Pilonidal Sinus

Although the precise cause of a Pilonidal Sinus is unknown, medical experts believe a combination of hormonal changes, hair growth in the area, or prolonged sitting is the reason.

Activities like sitting cause friction, affect hair growth in the area, and push such hair back under the skin. Your body now treats this hair as foreign objects and counters them with an immune response. This is similar to how your body would react to a splinter. The immune response from your body leads to the formation of a cyst around the hair. In some cases, a person may have more than one cyst connected below the skin.

The people most at risk to develop this disease are:

• Males
• People aged between 20-30 (most common among this group)
• Obese people
• People whose work requires long hours of sitting
• People with excessive body hair
• People with coarse hair

Initially, you might not notice any significant symptoms other than a hollow hole on the skin’s surface. If this hole gets infected, it might turn into a cyst filled with fluid or an abscess filled with pus.

The symptoms of infection are:

• A swollen cyst
• Red/sore skin around the infected area
• Sitting and/or standing causes pain
• A foul odor due to the pus or blood discharge
• Protruding hair
• Development of multiple sinus tracts
• In rare cases, a slight fever

There are various ways to treat a Pilonidal Sinus, depending on the stage at which it is diagnosed.

• Conservative treatment: If you get an early diagnosis and are not experiencing a lot of pain and inflammation, it can be treated by antibiotics. These antibiotics will mostly include broad-spectrum antibiotics, which, as the name suggests, can treat a broad range of bacteria. However, it should be noted that this medicine will not heal the sinus tract. It will only ease the discomfort and infection.
• Lancing: This process relieves the discomfort caused by an abscess (collection of pus). For this procedure, you will be given anesthesia. The doctor will then use a scalpel to cut open the abscess and clean any hair, pus, or blood from it. The wound is then dressed with a sterile dressing and left to heal from the inside out. It takes almost four weeks to heal. No further treatment is required.
• A phenol injection: Under this procedure, you will first receive anesthesia, followed by the phenol injection – a chemical antiseptic. This procedure might need to be carried out multiple times until the cyst hardens and closes. As it needs to be repeated, doctors prefer surgery over this procedure.
• Surgery: In case of multiple or recurring sinuses, the doctor will recommend you to go in for surgery. The surgical procedure begins with local anesthesia, and the doctor will then open the cyst/sinus to remove the abnormalities. After successfully removing the debris, the doctor will stitch up the wounds.

After the surgery, the doctor will advise you on how dressings need to be changed and might ask to shave the area to avoid any hair growth near the wound. The recovery time depends on whether your doctor has stitched up the wound or left it open. It generally takes up to 3 months to heal completely. You might feel pain and tenderness in this period.

The most important and common complication associated with this surgery is the recurrence of the pilonidal sinus. The recurrence rate observed is as high as 30%. This may be due to hair growth near the affected area or if it gets infected again.

Following are a few ways to avoid a recurrence of a Pilonidal Sinus:

• Closely follow the doctor’s instructions during the recovery period.
• Make sure to follow up with the doctor regularly.
• Keep the area clean and maintain hygiene.