A pilonidal cyst forms in the natal cleft when body hair becomes trapped beneath the skin instead of emerging, leading to the cyst's gradual enlargement as it collects debris. While some cysts may remain asymptomatic, infections can cause the cyst to become painful and start oozing. The condition often recurs, and over time, it can progress into a chronic, suppurative state known as pilonidal disease.

Given the high recurrence rate of pilonidal disease, surgical removal is widely considered the most effective treatment. Surgery helps to eliminate the cyst entirely, reducing the risk of infection and recurrence. Other treatments may provide temporary relief, but surgery addresses the root cause, offering a more permanent solution. Understanding the pain and why surgery might be the answer is crucial for managing this condition effectively.