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A pilo-nidal cyst, also referred to as a pilonidal abscess, pilonidal sinus or sacrococcygeal fistula, is a cyst or abscess near or on the natal cleft of the buttocks that often contains hair and skin debris. Pilonidal cysts are often very painful, and typically occur between the ages of 15 and 35. Although usually found near the coccyx, the condition can also affect the navel, armpit or genital region, though these locations are much more rare. Some people with a pilonidal cyst will have no symptoms at all. A sinus tract, or small channel, may originate from the source of infection and open to the surface of the skin. Material from the cyst may drain through the pilonidal sinus. A pilonidal cyst is usually painful, but with draining, the patient might not feel pain. One proposed cause of pilonidal cysts is ingrown hair. Excessive sitting is thought to predispose people to the condition because they increase pressure on the coccyx region.Initial treatment include antibiotic therapy, hot compresses and application of depilatory creams. In more severe cases, the cyst may need to be incised or surgically excised (along with pilonidal sinus tracts). Post-surgical wound packing may be necessary, and packing typically must be replaced twice daily for 4 to 8 weeks. In some cases, two years may be required for complete granulation to occur. Sometimes the cyst is resolved via surgical marsupialization. Surgeons can also excise the sinus and repair with a reconstructive flap technique, which is done under general anesthetic. This approach is mainly used for complicated or recurring pilonidal disease, leaves little scar tissue and flattens the region between the buttocks, reducing the risk of recurrence. Pilo-nidal sinus excision is done as a day care procedure.