cyst tends to feel like a tender, pressure-filled lump in the buttock crease that, while your butt is relaxed to a comfortable position, grows larger with sitting or moving. Early symptoms can be benign, but once infected, the cyst generally becomes intensely painful, swollen, warm and throbbing. Whether you have a slight bump or a huge cyst in the butt crack, knowing these sensations can help you identify a pilonidal cyst early, and get the relief you need.