Pilonidal sinus

Pilonidal sinus: a brief overview

The world pilonidal originated from the Latin word “pilus” meaning hair and “nidus” meaning nest.

A pilonidal sinus or PNS is a sinus tract, a tunnel or small hole that appears in the skin in the cleft between the buttocks. Some people develop natural dimples in this area where pilonidal sinus can appear and may develop hair follicles.

Pilonidal sinus mostly occurs in teenagers and young adults with a higher incidence in young men who sit for prolonged times in one position like cab drivers or office workers. Sometimes pilonidal sinus may develop into cysts or abscesses. They may get infected and ooze blood and pus and can be very painful.

During World War II, pilonidal sinus was very common especially among young army men who spent long hours driving jeeps during the war. The condition was popularly termed as “jeep seat” or “jeep riders’ disease”.

Who can develop a pilonidal sinus?

Pilonidal sinus or PNS is very common in young adults especially teenagers and young men. It is less common in children and adults over 40. Risk factors of pilonidal sinus diseases (PND) include:

• Sedentary lifestyle

• Jobs that require sitting for extensive periods

• Obesity

• Family history of the disease

• Previous injury or irritation in the area

• Hair growth in the area of the deep natal cleft

• Friction at the buttocks

Causes for pilonidal sinus

The exact cause for pilonidal sinuses is still unknown, however, there are some general theories.

• Skin deformity where the person is born with an abnormality between the buttocks region where the hair grows inward rather than outward.

• Family history of pilonidal sinuses.

• Development of hair follicles in skin dimples or pits on the area between the buttocks. This occurs due to friction or pressure below the skin surface for hair growth.

• Inflammation is due to hair fragments that get stuck in the skin. They may cause inflammation and recurrent infections can result in pilonidal sinuses.

• Injury or trauma to the area may later develop into a pilonidal sinus or cyst.

• Sitting for long durations.

• Excessive weight gain.

• Pilonidal sinus is more common in men because they tend to have more hair in their bodies.

Treatment Options

The treatment of pilonidal sinus depends on three factors:

• The severity of the symptoms

• Size of the pilonidal sinus

• Recurrence of the disease.

If the symptoms are mild, patients can start with home remedies and some medications to relieve the symptoms. However, for acute or chronic symptoms, doctors may recommend surgery.

Home remedies

• Patients can take sitz baths. Submerging the body in warm water can relieve the pain and reduce the chances of infection.

• Vitamin C, Vitamin A, and zinc supplements can help repair the tissues and heal the sinus. However, patients must consult a doctor before taking any of these supplements.

• Essential oils like sage oil or tea tree oil can help soothe the pain.

• Light regular exercises can help improve blood flow and reduce inflammation and pain.

• Soft cushions like donut cushions or coccyx cushions can provide comfort.

Conservative management

In the early stages of the disease, the patient may be asymptomatic and may not exhibit any symptoms. Doctors may not notice any inflammation or pain in the affected area. In that case, doctors advise keeping the affected area clean by shaving the hairs and by maintaining personal hygiene. In case of any discomfort or mild infection, doctors may prescribe antibiotics and recommend follow-up visits and examinations. However, if the symptoms are more acute, doctors recommend pain medications like ibuprofen or paracetamol and other antibiotics.

Injection

In this treatment, doctors inject phenol antiseptic solution into the pilonidal cyst. The treatment is done under local anesthesia and is repeated multiple times for healing the cyst. The cyst will eventually become hard and close. This alternative treatment is not so popular as there are always chances of recurrence.

Surgery

In most cases, surgical management is the only permanent solution for treating pilonidal sinuses. There are several surgical options. The surgeon will apply a local anesthetic and surgically open the lesions and remove the debris and the pus. The wounds will be stitched and dressings will be applied. It is mostly done in chronic pilonidal sinuses where there are multiple lesions and the patient is suffering from chronic pain and discomfort.

Preparation

Your doctor will ask you to visit the clinic or hospital for pre-operative diagnostic tests.

• A nurse or a medical supervisor will perform some tests like ECG, a chest x-ray, some blood tests, or swab tests to see whether you have any infections or not.

• The doctor will take your medical history. You will be asked to give details about any prescription or non-prescription drugs to the healthcare provider.

• The day before the surgery, the nurse will give instructions regarding the drinking of liquids or food intake.

• Do not drink alcohol or smoke a few days before the surgery.

• The doctor will ask you to discontinue certain medications and blood thinners like ibuprofen, aspirin, warfarin, and also certain vitamins and herbal supplements.

• If the patient is pregnant, she must inform the doctor during the consultation.

• Ask the doctor about the medicines you can take on the day of the surgery.

Procedures

For chronic and persistent pilonidal sinus, your doctor may suggest surgical excision or removal for treatment.

There are several surgical procedures to treat pilonidal sinuses.

Lancing

This treatment is used to clean the abscess or pus inside the sinus. Generally, the surgeon will perform this procedure under local anesthesia. A small cut is made with a scalpel to open the abscess and drain out pus, hair, blood, and other debris from the abscess.

A sterile dressing is used to pack the incision site. Hospital stay is not required.

Wide excision and open healing

This procedure is used to treat recurrent pilonidal sinuses. This technique involves excision of the sinus as well as surrounding tissues of the sinus. The wound is not closed but is left often to heal naturally by itself (healing by secondary intention). The surgeon administers general anesthesia. Regular dressings are required for faster healing. Full healing may take six to twelve weeks. Since the surrounding inflamed sinus tissues are removed, there are fewer chances of recurrence in this procedure.

Excision and closure of the wound

Surgeons use this procedure for treating large and recurring sinuses. The surgeon cuts a flap, the size of an oval on both sides of the sinus. The sinus is then taken out and the two sides of the flap are stitched. The procedure is performed under general anesthesia. The stitches are removed after 10 days. Though healing is much faster compared to wide excision surgery, the risks of recurrence and infection are also higher in this procedure. Regular dressings are required for full healing of the incision site.

Endoscopic ablation

A flexible tube with a camera called the endoscope is used to view the pilonidal sinus. The surgeon cleans the sinus with a solution and removes the hair and excess tissue in the surrounding area. After that, heat is used to close the sinus. The surgery is generally done under spinal or local anesthesia. The process is minimally-invasive as no cut is required and the risk of complications is also less compared to other surgical options. Total healing may take one month or less. Hospitalization is not required.

Plastic surgery

Sometimes the sinus is recurrent and covers a wide area of the skin. Plastic surgery can be used to remove the sinus and reconstruct the surrounding skin.

After the surgery

When your surgery is over, you will be taken to the recovery room where the nurse will check your vitals like pulse rate, temperature, oxygen level, and blood pressure. The nurse or physician will also check the incision site. After your vitals are stable, the nurse will take you to the ward where you will rest on a bed or a reclining chair. You will be given some water to drink and light food. Your intravenous drip will be removed.

Some pain medications will be prescribed. Hospitalization is not required and you will be allowed to go home after some rest.

When should you go for a pilonidal treatment?

Pilonidal sinus may be asymptomatic and people may not develop any signs of the disease at first until the area gets infected.

Some people may notice a small dent that appears like a dimple or depression on the area. This dent may later get infected and develop a painful abscess or a cyst filled with pus.

So, how do you know that your pilonidal sinus is infected? Here are a few signs:

• Inflammation in the cyst

• Pain and discomfort in the tailbone area while standing or sitting

• Redness in and around the pilonidal sinus area

• Foul-smelling yellowish discharge of pus or blood from the cyst or hole

• Noticeable hair follicle from the cyst

• Multiple occurrences of holes or pilonidal sinuses

• Low fever

Surgery options

Hospitals or private clinics? Which is the best option to have the surgery?

When it comes to choosing the right medical facility for your healthcare, you should consider all the factors before making a decision.

Small clinics

Pros

• Personalized care and balanced patient-doctor ratio

• Cheaper services

• Shorter waiting periods

Cons

• May not be equipped to handle critical patients

• Fewer amenities compared to big hospitals

Hospitals

Pros

• State-of-the-art technology

• High standards of healthcare facilities

• Multiple treatments done under one roof

Cons

• Cost is high

• May have to wait for several hours for consultations

Cost of surgery

Surgical costs for pilonidal sinus depend on:

• Type of surgery

• Big private hospitals charge more for human resources like housekeeping staff, nursing, and also for instrumentation and surgery procedures.

• Medical costs such as hospital stay, medications, equipment costs, etc.

• Doctor’s fees

• Incidental charges

• The place for surgery. Surgery costs in big metropolitan cities are more compared to small towns or cities

• Nursing care

• Home-care services

Post-op care and things to keep in mind

• You will be released two or three hours after the surgery. You must ask a responsible adult who can be a friend or a family member to accompany you during the surgery and assist you to get back home after the surgery.

• The doctor will ask you to refrain from driving at least seven to ten days post-surgery.

• Wash your genitals and anal area clean after every bowel movement. Even small pieces of feces can cause an infection.

• Do not shower until the surgeon removes the stitches.

• Avoid using soap to clean the area. Use a soft cotton cloth to keep it clean and dry. Alternatively, you can use non-medicated and alcohol-free wet wipes or baby wipes to clean the area.

• Do not use any talcum powder as it can irritate the skin and cause infection.

• Wear loose-fitting cotton underwear.

• Add plenty of roughage to your diet to avoid constipation and straining during bowel movements.

• You can shave or use alternative methods to remove hair from the area.

• Change the dressing frequently.

• Always come for follow-up visits.

• Consult a doctor immediately if you notice any signs of complications like swelling or redness in the area or fever.

Post-surgery complications

Post-surgery, some patients may develop certain complications.

Anesthesia-related complications:

• Headaches

• Nausea

• Vomiting

• Low back pain due to spinal anesthesia

• Hypotensive symptoms

Surgery-related complications:

• Infection on the wound site

• Flap necrosis

• Occurrence of hematoma or abscess underneath the flap

• Seroma formation

• Recurrence of pilonidal sinus or cysts

• Tenderness on the wound site

Best option

Pilonidal sinus surgery is generally done on an outpatient basis and hospitalization is not required unless the patient develops some complications. The risks are also minimal and patients can recover within a few weeks. Goficure is a one-stop platform where you can find details about some of the top surgeons, hospitals, and clinics for pilonidal treatment and surgery.

Why choose goficure?

• Assistance in booking consultations with top doctors

• Faster insurance approval

• Low costs

• Patient counseling

• Free pick-up and drops

• Arrangement for follow-up visits

References