Patient Information
Pilonidal Sinus
What are pilonidal sinus?
Pilonidal means ‘nest of hairs’. A pilonidal sinus is a small hole or tunnel in the skin at the top of the buttocks where they divide (the cleft). It does not always cause symptoms and only needs to be treated if it becomes infected or painful. Pilonidal sinus disease may fill with fluid, blood or pus, causing the formation of a cyst or abscess.
Causes
- Ingrown hair
- Cleft of the skin becoming blocked with fragments of skin/hair
- Pressure or friction
Contributing factors
Pilonidal sinuses are most common in young adults and are rarely seen in children or people over 40 years old. They occur more often in men than women. Certain factors increase the risk of developing a pilonidal sinus, including:
- Prolonged sitting
- Obesity
- A previous injury/repetitive irriation to the skin
- Family history
Symptoms
- Pain when sitting or standing
- Swelling of the cyst
- Reddened or sore skin around the area
- Pus or blood draining from the abscess causing a malodour
- Hair protruding from the sinus
- Formation of more than one sinus tract, or holes in the skin
An infection may happen quickly or over a few days. It may also be a long term and recurrent issue.
Surgical treatment
This can be done as a day case or as an overnight case. The main types of operation are:
Lay open and ‘marsupialisation’
This involves opening the sinus to the outside (‘turning the tunnel into a gutter’), and placement of sutures around it to prevent premature closing over of the wound. This often involves a long oblique wound. The risk of wound infection with this technique is low, and although the wound can be slow to heal, there is a very low recurrence rate. Specialized vacuum dressings and careful wound dressings are usually used.
Excision and Primary Closure
This means removing the section of the skin which contains the sinus and stitching the skin back together. This very often incorporates a plastic surgical repair, called a skin flap, to move local healthy tissue into the area. The advantage of this, if successful, is that the wound heals quite quickly. This technique is usually reserved for pilonidal sinuses that have failed an initial simple lay open.
Post operative care
Looking After Your Wound
This depends on what type of dressing/stitches you have:
- Open, with a little dressing packed into the wound: This is to encourage the wound to heal from the inside out, preventing the sinus from coming back. The dressing needs to be changed frequently until the wound heals up. This can be done from home by the district nurse that will be arranged when you are discharged from the hospital.
- Open, with a specialized vacuum dressing: This is to encourage the wound to heal from the inside out, preventing the sinus from coming back. The dressing will need to be changed once every few days until the wound heals up. This technique expedites the wound healing rate.
Healing from surgery takes time. It is common for such wounds to take up to 3 months to heal, or even longer, depending on its size, and your health status.
Primary closure
Keeping the Area Clean
Keep the area clean by washing after each bowel movement, and also each morning and night. A shower spray can be helpful. Make sure all small particles of faeces (stool) are removed from the skin crevices around the anus.
Do not use soap- as this cause irritation. Use water and a soft cloth to clean the area. Avoid using talc powder. If you away from home, baby wipes can be used. Keep the area dry and dab gently with soft towel. A hairdryer can also be used at a cooler setting.
Always remove a damp or wet dressing and replace with a clean, dry one.
Wear cotton underwear if you have any. Avoid any type of restrictive underwear that presses the buttocks together, as free circulation of air will help keep the wound dry.
Do not use cream or ointment unless specifically prescribed by your doctor.
Keep your bowels regular and smooth by eating plenty of fruits and vegetables.
Drink plenty of fluids.
Avoid prolong sitting and straining when opening your bowel.
