Can I just wait, and it will disappear?
Although it is unusual to start getting new pilonidal disease after age 40, preexisting pilonidal problems often will not go away if they have been untreated. The reason it is rare for pilonidal disease to start as one gets older, is that the gluteal cleft naturally opens up and widens as we age, and the cleft is less deep, and sharp. However, lingering sinus tracts and cysts may still be present and cause problems. So, if you have an untreated sinus tract or cyst, it will not suddenly disappear with age, and may be a problem at any time, even after age 40.
Trauma to the gluteal area may cause it to suddenly act up after years of being asymptomatic. Also, especially in women, starting a new habit of wearing tight stretch pants, can deepen the gluteal crease and start new pilonidal disease even after age 40.
We have seen patients as old as 70 with pilonidal disease that continues to be symptomatic.
So, although it is true that pilonidal disease becomes less and less of a problem as one ages, it is not something that you can rely on to make your pilonidal problems disappear.