All you need to know about Pilonidal Sinus

Herbert Mayo first described pilonidal sinus disease in 1833, with ‘pilus’ denoting hair and ‘nidus’ denoting nest and the disease is known to affect 26 individuals per population of 100,000.

When a small tunnel or hole forms within the skin, it is called pilonidal sinus (PNS). The hole is filled with pus or fluid and results in forming a cyst. PNS is found at the upper part of a human bottom. The cyst is filled with dirt, debris, and hair. PNS causes significant pain and can also become infected. Once infected, it secretes blood and pus with foul smells. 

Men are particularly vulnerable to this condition. It is common among younger people. PNS is more common among people with sitting jobs, such as cab drivers. 

What are the Causes?

Experts are yet to find the exact reason for this condition. Once we hit puberty, there are hormonal changes. These changes might increase the risks of PNS. It can also occur from the clothes we wear, friction, hair growth, or long sitting hours.

Sitting for long hours can force the hair in that region to disturb the skin. The body then starts an immune reaction against it. It results in cysts around the hair. Many sinuses can join beneath the skin and cause PNS. 

Signs and Symptoms 

It is critical to identify PNS and recognize the signs early on. The earliest sign includes small and dimple-like depression. This depression occurs on the skin’s surface. Once infected, this depression becomes a cyst. It is a closed and fluid-filled sac. It can also be an abscess or swollen tissue. The top signs & symptoms are: 

• Cyst swells up
• Pain while standing or sitting
• Sore and reddened skin around the place
• Blood or pus drains from the area
• Foul order of the pus 
• Hair protrudes from the infected area
• Many holes or sinus tracts within the skin
• A less common symptom is low-grade fever

Risk factors

Risk factors that increase susceptibility to PNS are: 

• Youngsters in their twenties
• Obesity
• Male sex
• Inactive lifestyle
• Unhealthy eating habits
• Work required long hours of sitting
• Coarse or stiff hair
• Excessive body hair
• Overweight or obesity
• Wearing tight clothes

What is the Treatment?

Treatment for PNS comprises medications, manual removal, injection, or surgery. The treatment options are: 

• Traditional treatment: Doctors suggest broad-spectrum antibiotics in early diagnosis. Symptoms include no severe pain and no inflammation. This antibiotic helps in treating several bacteria forms. The antibiotic is not used for healing the sinus tracts. Rather, it provides relief from discomfort and infection. Doctors then suggest a follow-up test. It is important to remove hair and shave. Keeping good hygiene is essential. 
• Lancing: It is a manual process of removing the cyst. The doctors cut the skin by using sharp equipment. This releases the infected matter. The method reduces symptoms from pus or abscess. Patients receive a local anesthetic before the procedure. Scalpel is then used for opening the abscess. The process cleans any hair, pus, or blood inside the cyst. 

A sterile dressing is used for packing the wound. This helps the wound to heal from the inside out. Healing generally occurs within three or four weeks. The process does not need further treatment.

• Phenol Injection: This treatment involves using chemical injection. The doctor first administers an anesthetic. It is followed by phenol injection. It is an antiseptic chemical compound injected into the abscess or cyst. This process is generally repeated many times. The lesion hardens and closes.

This treatment is rare due to the high rate of recurrence. Doctors often prefer surgery over phenol injection. 

• Surgery: Doctors suggest surgical treatment for many sinus tracks or recurring PNS. The first step is administering a local anesthetic. The surgeon opens the lesions and removes the debris and pus. The surgery is completed after stitching and closing the wounds.

It is important to know how to remove the dressings and make a fresh one. It is recommended to shave the site. This helps is preventing hair growth and opens the wound. 

Outlook

Pilonidal management depends on the wound’s severity, disorder, and treatment type. The PNS usually clears up after 4-8 weeks post-surgery. Return to the workplace is dependent on several factors. These include the type of procedure, ability to recover, and job type. Certain do’s and don’ts’ can help in quick recovery. 

Do’s 

• Keep the wound clean
• Check the affected site in regular manner
• Wear loose-fitting and comfortable cotton underwear
• Eat fiber to avoid straining during bowel movements
• Maintain a hygiene lifestyle 

Don’t 

• Avoid lifting heavy weights and objects
• Avoid strenuous exercise at least a few weeks after surgery 
• Avoid bike rides for a least six to eight weeks 
• Avoid swimming until the wound heals completely

Prevention 

Preventing PNS is easy. Improving daily habits can prevent them from recurring. These steps are: 

• Wash and dry your bottom area and private parts 
• Weight loss in case you are overweight or obese
• Avoid long hours of sitting. Engage in light walks while working
• Shave the area around your bottom. It is important to use good-quality hair removal products 
• You can also opt for permanent removal of hairs from the area 
• Routine checks of the area

Conclusion 

PNS is not a life-threatening disorder. Yet, it can create significant problems in daily life. Treatment becomes difficult once the cyst becomes chronic. So, it is important to seek expert help. Doctors recommend a quick diagnosis in case of any initial symptoms. It is important to have an honest conversation with the healthcare provider. This helps in the identification of symptoms and quick recovery. 

Medica Superspecialty Hospital, Kolkata’s Laser Proctology Program strives towards treating through the minimal invasive technique. Our renowned and experienced surgeons who will spend a significant amount of time with you in order to diagnose your condition. We have all types of diagnostic facilities available at our premises to provide you with the correct diagnostic results. All pre-surgery medical diagnostics are done for you right here at Medica.