Pilonidal Sinus: Symptoms, Causes, Treatment and Cost

Pilonidal sinus referred as the bulge or hole in the skin at the top of the buttocks close to the cleft. It only needs treatment when it is infected. Usually, when the infection is in its early stage then it is not considered a serious situation. But if the infection spreads then it should be definitely taken seriously. Pilonidal sinus infection can occur for a number of reasons. It may be a skin problem, friction, or hair growth around the buttocks.

Summary- Pilonidal sinus mentions the condition of infection near the cleft where the buttocks divide. Symptoms of Pilonidal sinus may start exhibiting after infection.

Your pilonidal cyst will usually throw up symptoms once it gets infected. Upon being infected, your cyst becomes a pilonidal abscess and starts showing symptoms.

Symptoms of Pilonidal Sinus include-

• Pain near the tailbone: Pilonidal sinus disease symptoms announce themselves through considerable pain around your tailbone, so much so that it is difficult for you to sit or stand up without feeling any pain in the area.
• Swelling of the skin near the tailbone:Pilonidal sinus brings noticeable swelling above the cleft of the buttocks near the tailbone accompanied by itching.
• Sore skin and reddening:Sore skin with a visible redness of the skin around the affected area is a sign of pilonidal sinus.
• Tenderness:The area where the pilonidal sinus has struck is characterized by tenderness to the touch.
• Discharge of Pus: Discharge of accumulated pus from the infected area is another symptom of pilonidal sinus.
• Bleeding:Bleeding from a cyst or swollen, red area between your tailbone and the anus is also a symptom of pilonidal cyst disease.
• Foul smell from the affected area:Foul smelling discharge from a cyst or red, swollen area between your buttocks is a harbinger of pilonidal sinus infection.
• Fatigue, nausea and fever:Appearance of a cyst, reddishness, swelling, tenderness between your buttocks is often accompanied by feelings of extreme fatigue, nausea and fever in pilonidal cyst disease.

Summary- Foul smell, nausea, pain, swelling, etc. are some of the commonly experienced symptoms of pilonidal sinus.

• Ingrown hair

  One of the main causes of pilonidal sinus is ingrown hair. The growth of hair inside the skin instead of on the skin is referred to as ingrown hair. The human body defence mechanism system considers such ingrown hair as alien and triggers an immune-response reaction.Pilonidal cyst disease or pilonidal sinus is the outcome of such immune response.

• Long periods of sitting

  Remaining seated over prolonged periods prevents the cleft between your buttocks and the area around the tailbone from breathing. This leads to skin friction, and accumulation of sweat and dust and is one of the causes of pilonidal sinus.

• Hairy skin

  Hair follicles due to excessive skin hair penetrate into the skin, obstructing the natural processes of the skin cells. This paves the way for the development of pilonidal sinus.

• Excessive sweating:

  Excessive sweating without passage for sweat escape induces formation of bacteria. Coupled with lack of hygiene this becomes an inevitable cause of pilonidal sinus.

Summary- Hair, sweating, longer periods of sitting, and bumpy rides are some of the possible causes of pilonidal sinus.

Here are some tips that may help prevent pilonidal sinus:

1. Keep the area clean: Regularly wash the area with soap and water to reduce the risk of infection.
2. Remove hair from the area: Shaving or waxing the hair in the area may help reduce the risk of pilonidal sinus.
3. Maintain a healthy weight: Being overweight or obese can increase the risk of pilonidal sinus, so it's important to maintain a healthy weight.
4. Avoid sitting for long periods of time: Prolonged sitting can increase the risk of pilonidal sinus, so try to stand up and walk around regularly.
5. Wear loose-fitting clothing: Tight clothing can irritate the skin and increase the risk of pilonidal sinus, so it's important to wear loose-fitting clothing that allows the skin to breathe.

Prevention of pilonidal sinus is simple. You need to form a few easy habits to keep yourself safe from contacting a pilonidal cyst. These also help prevent the recurrence of the disease.

Summary- Pilonidal sinus can be prevented if we follow some steps vigilantly.

An infected pilonidal cyst is visible to the naked eye. Pay a visit to your doctor once you see the visual manifestation or even when you start to feel pain in your buttock area while sitting.

Summary- A pilonidal sinus can be observed easily.

Pilonidal sinus may possess some common complications, such as-

• recurring pilonidal cyst problems.
• infection or abscesses
• Cancer

Summary- Infections, chronic issues, or cancer in rare cases are some of the possible complications of pilonidal sinus.

1. Cleanliness
   A daily bath or shower using a mild antibacterial soap followed by a thorough drying of the area in the cleft is one of the best ways to wash away skin debris, kill bacteria, and decrease swelling around the pores.
2. Avoid Trauma by Sitting, Driving, or Riding
   It is necessary that persons with enlarged gluteal creases take extra care by avoiding directly sitting on the area, bumpy rides, or any other means that create trauma to the buttock area
3. Clothing Choices
   Loose fitting clothes should be worn to bring relief and allow drainage.
4. Hair Removal
   Hair must be removed from the affected area to avoid irritation.
5. Antisepsis
   Topical application of an antiseptic in the gluteal crease is known to have brought relief to patients suffering from pilonidal sinus. Some of the common natural antiseptics are:
   • Tea tree oil (not to be used when a cavity or tunnel has been formed)
   • Garlic
   • Fenugreek
   • Turmeric
   • Coconut oil
   • Epsom salts
   • Castor oil
   • Grape seed oil
   • Oregano oil
   • Aloe vera
6. Use of antibiotic ointments is usually discouraged.
7. Air Circulation
   Inserting a gauge pad ensures good air circulation between the buttock cheeks.
8. Dealing with an abscess
   It is important to drain fluid or pus from a pilonidal abscess through warm moist heat.

Summary- Home remedies are not enough for treatment so we must not rely on them completely.

We must be aware of the diet that we should follow to treat pilonidal sinus. We must include moderate quantities of protein and large quantities of fiber and nutrients to constitute a healthy diet. Some good options include-

• Bananas
• Carrots
• Sweet potatoes
• Apples,
• Pears,
• Beetroots
• Oats

Summary- We must be careful about our diets while recovering from a disease and include healthy meals vigilantly.

Unhealthy foods and foods that aid weight gain are not to be had when infected with pilonidal sinus. The foods to be avoided include:-

• Deep-fried foods: These are difficult to digest and require strain during bowel movement aggravating the pilonidal sinus condition.
• Junk food: Processed food lacks nutritious value and triggers health issues like blood pressure, cardiac disease etc. Sweetened desserts like ice-cream, readymade snacks, chips, cakes and other baked goods, sweets and candies, salad dressing, and sweetened carbonated beverages are all part of the list of junk food.
• Spicy food: Spicy foods bring about indigestion, even diarrhoea, leading to pain and excessive stress during bowel movements. For pilonidal sinus, these are sure shot means to worsen your symptoms. Having hot food and beverages (hot tea, hot coffee included) also harbours similar problems.
• Caffeine and other diuretics: Food and beverages that drain your body of water leave you dehydrated. Dehydration ushers in its own set of problems like constipation.
• Smoking: Smokers and obese persons are prone to pilonidal sinus infection.

Summary- These above-stated foods must be avoided to prevent complications.

Pilonidal sinus treatment varies depending on several factors. These factors are-

1. The size of your sinus
2. The symptoms you show
3. The nature of occurrence i.e. whether it is chronic (recurring) or the first instance.

Pilonidal sinus treatment is usually almost tailor-made i.e. your plan of treatment will be such that best suits your individual case history. To arrive at such a plan, you may have to undergo some detailed questioning to reveal whether:

• You had a pilonidal cyst earlier.
• You have or have had other skin issues like abscesses or any skin disease in the same area prior to this occurrence of pilonidal sinus.
• The pace of recovery that you have or have had, was fast or slow or normal.

The decision whether you require surgery or not for the cure of your pilonidal cyst will depend on the severity of your symptoms.

In the interim period between consultation and treatment to commence, you manage and mitigate your pain through the use of a warm compress on the affected area. This not only soothes your skin but also helps drain fluid and pus from the sinus.

Some relief from the pain is also obtained through the use of an inflatable seat or mattress.

The option for surgery is exercised in cases of chronic pilonidal cyst, or, a worsening pilonidal cyst that has turned worse and formed into a sinus cavity under your skin.

In some instances, it so happens that pilonidal cysts heal by draining and disappearing on their own. In cases of chronic pilonidal cysts, symptoms arrive and go over time.

Summary- Treatment of pilonidal sinus depends on several factors and includes different procedures too.

As per available information, the approximate cost for pilonidal sinus surgery varies between Rs. 40,000/- to Rs. 55,000/-. The actual cost will be let known to you by your treating surgeon.

Summary- The pilonidal treatment cost is usually observed between 40,000 to 50,000 rupees.

There always remains a chance of recurrence of pilonidal cyst even after surgery. The results of the treatment may or may not be permanent, especially for those with its chronic ailment.

Summary- Results of treatment usually vary with different patients.

Any person suffering from pilonidal sinus is eligible for its treatment.

Summary- People suffering from pilonidal issues need medical attention.

A person who does not show signs of infection is advised “wait and watch” and no treatment is given.

Summary- A person with no pilonidal issue needs no treatment.

After your surgery you will be handed over guidelines for post-treatment at discharge. In general, these guidelines may be followed:

1. Do not miss any follow-up appointments with your doctor
2. Get your wound dressed and cleaned as advised.
3. Follow medications prescribed
4. Avoid strenuous work and activities.
5. Use a doughnut cushion to sit.
6. Avoid sitting on hard surfaces for long periods of time.
7. Complete your full prescribed course for antibiotics irrespective of the fact that you may be feeling fine.
8. Get in touch with your doctor immediately in the event you develop -
   • Fever.
   • Draining of pus from the site of incision.
   • Encounter any increase in pain or swelling or feel warmth at the site, or any redness near the incision.

Summary- Post-treatment guidelines are necessary to smoothen the recovery phase.

Pilonidal sinus treatment usually does not trigger side effects. However, sometimes complications may arise out of pilonidal sinus surgery . These include:

• Poor healing of the wound.
• Feeling of numbness around the wound.
• Bleeding.
• Pain.
• Scarring of the wound.
• Allergic reaction caused by surgical equipment, materials or medications.
• Infection at the site or of the wound.
• Clotting of blood.
• Your surgeon and doctor will advise you on a course of medication and diet to ensure that such side effects do not arise.

Summary- The above-stated effects are some of the common adverse consequences associated with Pilonidal sinus treatment .

If you choose to leave your pilonidal sinus untreated, your acute pilonidal cyst i.e. pilonidal sinus is likely to become a chronic condition. This means you start to develop recurrent pilonidal cysts and, even start getting new pilonidal cysts. As time passes, your risk of developing a life-threatening systemic infection increases.

Summary- It will lead to worsening symptoms if we leave the pilonidal sinus untreated.

Pilonidal cyst and associated pilonidal sinus is a benign disease and rarely has any long term effects. There are isolated reports of its degeneration into malignancy or skin cancer. However, such instances are few and far between. Pilonidal sinus has a quite high rate of recurrence and thus needs multiple interventions. With nominal modifications in lifestyle and accurate diagnosis, the overall prognosis of pilonidal sinus disease is very good.

Summary- Pilonidal treatment possesses an overall positive outlook. We must be cautious because it might happen again.