Table of Contents
Introduction
A small tunnel forms at the top of the crease in the buttocks. This crease is known as the pilonidal sinus. The pilonidal sinus does not need to be treated unless it becomes infected. The sinus goes unnoticed until it starts causing discomfort. When symptoms like abscess or pus and pain start at the site of the pilonidal sinus, then it is called infected. The word pilonidal comes from Latin, where “pilus” means hair and “nidus” means nest. This term came into existence in the 1800s. It is stated in some research that the occurrence of pilonidal sinus is rare after the age of 38. The probability of pilonidal sinus occurrence is higher in males than in females. This condition is more common in people with sitting jobs, such as taxi drivers. Young adults below the age of 38 suffer more from pilonidal sinus. The pilonidal sinus mostly contains hair and debris of skin and smells foul. It is a painful condition.
What Is a Pilonidal Sinus?
A pilonidal sinus is defined as a small tunnel or a hole in the skin at the top of the cleft of the buttocks. It can be filled with fluid or pus, causing the formation of an abscess or a cyst. A pilonidal cyst generally contains hair, dirt, and debris. It causes severe pain and can eventually become infected. If it becomes infected, it may ooze out pus and blood, and the sinus can get malodorous. Pilonidal cysts mostly occur when hair pierces into the skin and becomes embedded. The cyst can be drained through a small cut in the skin. In some cases, surgery is needed. The pilonidal sinus occurs after puberty when sex hormones are understood to affect the pilosebaceous gland and change the healthy growth of body hair.
What Causes Pilonidal Sinus?
The exact cause of this condition is unknown. Still, it is believed to be a combination of changing hormones (as it occurs after puberty hits the person), spending a long time sitting, hair growth, and friction from clothes. Activities that cause friction, like sitting, may force the hair growing in the area to tunnel back under the skin. The body considers this hair as foreign and launches an immune response against it, similar to how it would react when a splinter is stuck under the skin. This immune response creates the cyst around the hair. Sometimes a person can have multiple sinuses that link to each other under the skin. Excessive sweating can also contribute to the formation of a pilonidal cyst and may initiate moisture and it may fill a stretched hair follicle, which helps develop a low-oxygen environment that stimulates the development of anaerobic bacteria, frequently seen in pilonidal cysts. The existence of bacteria and low oxygen levels inhibit the process of wound healing and worsen a forming pilonidal cyst. Trauma is not considered one of the causes of the formation of the pilonidal sinuses. Excessive sitting puts extra pressure on the coccygeal area; hence, the pressure forces the hair to pierce back into the skin, and thus, sinuses may be formed.
What Are the Symptoms of a Pilonidal Sinus?
One may not have any noticeable symptoms at first other than a small depression that looks like a dimple on the skin's surface. However, once the infection manifests in the depression, it will quickly become a cyst. A cyst is a closed sac filled with fluid or an abscess. An abscess is a swollen and inflamed tissue where pus gets collected.
Following can be some of the symptoms of a pilonidal sinus:
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Near the buttock crease, a pit may occur.
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Inflammation and swelling of the skin.
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Pain.
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Oozing blood or pus from an opening in the skin.
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A foul smell from the draining pus.
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Uncontrolled or unexpected moisture in the area of a tailbone.
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Opaque, yellowish, purulent discharge from the sinus.
Some people can also be asymptomatic after the formation of the pilonidal sinus.
What Are the Risk Factors for the Formation of Pilonidal Sinuses?
Some of the factors that may increase the risk of the formation of pilonidal sinuses are given at the following points:
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Being overweight can be one of the major risk factors.
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Being a young male below the age of 38 years.
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Having a thick and hard type of hair.
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Being inactive for long periods of time.
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Sitting for longer periods of time.
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Being unhygienic.
What Are the Treatments for Pilonidal Sinus?
There are various treatment ways for eradication of pilonidal sinus, depending on the size of the sinus, whether it is occurring for the first time or the symptoms. The following are some of the treatments to treat pilonidal sinuses:
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Drainage and Incision: This procedure is done in a hospital setting for an uncomplicated abscess. A small hole is made in the skin to drain the pus. The patient is administered with local or general anesthesia, depending on the sinus size. The patient is discharged after 12 to 14 hours, and the dressing has to be changed regularly. Recovery time is four to seven weeks for this procedure.
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Open Healing and Wide Excision: Surgery becomes mandatory for a large or recurrent infected sinus. This procedure is carried out in a hospital environment. The patient is administered with general anesthesia. The sinus is excised out, and some skin surrounding it is removed. The wound is then left open to heal innately. The patient may leave the hospital on the same day. The dressing has to be changed every day. The probability of the sinus occurring again is less. The recovery time is about six to 11 weeks.
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Wound Closure and Excision With Flattening of the Groove in the Middle of the Buttocks: Surgery becomes essential when there is a large sinus that gets repeatedly infected. The sinus is cleared, and an oval-shaped skin flap is cut out on either side. The two sides are stitched and joined. This procedure is done under general anesthesia in a hospital setup. The patient may go home the same day, and the stitches should be removed 10 days after the operation. The recovery time is faster than the open healing and wide excision procedure. The drawback of this procedure is that infection may occur again at the operation site.
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Endoscopic Ablation for Pilonidal Sinus: An endoscope is a thin, flexible tube with a camera on the end that gives a clear view of the affected area. Hair and infected tissues are removed under spinal or local anesthesia, and the sinus is cleansed with a special solution. Heat is used to pack the sinus. This procedure is less invasive, and there is no need for a cut. Recovery time may take up to one month or a few days lesser than that. The success rate is good, and there are low amounts of risk present.
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Conservative Treatment: If the diagnosis is made early and there is severe pain but no inflammation, then the physician may prescribe the patient a broad spectrum of antibiotics to minister the infection. This may not heal the sinus but can relieve the patient from discomfort and pain. The physician may direct the patient to regular follow-ups and advise to keep the area clean and take care of overall hygiene.
Conclusion
One can prevent the recurrence of pilonidal sinus by washing the area daily with mild soap, making sure there are no remains of the soap, keeping the area totally dry, and avoiding long periods of sitting. Some people may have pilonidal cysts that become infected repeatedly over a long time. Without treatment, such people can be at advanced risk of skin cancer known as squamous cell carcinoma.
