Pilonidal Sinus

What is a pilonidal sinus and how does it develop?

The disease is usually seen in young, hairy men, but it can also occur in less hairy men and in women. Commonly known as pilonidal sinus, it is the embedding of hairs under the skin, most often in the sacrococcygeal (tailbone) region, the infection of this pocket, and its subsequent transformation into a discharging abscess. The disease is fundamentally an infection of the subcutaneous tissue. Besides the tailbone region, it can also be seen in the groin, the navel and the armpit. Although the exact cause is not fully known, it is thought to develop when small infections of the hair roots in the tailbone region gradually expand, and hairs become lodged in this inflamed pocket through sitting and hip movements.

How is a pilonidal sinus recognized?

Because the disease occurs in an area that the person cannot see, it is noticed after the complaints it causes. If there is discharge, pain, swelling or a foul odor in the tailbone region, a physician must be consulted without delay. The disease is often mistaken for a small pimple and is expected to heal on its own. When the tailbone region is examined, very small holes or swelling may be seen along the midline; rarely, the disease may develop without any hole. The disease manifests itself with complaints that begin within a day or two and cause pain and swelling, such as a pilonidal abscess, or with long-standing discharge and itching.

Which department should be consulted for a pilonidal sinus?

For its diagnosis and treatment, consultation with a general surgery specialist is required.

How and when is it treated?

It needs to be treated as soon as it is detected. This is because a pilonidal sinus does not heal on its own; on the contrary, the affected area grows over time and, if neglected, may involve a wider area, so that a larger amount of skin and subcutaneous tissue may need to be removed during surgery. The basic treatment of a pilonidal sinus is surgical removal of the affected area. In suitable patients, non-surgical applications using certain chemical agents may also be used. However, if an abscess forms, the abscess must be drained surgically without delay. If a physician is consulted before an abscess develops, definitive surgery is planned. Contrary to common belief, patients do not need to lie face down for a long time after pilonidal sinus surgery. During this rest period, the patient may lie in any position they wish, walk around, and take a bath after 48 hours. They can return to daily activities 3-5 days after surgery. After surgery, the tailbone region must be kept dry and hair-free. For this purpose, hair removal with depilatory creams or laser epilation is helpful. With a properly selected treatment method and in experienced hands, recurrence is not as frequent as is believed. Some of the recurrences can be treated with dressings.

How can it be prevented?

Considering that you cannot change your anatomical characteristics, keeping the area hair-free, avoiding prolonged sitting, and keeping it dry frequently if there is sweating in the area may reduce the likelihood.

What should be considered after treatment?

Keeping the area hair-free, having a close relative check the area frequently for the formation of new holes, and avoiding prolonged sitting are the matters you should pay attention to.