Pilonidal Sinus Treatment
Care for a sinus or infected tract near the tailbone, including treatment for recurrent disease
What is pilonidal sinus treatment?
A pilonidal sinus is a small tract under the skin at the top of the buttock cleft, just above the tailbone. Loose hairs work their way into a pit in the skin there, the body treats them as foreign material, and a cavity forms around them that keeps collecting debris.
It is a disease of friction and hair, not of hygiene, and it is commonest in young men, in people who sit for long periods, and in anyone with coarse body hair. Drivers get it often enough that it has been called jeep disease since the war.
It behaves in a cycle. For long stretches it does nothing, or leaks a little. Then it blocks, becomes an abscess, and turns into a swelling too painful to sit on. Draining the abscess relieves that, and the sinus stays behind. The flare and the sinus are two separate problems, and they are usually treated at two separate visits.
What you might notice
- Painful swelling at the top of the buttock cleft
- Discharge or wetness near the anus
How it is diagnosed
A doctor makes the diagnosis by looking at the top of the cleft. The midline pits are visible, often with a hair coming out of one, and there may be a second opening off to one side where the tract has burrowed.
They will note how many pits there are, how far off the midline the openings sit and whether there is a cavity underneath. Those three things decide which operation suits: a small number of pits with no big cavity can be dealt with through the pits themselves, while a wide tract or one that has already recurred usually needs the tissue removed and the skin rearranged.
A scan is rarely needed. If the disease has been operated on before, your surgeon may ask for one to see how far it extends.
Recovery
If an abscess is drained, the pain goes almost immediately and the wound is dressed for a couple of weeks. This is relief and not a cure, so arrange the follow-up.
After an endoscopic clearance most people are back at work within a week and there is no large wound to look after. After an excision it depends on whether the wound was closed or left open: an open wound heals from the base and takes four to eight weeks of dressings, and a flap repair means a few days in hospital and about two to three weeks before you are fully mobile, but the scar is closed from the start.
Hair removal from the area afterwards is the part people skip and the part that matters. Recurrence is common, and keeping the cleft free of hair is the best-evidenced thing you can do about it.
If it is left untreated
A sinus that has never flared and only leaks occasionally can reasonably be watched. Plenty of people have one and never know.
Once it starts flaring, leaving it means living with repeated abscesses, each of which is a week of not being able to sit and usually an unplanned trip to have it drained. Each episode also tends to extend the tract, so what began as one midline pit becomes several openings tracking sideways under the skin.
That progression is the real cost. The operations for a simple sinus are small and the ones for an extensive recurrent sinus are not, and the gap between them is largely a matter of how long it was left.
Questions about pilonidal sinus treatment
Is it caused by poor hygiene?
No. It is caused by loose hairs working into a pit in the skin at the top of the buttock cleft, and by the friction that drives them in. Washing more does not prevent it and has not caused it. It is commonest in young men with coarse hair, and in anyone who sits for long stretches.
Why do I need a second operation after the abscess was drained?
Draining an abscess lets the pus out and takes the pain away. It does not remove the sinus underneath, and the sinus is what collected the debris in the first place, so it will fill again. Those are two different problems treated at two different visits, and the second one is done once the infection has settled and the tissue is quiet. Skipping it usually means another abscess.
What stops it coming back?
Recurrence is common with every technique, and the best-evidenced thing you can do about it is keeping the cleft free of hair, by shaving, depilatory cream or laser. Laser hair removal has the most support. Beyond that, avoid long unbroken periods of sitting where you can, and keep the area dry. Which operation you had matters too: moving the scar off the midline, as a flap repair does, recurs less than a midline closure.
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Day CareTalk to a care coordinator about pilonidal sinus treatment
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one