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Pilonidal cyst spine. Pilonidal Sinus: Symptoms, Causes, and Treatment Options

by alexxlab

What is a pilonidal sinus. How does it develop. What are the symptoms of an infected pilonidal sinus. What treatment options are available for pilonidal sinus. How can you prevent pilonidal sinus recurrence. What is the recovery process after pilonidal sinus surgery. When should you seek medical attention for a pilonidal sinus.

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Understanding Pilonidal Sinus: A Comprehensive Overview

A pilonidal sinus is a small hole or tunnel that forms in the skin at the top of the buttocks, specifically in the cleft where the buttocks separate. This condition, while often asymptomatic, can become problematic if infected. Understanding its nature, symptoms, and treatment options is crucial for those affected by this condition.

What Exactly is a Pilonidal Sinus?

A pilonidal sinus is essentially a cavity beneath the skin that can collect hair, debris, and bacteria. It’s believed to form when hair penetrates the skin and becomes embedded, leading to inflammation and potential infection. The term “pilonidal” comes from the Latin words for “hair” (pilus) and “nest” (nidus), aptly describing the condition.

Recognizing the Symptoms of an Infected Pilonidal Sinus

Many individuals with a pilonidal sinus may not even be aware of its presence until it becomes infected. When infection occurs, several symptoms can manifest:

  • Pain and swelling in the affected area
  • Redness and tenderness
  • Formation of a pus-filled abscess
  • Bleeding or discharge from the sinus
  • Foul odor from the area

These symptoms often develop rapidly, sometimes over just a few days. If you experience any of these signs, it’s crucial to seek medical attention promptly.

Can a Pilonidal Sinus Resolve Without Treatment?

In some cases, an uninfected pilonidal sinus may not require immediate treatment. Healthcare providers may recommend a “watch and wait” approach, focusing on maintaining proper hygiene of the affected area. This involves regular showering or bathing to keep the area clean. It’s important to note that shaving the area is not recommended unless specifically advised by a healthcare professional.

Treatment Options for Infected Pilonidal Sinus

When a pilonidal sinus becomes infected, various treatment options are available. The choice of treatment depends on several factors, including the severity of symptoms, the size of the sinus, and whether it’s a recurring issue.

Antibiotics and Pain Management

In most cases, the initial treatment for an infected pilonidal sinus involves antibiotics to combat the infection. Pain management is also a crucial aspect of treatment, with healthcare providers often prescribing painkillers such as paracetamol and anti-inflammatory medications to alleviate discomfort and reduce swelling.

Surgical Interventions for Pilonidal Sinus

For more severe or recurring cases, surgical intervention may be necessary. Several surgical options are available:

  1. Incision and Drainage: This minor procedure involves making a small incision in the abscess to drain the pus. It’s typically performed under local or general anesthesia, depending on the size of the abscess.
  2. Wide Excision and Open Healing: In this procedure, the sinus and some surrounding skin are removed, leaving the wound open to heal naturally. While it has the lowest risk of recurrence, the recovery time can be lengthy, ranging from 6 to 12 weeks.
  3. Excision and Wound Closure: This method involves removing the sinus and closing the wound with stitches. It offers a quicker recovery time but carries a higher risk of infection.
  4. Endoscopic Ablation: A less invasive option, this procedure uses an endoscope to clean the sinus and remove infected tissue. It typically has a good success rate with lower complication risks.

Post-Operative Care and Recovery

After surgical treatment for a pilonidal sinus, proper post-operative care is essential for successful healing and prevention of recurrence. Here are some key points to consider during the recovery period:

  • Keep the affected area clean and dry
  • Change dressings regularly as instructed by your healthcare provider
  • Wear loose-fitting, comfortable cotton underwear
  • Consume a high-fiber diet to promote regular bowel movements and reduce strain on the surgical site
  • Avoid sitting for prolonged periods
  • Follow up with your healthcare provider as scheduled, typically around 6 weeks post-surgery

How Long Does Recovery Take After Pilonidal Sinus Surgery?

The recovery time following pilonidal sinus surgery can vary depending on the specific procedure performed. For instance, recovery from an incision and drainage procedure typically takes 4 to 6 weeks, while recovery from a wide excision and open healing can take 6 to 12 weeks. Endoscopic ablation generally has a shorter recovery period of about a month.

Preventing Pilonidal Sinus Recurrence

While not all cases of pilonidal sinus can be prevented, there are steps you can take to reduce the risk of recurrence:

  • Maintain good hygiene, especially in the buttocks area
  • Avoid prolonged sitting, particularly on hard surfaces
  • Engage in regular physical activity to reduce pressure on the tailbone area
  • Consider hair removal methods in the affected area, but only under medical guidance
  • Maintain a healthy weight to reduce friction in the buttocks area

Is Hair Removal Effective in Preventing Pilonidal Sinus?

While some studies suggest that hair removal in the affected area may help prevent recurrence of pilonidal sinus, it’s important to approach this method cautiously. Always consult with your healthcare provider before attempting any hair removal techniques, as improper hair removal could potentially irritate the skin and exacerbate the condition.

When to Seek Medical Attention for Pilonidal Sinus

It’s crucial to know when to seek medical help for a pilonidal sinus. You should consult a healthcare provider if you experience:

  • Pain, swelling, or redness in the tailbone area
  • Drainage of blood or pus from an opening in the tailbone area
  • Fever or chills, which may indicate a systemic infection
  • Persistent discomfort or symptoms that don’t improve with home care

Early intervention can prevent complications and lead to more effective treatment outcomes.

Living with Pilonidal Sinus: Long-Term Management

For individuals who have experienced pilonidal sinus, long-term management is key to preventing recurrence and maintaining quality of life. This involves a combination of lifestyle modifications and ongoing vigilance:

Lifestyle Adjustments for Pilonidal Sinus Management

  • Maintain optimal weight to reduce pressure and friction in the affected area
  • Practice good posture, especially when sitting for extended periods
  • Use cushions or donut-shaped pillows to relieve pressure on the tailbone when sitting
  • Wear breathable, loose-fitting clothing to reduce moisture and friction
  • Consider regular exercise routines that strengthen core muscles and improve overall health

Ongoing Monitoring and Self-Care

Even after successful treatment, it’s important to remain vigilant for signs of recurrence. Regular self-examinations of the affected area can help catch any potential issues early. Additionally, maintaining a dialogue with your healthcare provider about any concerns or changes in the area is crucial for long-term management.

Advances in Pilonidal Sinus Treatment

Medical research continues to explore new and improved methods for treating pilonidal sinus. Some of the emerging treatments and techniques include:

Minimally Invasive Techniques

Newer, less invasive procedures are being developed to treat pilonidal sinus with reduced recovery times and lower risks of complications. These include:

  • Laser treatments: Using laser technology to destroy the sinus tract
  • Fibrin glue injection: Sealing the sinus tract with a special adhesive
  • Endoscopic pilonidal sinus treatment (EPSiT): A minimally invasive technique using an endoscope for better visualization and precise treatment

Regenerative Medicine Approaches

Some researchers are exploring the potential of regenerative medicine in treating pilonidal sinus. This includes:

  • Platelet-rich plasma (PRP) therapy: Using the patient’s own blood components to promote healing
  • Stem cell treatments: Investigating the use of stem cells to enhance tissue regeneration and healing

While these advanced treatments show promise, more research is needed to establish their long-term efficacy and safety. Always consult with a healthcare professional to determine the most appropriate treatment option for your specific case.

Psychological Impact of Pilonidal Sinus

Living with pilonidal sinus can have significant psychological effects on individuals. The chronic nature of the condition, potential for recurrence, and impact on daily activities can lead to various emotional challenges:

Common Psychological Challenges

  • Anxiety about recurrence or complications
  • Embarrassment or self-consciousness about the condition
  • Frustration with ongoing treatments or lifestyle modifications
  • Depression related to chronic pain or limitations in activities
  • Social isolation due to discomfort or fear of symptoms

Coping Strategies and Support

Addressing the psychological aspects of pilonidal sinus is crucial for overall well-being. Some strategies include:

  • Seeking support from friends, family, or support groups
  • Engaging in stress-reduction techniques like meditation or yoga
  • Consulting with a mental health professional for coping strategies
  • Educating oneself about the condition to feel more in control
  • Focusing on overall health and wellness to improve quality of life

Remember, it’s important to address both the physical and emotional aspects of pilonidal sinus for comprehensive care and improved quality of life.

Pilonidal sinus – NHS

A pilonidal sinus is a small hole or tunnel in the skin at the top of the buttocks, where they divide (the cleft). It does not always cause symptoms and only needs to be treated if it becomes infected.

Check if you have an infected pilonidal sinus

Most people with a pilonidal sinus do not notice it unless it becomes infected and causes symptoms.

An infection will cause pain and swelling, and a pus-filled skin abscess can develop.

See what an infected pilonidal sinus looks like

An infected pilonidal sinus is red, painful and may bleed or leak pus

Credit:

GIRAND/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/127112/view

Non-urgent advice: See a GP if:

  • you have a small lump at the top of your bottom (between your buttocks) that’s painful, red, bleeding or leaking pus

These symptoms can develop quickly, often over a few days. They’re signs of infection and need to be treated.

A pilonidal sinus that’s not infected

Treatment is not needed if there are no signs of infection. A “watch and wait” approach will be recommended.

It’s very important to keep the area between your buttocks clean by showering or bathing regularly.

Do not shave the affected area unless a GP advises you to.

Treatments for an infected pilonidal sinus

Treatment for an infected pilonidal sinus will depend on:

  • your symptoms
  • the size of the sinus
  • whether it’s your first sinus or it keeps coming back

A pilonidal sinus abscess will need treatment with antibiotics. The pus inside will also probably need to be drained.

There are a number of treatment options for a pilonidal sinus that keeps coming back and that’s painful, bleeding or leaking discharge. Your doctor will discuss these with you.

In most cases you’ll be offered painkillers, such as paracetamol and anti-inflammatories to help reduce pain and swelling.

Minor operation to drain pus from sinus

Incision and drainage

Hospital procedure for an uncomplicated abscess. A small hole is made in the abscess so the pus can be drained.

  • general anaesthetic or local anaesthetic, depending on the size of the abscess
  • hospital stay (you can leave the same day)
  • regular (daily) dressing changes
  • recovery time is 4 to 6 weeks

Surgery to remove sinus (wound left open)

Wide excision and open healing

Surgery for a large or repeatedly infected sinus. The sinus is cut out and some surrounding skin removed. The wound is left open to heal naturally.

  • general anaesthetic
  • hospital stay (you can usually leave the same day)
  • regular (daily) dressing changes
  • lowest risk of sinus coming back
  • recovery time is 6 to 12 weeks

Surgery to remove sinus (wound closed)

Excision and wound closure, often with flattening of the groove between the buttocks

Surgery for a large or repeatedly infected sinus. The sinus is removed and an oval-shaped flap of skin cut out on either side of it. The 2 sides are stitched together.

  • general anaesthetic
  • hospital stay (you can usually leave the same day)
  • stitches removed about 10 days after the operation
  • quicker recovery time than wide excision and open healing
  • higher risk of infection (the wound may need to be opened and dressings changed regularly)

Procedure to clean sinus and encourage healing

Endoscopic ablation for a pilonidal sinus

An endoscope (a thin, flexible tube with a camera on the end) is used to give a clear view of the affected area.

Hair and infected tissue are removed, and the sinus cleaned with a special solution. Heat is used to seal the sinus.

  • spinal or local anaesthetic
  • hospital stay (you can usually leave the same day)
  • less invasive than surgery as no cut needed
  • good success rate with low risk of complications
  • recovery time is about a month to completely heal (but can be quicker)

Plastic surgery is sometimes used if the area being treated is particularly large. The sinus is removed and the surrounding skin reconstructed.

Less invasive procedures, like injection with fibrin glue, are also available in some places.

Follow-up

You’ll have a follow-up appointment with your specialist after your surgery. This is usually about 6 weeks later, but may be slightly longer.

What to do after your operation

Do

  • keep the affected area clean

  • wear comfortable, loose-fitting cotton underwear

  • eat plenty of fibre to make going to the toilet easier and avoid straining

Don’t

  • do not lift heavy objects or do strenuous exercise for the first week or so

  • do not ride a bike for 6 to 8 weeks

  • do not go swimming until your wound has completely healed

How soon you can return to work depends on:

  • the procedure you had
  • how quickly you recover
  • the type of job you do

Most people are able to return to work within 2 weeks of surgery.

Your surgeon will be able to give you more advice about your recovery.

Causes of pilonidal sinus

It’s not clear what causes a pilonidal sinus.

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 and enters the pilonidal sinus.

Pilonidal sinuses are more common in men because they tend to be hairier.

Sitting for long periods can also increase your chances of getting a pilonidal sinus.

Page last reviewed: 11 December 2020
Next review due: 11 December 2023

Symptoms, Causes, Diagnosis, Treatment, Surgery

Written by WebMD Editorial Contributors

  • What Causes a Pilonidal Cyst?
  • Symptoms
  • When Should I Call a Doctor?
  • Diagnosis
  • What Can I Do to Feel Better?
  • Treatments
  • After Surgery
  • More

There’s a type of cyst you can get at the bottom of your tailbone, or coccyx. It’s called a pilonidal cyst, and it can become infected and filled with pus. Once infected, the technical term is “pilonidal abscess,” and it can be painful.

It looks like a large pimple at the bottom of your tailbone. It is more common in men than in women. It usually happens more often in younger people.

People who sit a lot, such as truck drivers, have a higher chance of getting one.

They can be treated. If your cyst becomes a problem, your doctor can drain it or take it out through surgery.

Most doctors think that ingrown hairs are the reason for many of them. Pilonidal means “nest of hair,” and doctors sometimes find hair follicles inside the cyst.

Another theory is that pilonidal cysts appear after a trauma to that region of your body.

During World War II, more than 80,000 soldiers got pilonidal cysts that put them in the hospital. People thought they were because of irritation from riding in bumpy Jeeps. For a while, the condition was called “Jeep disease. “

You might be more likely to get one if you were born with a small dimple in the skin between your buttocks. This dimple can tend to get infected, though doctors aren’t exactly sure why.

Other risk factors include obesity, large amounts of hair, not enough exercise, prolonged sitting, and excessive sweating.

The symptoms of a pilonidal cyst include:

  • Pain, redness, and swelling at the bottom of the spine
  • Pus or blood draining out of it
  • Bad smell from the pus
  • Tenderness to the touch
  • Fever

They can vary in size. Yours may be a small dimple or cover a large, painful area.

A pilonidal cyst is an abscess or boil. Treatment may include antibiotics, hot compresses and topical treatment with depilatory creams. In more severe cases it needs to be drained, or lanced, to heal. Like other boils, it does not get better with antibiotics.

If you have any of the symptoms, call your doctor.

Your doctor can diagnose a pilonidal cyst with a physical exam and by asking you questions about it. Among the things they may ask you:

  • When did you first feel symptoms?
  • Have you had this problem before?
  • Have you had a fever?
  • What medications or supplements do you take?

Early in the infection of a pilonidal cyst, the redness, swelling, and pain may not be too bad. Some things you might want to try:

  • To ease any pain, soak in a tub of warm water. Sometimes, your cyst may open and drain on its own this way.
  • Take nonprescription pain medicine, but follow the dosing instructions.
  • Keep the cyst and area around it clean and dry.

Antibiotics do not heal a pilonidal cyst. But doctors have any number of procedures they can try. Here are some options:

Incision and drainage: This is the preferred method for a first pilonidal cyst. Your doctor makes a cut into the cyst and drains it. They remove any hair follicles and leaves the wound open, packing the space with gauze.

Advantage — It’s a simple procedure done under local anesthesia, meaning just the area around the cyst is numbed.

Disadvantage — You have to change the gauze often until the cyst heals, which sometimes takes up to 3 weeks.

Marsupialization: In this procedure, your doctor makes a cut and drains the cyst, removing pus and any hair that are inside. They’ll sew the edges of the cut to the wound edges to make a pouch.

Advantages — This is outpatient surgery under local anesthesia. It also lets the doctor make a smaller, shallower cut so that you don’t need to take out and repack gauze daily.

Disadvantages — It takes about 6 weeks to heal, and you need a doctor specially trained in the technique.

Incision, drainage, closing of wound: In this technique, the cyst is drained, but it’s not left open.

Advantage — You don’t need to pack gauze because your doctor fully closes the wound right after surgery.

Disadvantages — You’re more likely to have more problems with the cyst down the road. It’s harder to remove the entire cyst with this method. It’s usually done in an operating room with a specially trained surgeon.’

Other surgical procedures include complete cyst and cyst wall excision along with the pilonidal sinus tracts, the use of fibrin glue, and taking (core out) only diseased tissue and the cyst out with punch biopsies.

Follow all of your doctor’s instructions about at-home care, especially if you need to remove and pack gauze. Other tips:

  • Try to keep the area clean.
  • Check for any signs of a new infection, such as redness, pus, or pain.
  • Keep your follow-up appointments with your doctor so they can see how your cyst is healing.

A complete cure is possible, but remember that a pilonidal cyst may recur even if you had one surgically removed.

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Pilonidal cyst – article

Pilonidal cyst, epithelial pilonidal cyst – a congenital disease, the formation of a cystic cavity from skin cells in the projection of the coccyx and sacrum. It can fester and externally manifests itself as an infiltrate or abscess.

Epithelial coccygeal passage – a congenital epithelial immersion in the sacrococcygeal region – outwardly manifests itself as a depression, a funnel, a passage from which hair often stands out. The epithelial coccygeal passage is subject to inflammation. Often inflammation and suppuration are repeated. Purulent fistulas may form.

Epithelial coccygeal cysts and moves must be operated on.

We operate on such patients in different ways, depending on the specific situation of the individual manifestation of coccygeal cysts and passages. The meaning of operations is to radically remove the affected tissues, which will avoid relapses. We use methods of radio wave surgery and author’s methods of treatment.

The author of the article:

Ivanova Natalya Vladimirovna

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