People who sit for longer periods or have lots of thick body hair may start experiencing some pain at the top of the cleft in their buttocks. You may see a small opening or a hole, and it may cause some discomfort. This is called the pilonidal sinus. If this condition is not causing any discomfort, you may not need any treatment. However, if you experience pain or other symptoms like pus discharge, you must understand the different types of pilonidal sinus treatment options to seek timely medical care. Let’s understand the causes, symptoms, and signs you should watch out for when you have a pilonidal sinus.
What is the Pilonidal Sinus?
A pilonidal sinus is a narrow tract beneath the skin. It most commonly develops at the top of the buttocks, in the crease between the cheeks.
If infected, it will become a painful abscess or cyst. The cyst will tend to trap hair, dirt, and dead skin. It will leak pus or blood and may have an odour.
This condition primarily occurs in men and young adults. It’s more prevalent in individuals who spend long periods sitting, such as cab drivers or office employees.
Types of Pilonidal Sinus
Knowing the various types of pilonidal sinus can assist you in recognising the signs early enough to obtain appropriate treatment. The types vary in how they present and how severe they are.
- Acute Pilonidal Abscess: This is a painful, inflamed lump of pus that forms rapidly when a pilonidal sinus gets infected. The swelling occurs, and the infection may cause severe pain.
- Chronic Pilonidal Sinus: Chronic conditions are long-standing and are frequently associated with persistent or recurring sinus tracts and cysts. These are difficult to diagnose, as inflammation and scarring can obscure the condition over time.
- Pilonidal Cyst: A pilonidal cyst is a sac-like structure under the skin. It tends to contain hair, fluid, or pus. Left untreated, it can become infected and develop into an abscess, which poses additional problems.
- Pilonidal Sinus Tracts: These are tubes or tracts within the skin, joining the surface to more internal tissues. They may entrap hair, debris, and dirt, which may become infected and painful if they are not treated.
- Pilonidal Pit: A pilonidal pit is a tiny visible pore in the skin, typically occurring at the crest of the buttocks. It may be an initial manifestation of a pilonidal sinus and is possibly an indication of requiring medical attention.
What are the Causes of a Pilonidal Sinus Infection?
The precise reason behind an infected pilonidal sinus is not completely known. It’s believed, though, to be due to a combination of factors, such as hormonal activity following puberty, hair growth, and irritation caused by sitting or tight clothing.
When activities such as sitting and creating repeated friction, the hair within the affected area can become lodged under the skin. The body recognizes the embedded hair as an invader and mounts an immune response against it as if it were a splinter.
This results in the formation of a cyst over the embedded hair. Several sinuses will develop and interconnect under the skin in other cases.
Identifying a Pilonidal Sinus and Recognising Signs of Infection
At first, you may not see much of a symptom other than a little depression in the skin that looks like a dimple. But when this spot gets infected, it becomes a cyst (fluid-filled sac) or an abscess (swollen, inflamed tissue and pus) very rapidly.
Symptoms of an infection are:
- Painful sitting and sometimes standing
- Swollen skin around the cyst
- Red, tender skin on the affected area
- Pus or blood discharge from the abscess, usually with a bad odour
- Hair protruding from the sinus opening
- Development of several sinus tracts or openings in the skin
- You may also have a low-grade fever in some instances.
How are Pilonidal Sinus Infections Treated?
Some of the available treatment options for pilonidal sinus are:
Conservative Treatment
If your pilonidal sinus is diagnosed early and without severe pain or inflammation, your physician may initially prescribe a broad-spectrum antibiotic. Such an antibiotic kills a broad variety of bacteria, keeping the infection in check and minimising discomfort. However, antibiotics will not cure the sinus tract; they just temporarily control the infection.
In addition to antibiotics, your physician will probably recommend future care to avoid problems. This involves frequent hair removal (shaving the area) and attention to hygiene to avoid dirt and sweat accumulation. You will also require follow-up visits to check on the condition.
- Lancing: If an abscess or pus collection develops within the sinus, lancing can alleviate symptoms. Your doctor will initially anaesthetise the area with a local anaesthetic for this procedure. With a scalpel, they will gently open the abscess and remove the pus, blood, and any hair that is trapped within. Then, the doctor will wash the area and dress the wound with a sterile dressing. This will heal the wound from the inside out, typically in four weeks, if there are no other tracts or abscesses. Most patients prefer this remedy, and no additional treatment is needed.
- Phenol Injection: In some cases, a phenol injection might be considered. Your doctor will apply a local anaesthetic before injecting phenol, a chemical antiseptic, straight into the cyst. The phenol slowly hardens the lesion, thereby closing it. The treatment might need to be repeated a few times for optimal outcomes. While injection of phenol may be successful, it carries a greater likelihood of recurrence than other treatments. Therefore, it’s not so widely used.
- Surgery: Surgery is often advised for more serious or recurring pilonidal sinus infections, or if more than one sinus forms. The operation begins with a local anaesthetic to anaesthetise the area. The surgeon will then gently open the infected areas, removing any pus, debris, and hair. Once the sinus is cleaned, the surgeon will stitch the wounds closed, ensuring they heal properly. Post-surgery, your doctor will give specific instructions on dress changes and self-care. Shaving the site regularly to prevent hair growth and re-infection is also recommended. While surgery is a more invasive option, it is often the most effective for long-term relief.
- Laser Surgery at Chirag: For a pilonidal sinus, a minimally invasive laser surgery can be even more effective and doesn’t result in an open wound. After a thorough diagnosis, the sinus tract is drained and cleared. Using lasers, the entire tract is ablated so that there are no large wounds, minimal tissue damage, and no need for stitches. Patients experience faster recovery and reduced pain.
- Ayurvedic Therapies: Ayurvedic therapies can also provide good relief from the pilonidal sinus. Kshara karma treatment involves applying a caustic herbal paste to the sinus tract, effectively debriding unhealthy tissue. This non-surgical procedure is safe, effective, and has minimal complications. Kshara sutra requires a local anaesthesia to cut through the tract and use a medicated thread to deliver medicinal agents directly. It’s also an effective, minimally invasive procedure, but the thread must be replaced weekly until the tract is fully healed.
What Complications Are Associated with a Pilonidal Sinus Infection?
Pilonidal sinus infections may also cause a variety of complications post-treatment. Wound infection is one problem that can follow surgery. Another problem is the recurrence of infection even after successful treatment.
Symptoms of an infected wound are:
- Severe tenderness over the affected area
- Swelling and redness near the wound
- A fever higher than 100.4°F (38°C)
- Pus or blood from the wound
- A bad smell from the location
If you experience any of these symptoms, it is crucial to visit your doctor immediately for further treatment.
How can I prevent Pilonidal Sinus Infection?
To avoid a pilonidal sinus infection, keep the area clean and dry. Clean the area once a day using mild soap, washing away all soap residue so you do not irritate it. Keep the area dry and clean daily. Also, take regular breaks from prolonged sitting as it causes friction and pressure, which can make existing infections worse or cause new ones.
How to Prepare Before Pilonidal Sinus Surgery?
By taking a few easy steps prior to surgery, you can make your recovery easier and lower the risk of complications. Begin by adhering to your surgeon’s advice. They might request that you discontinue certain medications or abstain from food for a few hours before the procedure.
Keep the area dry and clean in the days before surgery. You might be asked to shave or trim your hair around the area but always get permission from your doctor first. Dress in loose, comfortable clothes on the day of surgery to prevent pressure on the wound.
Make arrangements for time off work, particularly if you have a job that requires sitting for extended periods. Above all, remain calm and have any questions you may have answered by your doctor. Being well-informed makes you feel more in control and prepared for the procedure.
How to Recover After Pilonidal Sinus Surgery?
Proper care after pilonidal sinus surgery is important to recovery. Rest and sleep well to recover faster.
After laser ablation surgery, you won’t have an open wound. It is much easier to maintain. However, you have to come regularly for dressings, depending on the wound, as advised by the surgeons.
Keep the wound area clean as advised by your doctor to prevent infection. Take any pain medication as directed by your doctor to be comfortable. Stay away from strenuous activities and prolonged sitting during the initial few weeks, then gradually resume your activities.
Attend all follow-up visits to monitor healing and have questions answered if necessary. Consume a balanced diet with sufficient protein and vitamins to facilitate tissue healing. Shower daily and maintain the wound’s cleanliness to ensure hygiene.
What Lifestyle Changes Need to Be Made After Pilonidal Sinus Surgery?
Recovery doesn’t end when the surgery is over. How you care for yourself in the weeks after surgery plays a big role in how well and how fast you heal.
- Physical activity: Avoid sitting for long periods or lifting heavy items, especially in the first few weeks. Walking short distances is encouraged, as it helps blood flow and speeds up recovery. Only return to normal activities when your doctor says it’s safe.
- Diet: Eat more fibre to avoid constipation, as straining can affect healing. Drink plenty of water to stay hydrated. Avoid excess sugar, as it may contribute to increasing inflammation and slow down recovery. More importantly, consult with your doctor to learn the right diet suitable for your body. At Chirag, the procedures and dietary recommendations are personalised for the patient.
- Hygiene: Shower daily, wear loose clothes, and keep the wound clean and dry at all times. Tight clothes can rub against the wound and cause pain or delay healing.
- Other tips: Avoid smoking, as it reduces oxygen in the blood and delays healing. Do not drive or use heavy machinery unless cleared by your doctor, especially if you’re still on pain medication.
What are the Signs of Healing Pilonidal Sinus?
Once you have received treatment like pilonidal sinus surgery, you would want to know if you are healing normally. These are some of the signs that your condition is healing:
- Pain that gradually becomes less severe is one of the major signs of healing. If the pain disappears during rest or movement, your body is most likely recovering as expected. Pain will be very minimal after laser surgery for the pilonidal sinus. However, if the sinus has recurred or if infection has spread, thorough curettage becomes essential. In such cases, pain may be slightly higher due to deeper tract cleaning. Even then, pain is still lower compared to open surgery.
- Swelling around the surgery/ablated site is minimal and quickly decreases when healing sets in, since tissue damage is minimal. This improvement reflects reduced inflammation and better tissue repair under the skin.
- Discharge is generally minimal after laser surgery and subsides quickly if present.
- Redness on the surrounding skin typically diminishes during healing. If the shiny or red look lessens, irritation decreases.
- Skin temperature around the surgery site gradually becomes normal. A decrease in heat can be a sign that inflammation is resolving and there is no remaining infection.
- Itching can develop as part of the healing process, but it’s generally minimal with laser procedure. This is normal and frequently indicates that new skin is growing over the treatment area and it’s healing internally.
- Moving pain-free and sitting for increased time periods without discomfort is indicative of stabilising and healing internal tissues.
Important Considerations: Early Intervention, Preventing Recurrence, Consult with a Doctor
Early treatment prevents complications. If you experience pain, swelling, or discharge around the tailbone, don‘t wait to get treated. Treating a pilonidal sinus early often prevents surgery and shortens recovery.
Prevention of recurrence is as crucial as the treatment of the infection. Hair removal, good hygiene, and avoiding extended sitting can also minimise the risk of the sinus returning. Even after surgery, long-term management is essential.
Consult a physician if you observe any symptoms. The physicians in Chirag Hospitals provide reliable diagnosis, personalised treatment, and innovative solutions with the help of minimally invasive procedures that support quicker healing and reduced recurrence. Early consultation saves time, cost, and pain in the long term.
Conclusion
Pilonidal sinus can begin as a minor skin condition, but if left untreated, it can result in chronic infections and pain. Being aware of the signs, knowing the treatments, and sticking to post-care can be the turning point in recovery. Managing early symptoms and maintaining proper hygiene can help avoid complications or recurrence.
If you have pain, swelling, or discharge around your tailbone, don’t just brush it aside. Early intervention makes you heal quicker and reduces the risk of future complications. For professional consultation and cutting-edge treatment, consult with specialists at Chirag Global Hospitals.
