Q. Is surgery the only option to cure pilonidal sinus?

Answered by Dr. Datta Ram Udayagiri and medically reviewed by iCliniq medical review team.

 

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Image: Is surgery the only option to cure pilonidal sinus?

Hello doctor,

I am a 26-year-old male. I have a sitting job (mostly eight to 10 hours a day with no exercise). I was diagnosed with pilonidal sinus a few months ago and was suggested a surgery. As it comes with a long recovery time, I never opted for it. One of the doctors suggested that I just live with it as it causes no harm if there is not much discomfort and pain. It is situated at the back (tailbone) photos attached. It normally pains (drain with pus/ blood) once a month and causes discomfort. So, I just apply betadine ointment till it is cured. It again comes back after few weeks or a month's time. So, I need your help and got few questions: What can be the possible cause of it?

Is surgery the only option to cure this or can I try something that can help me to escape from surgery? Someone suggested me to use salicylic acid pads to wipe the area twice a day. Will this work? Can you please suggest me anything else that can help me to get rid of it?

One doctor suggested that he will be keeping the wound open after surgery and other doctor suggested to use stitches once the surgery is done. Which method is more beneficial in case of a surgery? Also is there any chance of recurrence even after surgery?

I want to get a scan done of the area just to know if it is not critical as it has been more than one or two years I am having this problem. What scan is the best for this? MRI or CT scan? I will share the scan results with you in the next query.

Please share your consultation on the same. What do you suggest, please? Any medications, etc.? Can it worsen and damage other parts if delayed? Just worried as it has been long. Thanks and regards.


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Dr. Datta Ram Udayagiri
MBBS., MS (GERENAL SURGERY)., DNB ( SURGICAL GASTROENTEROLOGY
General Surgery, Surgical Gastroenterology

Hello,

Welcome to icliniq.com.

I have gone through the clinical images (attachment removed to protect patient identity).

The reason why this occurs is elusive, although many hypothetical explanations are given.

Surgery is the best and only curative option.

The wound can be closed without any problems after surgery. Keeping the wound open is an outdated technique of operation.

Generally, no scan is advised. You can get an MRI if you want to get it done but it will not be of great help.

Do not worry. It is not a life-threatening condition. It will not spread to other parts of the body.

It is an easily treatable condition. You should go and get it operated. I would advise you to reduce weight, and check blood sugars, and BP.

For more information consult a general surgeon online --> https://www.icliniq.com/ask-a-doctor-online/general-surgeon

 

Hello doctor,

Many thanks for your reply. Attached is my MRI for the same. I would like to have answers to the following questions, please.

  1. What is your call on the MRI scan report in easy language?
  2. Is operation the only cure possible? Or can it be treated with any medicines?
  3. Is there any chance of it getting worse if I postpone the operation for six months? Will it increase with time?
  4. In case of operation, how much time I will have to be on complete bed rest? Will I be able to sit and work as my job is of a web designer? So, I need to sit in front of the PC for eight hours a day.
  5. What is the recovery time after the operation? Is it painful?
  6. I have read somewhere that the possibility of recurrence of a pilonidal cyst is a lot higher even after an operation, is it true?
  7. Someone suggested me to go for Ayurvedic Ksharsutra surgery. Is it a better choice?
 

Dr. Datta Ram Udayagiri
MBBS., MS (GERENAL SURGERY)., DNB ( SURGICAL GASTROENTEROLOGY
General Surgery, Surgical Gastroenterology

Hello,

Welcome back to icliniq.com.

MRI is fine. It shows a pilonidal sinus. A surgery is the only curative option. Medicines are not useful except for some antibiotics when there is an active infection.

Postponing may make it worse. The tract can extend in size and length, side tracts can form especially if there are repeated infections. It is simpler to get operated when it is small and not infected.

You can sit and work in a few days time. There will be a pain for first two to three days. Now, there are excellent pain medications. You can go back to work in a week's time and slowly resume your busy schedule. Recovery will take one week approximately. There will be some pain, but tolerable. Pain is a very subjective symptom, it depends on how you react to pain.

It can recur but if the tract/ cyst is completely removed, the chance of recurrence is very very low. Do not worry about it. Surgery is the best treatment. Ksharasutra is not for pilonidal sinus as far as I know. It is for fistula-in-ano, a totally different condition. You should not go for Ksharasutra. It is not helpful for this condition as far as I know. Do not be too anxious about this. It is a common and simple condition to treat. Go ahead with surgery.

For further queries consult a general surgeon online --> https://www.icliniq.com/ask-a-doctor-online/general-surgeon

 

Thank you doctor,

I got my surgery done by a plastic surgeon. He closed the wound with stitches. Attached is the photo of thing that was removed. I am still in the hospital. It is day-3 today. I have an attached drain pipe with my wound. Please help with following questions.

  1. What you figure out by seeing the attached photo of the sinus removed? Is it big? Is it completely removed? What is that black thing in there just curious.
  2. What should be my diet? I am just taking liquid diet mostly juice and milk till now. Anything specific which can help it heal faster?
  3. What precautions should I take care now?
  4. How much time do you think it will take to heal?
  5. The doctor suggested to buy a tube to sit but that was not available, so I ordered this cushion online. Is it the right thing or should I go for the tube only?
 

Dr. Datta Ram Udayagiri
MBBS., MS (GERENAL SURGERY)., DNB ( SURGICAL GASTROENTEROLOGY
General Surgery, Surgical Gastroenterology

Hello,

Welcome back to icliniq.com.

I am glad that you finally got your surgery done. The doctor has done a perfect job. It is a clean and perfectly fine surgery. For the completeness, please ask the surgeon, he will tell you. It was probably a straight tract. So, it looks long, with few side tracts. Take high protein diet. Gradually you can resume your regular diet. There are no specific precautions. Take some rest for few days until the wound heals well and the pain goes off. Try to sleep on the sides rather than the back till the wound heals well. You can go back to work after the wound heals. The wound would heal fast as it is primarily closed with stitches. In 10 to 14 days, the wound heals unless there is an infection. The cushion is fair enough, but the ring seat would have been better.

For more information consult a general surgeon online --> https://www.icliniq.com/ask-a-doctor-online/general-surgeon

 

Hello doctor,

Thanks for the reply. I got relieved from the hospital today. I got few questions:

  1. On my left hand, there was drip needle installed all four days. I attached the photo. Can I clean those red spots with spirit? Also, can I apply betadine where the prick was done with the needle? It pains on that hand at some positions when I touch, the nurse said it is because of clots formed inside. Is it normal? Will this go back to normal automatically with time? That left hand itself feels numb many times a day. Is it normal because there was not much movement in that hand in that time period?
  2. It is rainy winter days here. Do I need to take any specific precautions? The doctor said he will change the dressing of the wound in few days. And then on the 12th day, he will remove the stitches. I am curious to know if I will be given a spinal block again to remove stitches and is it painful to remove them?
  3. I did not have any fever while I was admitted there. While tonight, I just noticed fever to be 99. Is it normal?
  4. What are the symptoms of infection? What can I do to prevent it from getting infected? When should I report to a doctor in case of emergency?
  5. While using the toilet seat, I splashed little water on the dressing while using a jet. Will it be harmful or is it fine?

I am really thankful to you for all the help and will always keep you posted.

 

Dr. Datta Ram Udayagiri
MBBS., MS (GERENAL SURGERY)., DNB ( SURGICAL GASTROENTEROLOGY
General Surgery, Surgical Gastroenterology

Hello,

Welcome back to icliniq.com.

  1. Yes, you can clean it with spirit. It will be fine in a few days time.
  2. Just keep the dressing changed and wound examined on alternate days. There is no need for spinal for suture removal.
  3. If the wound is fine (not infected) then look if you have cough or urinary tract infection which can cause fever. If none, then no need to worry.
  4. Increasing pain, discharge from the wound and fever are the signs of infection.
  5. Change the wet dressing.

My pleasure to answer your queries. Hope my suggestions were useful.

For more information consult a general surgeon online --> https://www.icliniq.com/ask-a-doctor-online/general-surgeon

 
 
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