Pilonidal Surgery – Frequently Asked Questions

Many patients who experience pain near the tailbone are told they have coccydynia — a condition characterized by inflammation or injury of the coccyx (tailbone). While this is a genuine and distinct medical issue, it’s important to know that pilonidal disease can manifest in a very similar way — and the two are sometimes confused.

Understanding Coccydynia

Coccydynia is pain centered on the coccyx itself. It is typically caused by:

• A direct injury, such as a fall onto the tailbone
• Chronic pressure from prolonged sitting on hard surfaces, cycling, or horseback riding
• Sometimes, the cause may be anatomical, such as a misaligned or overly mobile coccyx

Pain from coccydynia tends to be deep, achy and localized right at the tailbone. Swelling is rare, and there are usually no visible skin changes.

Pilonidal Disease: A Different Cause of Tailbone-Area Pain

Pilonidal disease is an infection of the skin and subcutaneous tissue in the gluteal cleft (also known as the natal cleft) — the area just above or around the tailbone. Similar to coccydynia, it can be triggered by trauma or prolonged pressure, but it is fundamentally different in nature. It involves the formation of pits or pores along the midline, which become infected, leading to the development of a chronic abscess. Over time, a draining sinus opening can develop, often near the top of the cleft.

Why the Distinction Matters

Misdiagnosing pilonidal disease as coccydynia can delay proper treatment. If you’re experiencing tailbone-area pain, especially if it’s accompanied by swelling, drainage, or tenderness off the midline, it’s essential to be evaluated by a provider experienced in distinguishing these conditions.

At The Sternberg Clinic, we specialize in diagnosing and treating pilonidal disease — and we frequently see patients who were initially told they had coccydynia but had a chronic or recurring pilonidal infection.

Not Sure If It’s Coccydynia or Pilonidal Disease?

If you’ve been diagnosed with coccydynia but are still experiencing pain, swelling, or drainage near your tailbone, it’s worth getting a second opinion. At The Sternberg Clinic, we specialize in accurately diagnosing and treating pilonidal disease — and helping patients find lasting relief after years of misdiagnosis.

📞 Call us today at (415) 417-3377 or

💬 Request a consultation by submitting forms to our Become a Patient page of our website.

Don’t settle for uncertainty. The correct diagnosis is the first step toward getting your life back.

It may be both! Hidradenitis suppurativa (HS) is a chronic skin condition that causes painful, inflamed nodules, abscesses, and sinus tracts—most commonly in areas where skin rubs together, such as the armpits, groin, buttocks, and under the breasts. While HS and pilonidal disease are separate conditions, they can appear similar and sometimes even coexist, especially in the buttock and tailbone region. If you have HS, it’s important to let us know before pilonidal surgery, as it can significantly affect your recovery. HS-related inflammation may cause ongoing drainage, delayed wound healing, and a higher risk of postoperative complications if not properly managed.

For patients with moderate to severe HS, treatment before or alongside pilonidal surgery is critical. Medical management options include oral antibiotics, hormonal therapy, and biologic medications such as adalimumab (Humira) or secukinumab (Cosentyx), which can help control chronic inflammation and reduce flare-ups. If HS goes undiagnosed or untreated, having pilonidal surgery may lead to poor outcomes, with persistent wounds, recurrent infections, or ongoing discomfort. Early identification and treatment of HS not only improves surgical success but also enhances your overall quality of life by managing this often misunderstood and underdiagnosed condition.

The operation takes around 90 to 120 minutes, depending on the complexity of your disease. You will be in the recovery area for around an hour. During this time, the nurses will go over all of your postoperative instructions and the drainage procedure with you and your helper. You will arrive at the surgery center 1.5 hours before your surgery time. In total, patients are generally at the surgery center for approximately 6 hours.

Most patients receive general anesthesia. This is usually the safest approach, as many of our patients have complicated pilonidal disease. Dr. Sternberg always takes the necessary time to ensure the best results. During the procedure, you will be sedated, allowing you to sleep and ensuring that you won’t feel any pain.

• We recommend wearing snug-fitting athletic compression shorts while the drain is in and for one to two weeks after removal to help support healing. The compression helps the thin skin flap stick to the underlying tissue and prevents fluid from reaccumulating under the flap after the drain is removed. They should fit snugly, so buying a size smaller than you typically wear is best. You may purchase these but any good quality compression shorts that place pressure on your backside are fine.

• Qleanse or Balneol– either is a great cleanser that helps wiping after a BM. Just put a small amount on the TP, and wiping after a BM is easy.

• MOM (Milk of Magnesia) – if you become constipated after surgery, take 2 Tablespoons every 6 hours until you have a BM. Then stop taking it so that you don’t develop diarrhea.
• Mild incisional separation is a normal part of the healing process for this active part of the body, as sitting, stretching, and using the buttock muscles are necessary in everyday life. So we advise that you purchase a bottle of Vashe liquid in case we need you to apply it to a fragile portion of the wound or an area of separation.

Yes! Please make an appointment to see me for the day following surgery and bring your drain helper. I will want to review proper drain care and removal as it is critical for a good outcome. If you live far from San Francisco, I will show you and your helper how to remove the drain yourself so you can travel back home. Don’t worry; removing the drain is super easy and doesn’t hurt at all!

Yes you will. It will be 15-22 cm (6-8 inches) in length, depending on the length of your natal cleft. Remember, scars fade over time!

Most patients can return to work several days to a week after the drain is removed or so after surgery. Depending on your job, we may recommend taking more time off. Taking the week off is perfectly acceptable until the drain is removed. If you feel you need more time off, our office staff is happy to work with you and your employer.

Please don’t exercise while the drain is in place. Walking is okay, but nothing vigorous. You can sit on the operative site immediately after surgery (it helps push fluid from under the flap). This is not a small operation and excercise imposes great tesion of the incision. We ask for your patience and to wait around a month after the drain has been removed before returning to gentle exercise, and only if the incision is fully healed and the supporting external sutures have been removed.

When returning to physical activity, please avoid any exercises that cause pain. Refrain from deep squats, riding a bike, or submersion in water. It’s also important to avoid rigorous activities where there’s a risk of falling, such as skiing and snowboarding, for one month after the drain is removed.

For those patients that have had a prior failed operation or very complex pilonidal disease (a large wound close to the anus), I often ask them to refrain from sports for a few weeks more. 

Around 30% of patients may have some incisional separation near the anal end of the wound. Most of this is a “minor” separation.  If this occurs, it may delay your recovery, but it usually heals perfectly well.  Please see this page of our website for advice.

An infected fluid collection can occur under the flap, which may require a change of your antibiotics. Although it may delay your recovery, you should still have an excellent result.

Shaving before or after a Pilonidal RAF/Cleft Lift operation is not advised and it may cause problems. You should know that:

• Laser hair removal is expensive, time-consuming, embarrassing, and unnecessary for the above reasons.

• Ingrown hairs do not cause the disease.

• Hairs that deposit in pilonidal wounds are shed hairs that may come from areas other than the buttocks and natal cleft.

• The skin of the natal cleft is sensitive, and small nicks and cuts from shaving can contribute to infections. Chemical hair removers are very irritating.

Once you have undergone a successful Pilonidal RAF/Cleft Lift Procedure, you are no longer at significant risk of developing a recurrent pilonidal abscess.

Most likely! The cleft lift procedure intends to prevent recurrent pilonidal disease. In Dr. Sternberg’s last 1,300 Cleft Lift patients, only 10 required a second operation, and all were cured. Those are pretty awesome results.

Most patients experience very little discomfort from the operation. After surgery, individuals experience numbness on the side of the flap that can take 6-8 weeks to completely go away. The numbness always goes away.

The discomfort is usually well controlled with the two prescribed pain medications: ibuprofen and a narcotic (typically Oxycodone/Acetaminophen). Ibuprofen should be taken regularly, three times a day with meals, and the narcotic pain reliever should be taken only as needed for additional discomfort. Please take all pain medications with food, as they may cause nausea.

Additionally, you will be prescribed an antibiotic for two weeks after the procedure to decrease your chance of developing a postoperative infection.

Having someone help you drain the wound is necessary, as you cannot inspect your incision or take care of the drain easily (it’s all behind you :-)). Drain care is simple, but a helper does it best. Also, you are required to have a responsible adult pick you up after surgery and stay with you overnight, as you will have had sedation and general anesthesia.  This safety requirement is mandated by the State of California and the ambulatory surgery center where Dr. Sternberg will perform your operation.

Let’s face it: You’ve decided to have an operation to fix this terrible condition. You can recruit a parent, girlfriend, boyfriend, or roommate to help you conquer this disease!

For more information on drain care and other postop care please visit this page.

Yes. You can shower the morning after surgery. Please don’t attempt to shower on the same day as your surgery, as you may still feel light-headed from the anesthesia and could fall.  Make sure to remove all the gauze first. Do not take off the steri-strips that are crisscrossed over the wound, as they need to remain in place until three days after your drain is removed. It’s important to keep the wound dry after showering. Soaking in a bathtub is not allowed for four weeks or until the wound is fully healed. You will find the lanyard we provide very helpful in securing the drain while you shower. 

I recommend that you try and keep the wound clean and dry. Remove the gauze bandages when having a bowel movement or showering. Please clean the wound carefully after a bowel movement. Wet wipes, Qleanse foam, or Balneol lotion on toilet paper works best. After cleaning or showering, blot the wound and your perianal area carefully with a towel, and then dry completely with a hairdryer on the “low” setting.

Tight-fitting athletic compression shorts are best to wear while recovering from the cleft lift. They help hold dressings over the wound and place gentle pressure on the flap of skin so that it sticks to the underlying flat bed of tissue underneath (discouraging fluid accumulation). The dressing applied after surgery is there to protect your clothing. Don’t use tape to hold gauze in place, as it can injure your incision—instead, use tight-fitting underwear to hold dressings in place.

If you feel that you develop any wound separation during your recovery, please read this section.

The majority of patients will be prescribed the following medications:

• Ibuprofen, a NSAID that relieves pain and decreases inflammation
• A narcotic pain reliever (typically Oxycodone with Acetaminophen)
• And, an antibiotic for two weeks.
• If you end up taking the narcotic pain medication, it may constipate you, so having a bottle of Milk of Magnesia (an over-the-counter laxative readily available at all pharmacies) around is helpful. The proper dose is 2 tablespoons 3 times a day until you have a bowel movement. Stop as soon as you do have a bowel movement, or you will have diarrhea. This is likely different than the instructions on the bottle.

All medications should be taken with food, or they may induce nausea. Ibuprofen is the most important pain reliever as it decreases inflammation. It should be taken three times a day for 10 days, while the narcotic should only be taken every 4 hours if needed (and discontinued once the ibuprofen adequately relieves your pain). Also, narcotics may cause constipation, so you should only take them if you need to.

Please let Dr. Sternberg or his office staff know if you have any allergies or prior reactions to the medications listed above well in advance of surgery.

Yes. Sitting is encouraged as it helps push any fluid that accumulates out from under the flap. Please don’t sit if it is too painful. Don’t forget to stand up periodically.

Nausea for a day or so after surgery is common. It’s often due to the anesthetic on the day of the operation. Oral anti-nausea medication is often not helpful and has many side effects, so I don’t like to prescribe it. Nausea may be due to the pain medications oxycodone, hydrocodone, or Ibuprofen. Please make certain that you never take any pain medication on an empty stomach.

Should you develop nausea, please hold your pain medications for several hours and try to nap. Place a cool, moist cloth on your forehead. You may resume the pain medications with food after the nausea subsides. It’s best to just take the ibuprofen and avoid the narcotic (oxycodone or hydrocodone). Remember, never take any of your prescribed medications on an empty stomach. A small amount of food, such as bread or toast, will help settle your stomach!

The drain will stay in for a minimum of 8 days. Please see our Drain Care page for detailed instructions.

In patients with long clefts and in those patients with pits or unhealed wounds approaching the anus, the surgical incision needs to end close to the anus. Nonetheless, having a bowel movement shouldn’t be much of a problem. Several pointers:

Showering (not bathing) after a bowel movement is a good idea for the first several days after surgery.

Don’t get constipated! Take a fiber supplement to help prevent constipation such as Konsyl or take Milk of Magnesia to relieve constipation if it happens (see the next FAQ section)

We recommend using Qleanse foam or Balneol lotion on toilet paper as it works best for cleaning after a bowel movement for several weeks after surgery.

Not as a result of the procedure. However, taking a narcotic can lead to constipation. If you go for a day without a bowel movement, please buy Milk of Magnesia. It is available over the counter. Take 2 tablespoons every 8 hours until you have a BM. Then stop taking it to avoid having diarrhea.

Bruising after the cleft lift is common. You must see Dr. Sternberg the day after your surgery (this appointment should have been arranged when you scheduled your surgery). The purpose of this appointment is to 1) ensure that your drain helper is properly caring for and emptying the drain and 2) make certain that a blood clot hasn’t accumulated under the flap and clogged the drain. If the latter has occurred, Dr. Sternberg can often easily evacuate the blood clot in the office.