A pilonidal sinus is a small hole or tunnel in the skin. It may fill with fluid or pus causing the formation of a cyst or abscess. It occurs in the cleft at the top of the buttocks. The cyst contains hair, dirt and debris. It causes severe pain and can often become infected. Causes: A skin problem, pressure or friction may cause hair between the buttocks to be pushed inwards. This may either be hair growing around the buttock area, or loose hair shed from the buttocks or elsewhere that gathers around the buttock cleft. Treatment: Surgery is done if it causes pain.