Pilonidal Sinus

What is Pilonidal Sinus?

Pilonidal means “nest of hair”. A pilonidal sinus is a sinus tract, or channel, that tracks from the source of the infection to the skin.  It is usually noticed by a small opening in the skin where the buttocks separate. A pilonidal sinus can become infected and be painful. With this can be drainage of fluid or pus.

Pilonidal sinuses or cysts are thought to be caused by loose hairs piercing the skin. This is partly due to the natural folding contour of the buttocks.  Some factors that may increase the risk of developing pilonidal sinuses are:
  • Obesity 
  • Having a large amount of hair 
  • Local pressure or friction to the area 
  • Involvement in activities that demand lots of sitting
Pilonidal sinuses or cysts can happen to anyone, but are often seen in teenagers and young adults. They affect males twice as much as females. They are usually first identified by pain at the base of the back or what feels like a pimple or small lump at the base of the coccyx, between the buttocks.

While the disease does not cause life-threatening complications, it can have a profound impact on the quality of life of affected children and families due to symptoms and the challenges in healing the affected area, even after surgery.

How is it treated?

If the pilonidal is not causing any problems, it is recommended to keep the area clean and free of hair. To achieve this, we may recommend that the area be shaved. We may recommend this be done regularly with an electric clipper rather than a razor, as the clipper is less likely to cause excessive trauma to the skin.

Warm baths will help to decrease the pain as well as decreasing the chance of it forming a pus filled pocket.

You can tell if a pilonidal is infected if you notice a ball of pus with redness surrounding the area. The ball of pus is known as a pilonidal abscess. This can be accompanied by a fever. A first line of treatment for an infected pilonidal sinus or cysts is antibiotics and pain medicine. This may also require a minor procedure known as an incision and drainage, or I&D. This is done with either local anesthesia in the clinic or emergency room, or general anesthesia in the operating room.

Persistent pilonidal disease may require an operation. This can be done several ways:
  • Excision and healing by primary closure: This entails removal of the section which contains the sinus and closure of the skin and the defect at the time of surgery. This risk of recurrence is higher with this treatment. 
  • Wide excision and healing by secondary intention: Involves cutting out the sinus as well as the skin surrounding the sinus. The wound is left open to heal by natural healing. This treatment also involves post-surgical daily wound packing and dressing changes. This method can often take several months to heal. The risk of recurrence is lower.  In select cases, a wound V.A.C, or vacuum assisted closure, may be used rather than dressing changes, to promote wound healing. 
  • Reconstructive flap: This method involves removing the affected area, and closing the resulting wound with a flap of skin and subcutaneous tissue with stitches.  Often, a small plastic drainage tube may be left in place that will remain for 1-2 weeks to drain fluid from the wound cavity. The risk of recurrence is low.
Your surgeon will review with you the various surgical options and discuss which method may be best for your child.

What will happen in the hospital?

Your child will come in to the hospital and, depending on the status of the pilonidal and method of treatment, will be discharged the same day or be admitted. Generally, the operation is done as same-day discharge.

What will be my child's recovery?

  • Your child will usually be on pain medication, generally including a narcotic pain medicine. This usually requires use of an accompanying stool softener. 
  • It is recommended to keep pressure off the affected area. 
  • It is wise to keep the area free from hair. This can be done by shaving, laser hair removal or by other means. Even once the wound is healed, it is still important to keep it well shaved to avoid recurrence. 
  • If your child requires daily or twice daily dressing changes, a visiting nurse will be set up before discharge from the hospital. 
  • Recovery can take weeks to months, regardless of the surgical approach. We do not recommend participating in sports or any activities that will increase accumulation of sweat in the area.

What should I be looking out for after the operation? Hospitalization?

  • Recurrence (in the longer-term, over the first year after surgery) 
  • Drainage 
  • Swelling and redness 
  • Fevers 
  • Increased pain 
  • Initially, your child will be coming to clinic weekly for check-ups. If the wound is healing well, the visits will be spaced out.