A pilonidal cyst occurs at the top of the gluteal cleft (buttock crease) and typically presents as a swollen, uncomfortable lump. The cyst occurs due to hair burrowing under the skin and promoting an inflammatory response. The cyst may become infected and develop a pilonidal abscess, which will usually cause more acute pain and possibly a fever. The abscess may drain spontaneously or it may require drainage in the office or operating room. If there are recurrent abscesses or persistent discomfort and drainage, surgery may be recommended to treat the pilonidal cyst. There are several surgical options available for pilonidal cysts; your provider will discuss these options with you.