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Pilonidal Sinus

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What is pilonidal sinus ?

A pilonidal sinus is a small, abnormal tract (tunnel) that develops in the skin near the tailbone (coccyx) at the top of the buttocks. It can become infected and filled with pus, hair, and debris. This condition can be quite uncomfortable and frustrating.

CAUSES

The exact cause of pilonidal sinus disease is unknown, but latest research studies believed to be a combination of factors, including:

  • Ingrown hairs: This is thought to be the main culprit. Hair growing in the crease of the buttocks can burrow back into the skin, causing irritation and inflammation.
  • Friction and pressure: Tight clothing, sitting for long periods of time, especially on rough surfaces, can irritate the skin and cause ingrown hairs.
  • Excess sweating: Sweating can irritate the skin and make it more susceptible to infection.
  • Obesity: Excess weight can put more pressure on the buttocks, which can irritate the skin and contribute to ingrown hairs.
  • Family history: Having a family member with pilonidal sinus disease may increase your risk.
  • Genetics: Some people may be more predisposed to developing pilonidal sinuses due to their hair type or skin structure.
  • Hair characteristics: Coarse, curly hair may be more prone to ingrowing.
  • Deep natal cleft: A deeper crease at the buttocks may trap hair and debris.
  • Hygiene: While not a direct cause, proper hygiene can help prevent infection if a pilonidal sinus develops.

The cause of Pilonidal sinus may differ from person to person.Risk factors like obesity, certain occupations like it is most often diagnosed in teenagers and young adults, and family history can influence development.

Pilonidal Sinus Flow Chart
Pilonidal Sinus Real Img 1
Pilonidal Sinus Real Img 2
Pilonidal Sinus Real Img 3

Symptoms

The initial stages of pilonidal sinus disease might be subtle. You might not experience any noticeable symptoms for some time. However, as the condition progresses, be on the lookout for:

  • Pimple or bump: A small, red bump may appear in the crease of your buttocks near the tailbone. This could be a sign of an ingrown hair or early pilonidal sinus.
  • Pain: You might feel mild discomfort or tenderness in the affected area, especially when sitting for extended periods or engaging in activities that put pressure on the buttocks.
  • Redness and swelling: The area surrounding the bump may become red and swollen, indicating inflammation.
  • Discharge: Sometimes, a pilonidal sinus can develop a small opening (sinus tract) that drains pus or a foul-smelling discharge.
  • Pilonidal abscess: If the pilonidal sinus becomes infected, it can develop into an abscess. This can cause more pronounced symptoms, including:
  • Increased pain: The pain becomes more intense, throbbing, and constant, often worsening with sitting, pressure, or movement.
  • Swelling: The affected area becomes significantly swollen, often extending beyond the initial bump.
  • Redness: The redness around the bump intensifies and might spread.
  • Fever: In some cases, an abscess can cause a low-grade fever.
  • Drainage: The sinus tract may drain pus, which can be bloody or have a foul odor.

The cause of Pilonidal sinus may differ from person to person.Risk factors like obesity, certain occupations like it is most often diagnosed in teenagers and young adults, and family history can influence development.

Treatment

Pilonidal sinus disease can be treated differently depending on whether it's in a silent (non-infected) stage or has become infected. Here's a breakdown of treatment options for each scenario:

Silent Stage Pilonidal Sinus:
  • Conservative Management: This is often the preferred approach for silent pilonidal sinus. It focuses on preventing future problems and managing symptoms like mild discomfort. Options include:
    • Warm Soaks: Soaking the affected area in warm sitz baths can help reduce inflammation and discomfort.
    • Hair Removal: Techniques like shaving or laser hair removal in the affected area can minimise the risk of ingrown hairs.
    • Loose Clothing: Wearing loose-fitting clothing allows for better airflow and reduces friction.
    • Dietary Changes: Maintaining a high-fiber diet can promote bowel regularity and potentially reduce pressure on the area.
    • Minimise friction: Avoid tight clothing or rough surfaces for extended periods.
    • Maintain good hygiene: Keep the area clean and dry with regular showers.
Infected Pilonidal Sinus:

If the pilonidal sinus becomes infected (abscess), a more aggressive approach might be necessary. Here are the main treatment options:

Incision and Drainage (I&D): This is a minimally invasive procedure where a doctor numbs the area, makes a small incision to drain the pus, and packs the wound to allow further drainage. Antibiotics might be prescribed to prevent further infection.

  • Surgical Treatment Options for Chronic Pilonidal Sinus
    • Excision with Primary Closure The entire sinus tract is surgically removed, and the wound is closed with stitches.
        Advantages:
      • Simple procedure, short hospitalisation (typically outpatient).
      • Faster healing time since the wound is closed.
      • Less postoperative care compared to open methods.
        Disadvantages:
      • Higher risk of wound infection due to closed environment.
      • Higher chance of recurrence (up to 20-40%) compared to other methods.
      • Longer initial recovery period due to more extensive surgery.
    • Excision with Secondary Intention Healing The sinus tract is excised, but the wound is left open to heal from the inside out.
        Advantages:
      • Lower risk of infection as the wound remains open.
      • Lower recurrence rate as the entire sinus tract is removed.
      • Good option for recurrent or complex pilonidal sinuses.
        Disadvantages:
      • Longer healing time, often requiring weeks to months.
      • More intensive wound care needed, including regular dressings.
      • Potential for significant scarring.
    • Flap Surgery (e.g., Limberg Flap, Karydakis Procedure, Baskom’s, Rhomboid flap) Advanced techniques where the sinus is excised, and a flap of skin is used to cover the wound, often repositioning the cleft to avoid future issues.
        Advantages:
      • Very low recurrence rates due to complete removal and reshaping of the area.
      • Faster healing and less discomfort postoperatively.
      • Reduced risk of complications like infection and chronic wounds.
        Disadvantages:
      • More complex and technically demanding surgery.
      • Longer operating time and often requires general anaesthesia or spinal anaesthesia.
      • Higher initial recovery period and potential for flap failure.
      • Flap surgery will leave a scar
      • You will likely experience pain and discomfort after surgery, especially when sitting or going to the bathroom.
      • It can take several weeks to fully recover from pilonidal sinus flap surgery. You may need to take time off work
    • Laser Pilonidal Sinus Treatment (SiLaC) SiLaC uses a laser fiber to ablate the sinus tract, effectively sealing it off and promoting healing.
        Advantages:
      • Faster healing: Compared to traditional surgery, laser offers quicker wound closure and healing time.
      • Less pain: Laser surgery typically involves minimal cutting and less tissue disruption, leading to reduced pain.
      • Outpatient procedure: Often performed on an outpatient basis, allowing you to go home the same day.
      • Minimally invasive with small entry points.
      • Laser energy precisely targets the affected area, minimising damage to surrounding tissues.
      • Quick procedure with minimal postoperative pain.
      • High success rate with low recurrence.
        Disadvantages:
      • Access to laser equipment and trained specialists may be limited.
      • Initial cost can be higher than traditional surgery.
    • Endoscopic Pilonidal Sinus Treatment (EPSiT) EPSiT involves the use of an endoscope, a thin, flexible tube with a camera and light, to visualisation and treat the sinus tract from the inside.
        Advantages:
      • Small incisions, resulting in minimal scarring.
      • Precise removal of the sinus tract with real-time visualisation.
      • Faster recovery and return to normal activities.
      • Reduced postoperative pain and lower risk of infection.
        Disadvantages:
      • Requires specialised equipment and surgical expertise.
      • May not be suitable for very large or complex sinus tracts.
      • Follow-up visits needed to ensure complete healing.

If you're suffering from pilonidal sinus and considering your treatment options, explore the benefits of minimally invasive surgery with a Procto Surgical Hospital where Dr Saurabh Patel specialises in these advanced techniques.

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After Surgery Care

After surgery care is crucial for proper healing and preventing complications. Here are the key points to follow:

  • Wound Care: Keep the wound clean and dry, change dressings regularly, and watch for signs of infection.
  • Pain Management: Take prescribed pain medications and use over-the-counter options as needed to alleviate discomfort.
  • Hygiene: Take showers, pat the area dry gently, and avoid irritating the wound to promote cleanliness and prevent infection.
  • Activity Restrictions: Avoid strenuous activities and heavy lifting, and limit prolonged sitting to reduce pressure on the wound and aid healing.
  • Diet and Hydration: Maintain a healthy diet and drink plenty of fluids to aid in healing and prevent complications like constipation.
  • Follow-Up Appointments: Attend all scheduled follow-up visits with your surgeon for monitoring and guidance during recovery.
  • Managing Drainage: Care for any drains as instructed and monitor for changes in drainage to prevent infection and aid healing.
  • Signs of Complications: Be vigilant for signs of infection or other complications such as increased pain, redness, swelling, or discharge, and report them promptly for timely intervention.
  • Personal Hygiene: Maintain good hygiene practices to prevent future infections, and follow any recommendations regarding hair removal to reduce recurrence risk.
  • Comfort Measures: Use cushions or pillows when sitting and wear loose-fitting clothing for comfort and to minimize irritation to the surgical site.

By adhering to these after-surgery care points diligently, you can promote healing and reduce the risk of complications following pilonidal sinus surgery.

A pilonidal sinus is a small tunnel or tract that develops in the cleft of the buttocks, usually near the tailbone. It can become filled with pus and cause discomfort or pain.

The exact cause is unclear, but it's often associated with hair penetration into the skin, leading to inflammation and the formation of sinus tracts. Other factors like obesity and prolonged sitting may contribute.

Symptoms include a small dimple or pit in the skin, swelling, tenderness, pain, and drainage of pus or blood from the sinus tract.

Diagnosis is typically made based on clinical examination. Imaging tests like ultrasound or MRI may be used to assess the extent of the condition.

Treatment may involve antibiotics for infection, pain management, and surgical procedures like incision and drainage, excision of the sinus tract, or flap surgery for chronic or recurrent cases.

Not always. Small, asymptomatic sinuses may not require treatment. However, if symptoms persist or worsen, surgical intervention may be necessary.

Recovery varies depending on the type of surgery performed and individual healing factors. It may take a few weeks to several months for complete recovery.

Yes, recurrence is possible, especially if proper wound care and hygiene are not maintained post-surgery. Following the surgeon's instructions for aftercare can help reduce the risk of recurrence.

Preventive measures include keeping the area clean and dry, avoiding prolonged sitting, maintaining a healthy weight, and considering hair removal from the area if recommended.

No, pilonidal sinus is not contagious. It is not caused by bacteria or viruses that can be transmitted from person to person. It develops primarily due to anatomical and lifestyle factors.

Discover What Our Patient Have to Say

" It was a very good experience from the beginning to the end, i.e. from the initial checkups to the post surgery follow ups. The staff and Dr. was very helpful and kind, always available on the call as well for support. Doctor himself was very polite and is a very good surgeon. He was quite supportive with everything and other patients also seemed very happy with his work. I am so glad I chose Dr. Saurabh Patel and would highly recommend to anyone.Dr. Saurabh patel is not only an expert in proctologist surgery but also extremely kind and helpful person.He was very thorough with his observations and recommended timely treatment for the same. Dr. Have been done my Pilonidal sinus surgery With modern technology and painless surgery. Thanks a lot of sir. "

- Dushyant samaria Pilonidal Sinus Patient

" I had pilonidal sinus disease since 4 years I had consulted 3 doctors they advised medicine but didn't relief and suggested for open surgery my sisters friend suggested to consult Dr saurabh Patel we consulted sir then sir explained minimal invasive surgery , laser pilonidal sinus surgery, we gone through surgery and wound recovery is very well. My surgery done in local anaesthesia and got discharged from hospital within 5hours of surgery. Surgery was painless with music 🎵🎶 . Surgery was smooth I didn't even realise that it was done so fast 😊 "

- Patel Pratham Pilonidal Sinus Patient

" I got laser pilonidal sinus surgery, which was somewhat life-changing for me. It eliminated the chronic pain and discomfort I had been experiencing for a long time and significantly improved my quality of life.Thank you so much sir 🙏 … "

- Rahul Sharma Pilonidal Sinus Patient

" I had Pilonidal sinus and consulted manny doctors and surgeon but when i had conaulted Dr Saurabh Patel i had gained trust. Now its years passing there is no any difficulty and my disease is completely cured "

- Damini Patel Pilonidal Sinus Patient
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