Pilonidal Sinus: A Comprehensive Guide to Diagnosis and Care

Tuesday, May 16, 2023

Some people may suffer from a Pilonidal Fistula, which requires surgery at times, so you should consult a doctor as soon as the warning symptoms appear. In this article, learn about the symptoms and causes of Pilonidal Sinus, and methods of diagnosis and treatment.

Pilonidal sinus

Pilonidal sinus

What is a Pilonidal Sinus?

A pilonidal cyst is a chronic dermatitis that develops at the base of the tailbone at the gluteal notch (the crease in the upper part of the buttocks). This inflammation appears as a hole in the skin that may fill with fluid or pus, causing the formation of a cyst containing dirt and hair.

Pilonidal cyst often occurs after puberty in young adults 15 and 30, which is more common in men than in women. If the cyst continues to become infected, it may have to be surgically removed.

Pilonidal sinus form in its infancy

Pilonidal fistula is a recurrent suppurative condition that appears under the skin of the sacrococcygeal region that occurs between the buttocks (gluteal crease or notch) near the tailbone in the lower back. The abscess appears acutely.

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Symptoms of Pilonidal Sinus

Most people with a Pilonidal Sinus do not notice any symptoms unless the fistula becomes infected and causes the following symptoms:

Pain, swelling and redness in the sacral region

A Pilonidal Sinus may not cause any symptoms unless it becomes infected, as it may result in pain, swelling, and lumps in the skin surrounding the cyst.

Drainage of pus or blood from the sinus openings

In some cases, the infection may cause pus or blood to ooze from an opening in the skin, causing a foul-smelling place where the pus drains.

Frequent infections or abscess formation

Pilonidal cyst disease is known as a condition that may be recurrent, causing the formation of a cyst (abscess), and its symptoms may develop to include fever, extreme fatigue, and nausea in some people.

Causes of Pilonidal Sinus

The exact cause of this condition is not known, but people may develop a Pilonidal Sinus as a result of:

  • Irritation of the hair follicles from things like exercise, tight clothing, or heavy perspiration.
  • Sitting for long periods
  • Frictional activities
  • friction from clothing
  • Ingrown hairs causing irritation.
  • changing hormones

It often occurs in young people between the ages of 15 and 30 years old. It is more common in males and in people who are overweight, wear tight clothes, have a lot of hair near the crease of their buttocks, or don’t shower or bathe often. In some cases, some people may be born with fistula cysts.

How can a Pilonidal Sinus be diagnosed?

The disease is diagnosed by a physical examination to check the crease of the buttocks for signs of a pilonidal cyst. The cyst should be visible to the naked eye. Some MRI or CT scans may also be done to check for a nerve fistula under the skin’s surface.

Pilonidal fistula treatment

Incision and drainage of abscesses

Treatment depends mainly on the condition of each person, the symptoms of the Pilonidal Sinus, the size of the cyst, whether it is recurrent or has been infected for the first time. Some people with pilonidal cysts will require drainage of the affected area. and closed by the specialist doctor.

It is difficult to remove the entire cyst this way, so it is more likely that the infection will recur after this procedure.


The affected area is locally anesthetized, then phenol (an acidic chemical compound used as an antiseptic) is injected into the cyst. This procedure may need to be repeated several times to ensure a better result. This procedure prevents mild to moderate cysts.


Antibiotics can treat dermatitis. However, antibiotics cannot cure pilonidal cysts on their own until after doing the procedures mentioned above.


If a patient has multiple pilonidal cysts, or is experiencing severe pain or discomfort, surgery may be the most effective way to treat the pilonidal fistula and prevent further infection.

In the event of surgery, the specialist doctor will numb the area and remove the cyst through an incision. After removing the cyst, the doctor may choose to leave the wound open and apply a bandage. This allows the area to fully recover. This may take longer, but it reduces the chance that the cyst will return or the wound will be closed with stitches. The recovery time from this operation will be shorter, but it may increase the chance that the cyst will return.

In cases where the patient suffers from many pilonidal cysts in one area, the following procedure can be followed:

Radical resection, alternating or off-center flap

Radical excision of all cysts and closure of the wound can be performed to allow for better healing. The most common technique used is called a gluteal notch lift.

After surgery, your doctor will give you some explanations and instructions on how to change the dressing and take care of the area, including, keeping the area clean and checking for any signs of new infection, such as redness, pus, or pain. And keep follow-up appointments with your doctor.

Laser therapy

Laser treatment can remove hair that may be ingrown and causing recurrence of pilonidal cysts.

Pilonidal sinus treatment at home

One of the home methods that help treat a Pilonidal Sinus is applying a clean, hot, wet compress to the cyst several times a day. The heat will help draw out the pus and drain it out, which will relieve the pain and itching. You can also try soaking the area in a warm bath. If the cyst is painful, non-steroidal anti-inflammatory drugs can be taken.

Post-treatment care and prevention

Aftercare techniques for a Pilonidal Sinus include:

  • Follow wound care instructions and dressing changes
  • Remove hair regularly and maintain good hygiene
  • Lifestyle modifications to reduce friction and trauma in the sacral region (lower back cavity)
  • After surgery, it is important to avoid heavy lifting or strenuous exercise for the first week
  • Avoid riding a bike for a while 6 to 8 weeks
  • Avoid swimming until the wound has completely healed

Preventive measures that can prevent a pilonidal cyst include:

  • Clean the area with mild soap and water. Rinse well to get rid of soap residue
  • Take breaks from time to time if you have to sit for long periods
  • Avoid wearing tight clothes
  • Laser hair removal may reduce the risk of recurring infections

Frequently asked questions that may interest you

How do I know that I have a Pilonidal Sinus?

At first, a Pilonidal Sinus will not cause any noticeable symptoms unless it becomes infected. Where the infection can cause the formation of a pus-filled abscess.

An abscess is a painful collection of pus that causes the following symptoms:

  • pain
  • A tender bump under the skin
  • skin redness
  • The discharge of pus may often be foul-smelling
  • Bleeding
  • Some people have a high temperature

What are the risks of Pilonidal Sinus?

Although a pilonidal cyst is not life-threatening, it can make it difficult to sit, stand, or walk for long periods of time, which may interfere with work or driving, and it can cause many long-term health problems, as some people develop a chronic condition. From the disease, as the cysts recur even after surgical treatment.

According to search Published in 2018, the recurrence of pilonidal fistula after treatment is up to 30%. In addition, these cysts increase the risk of systemic infection and squamous cell carcinoma (a common type of skin cancer that arises in the squamous cells that make up the middle and outer layers of the skin).

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