What is a Pilonidal Sinus & how does it occur?

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The natal cleft is a region of the body that is located between the buttocks in the lower back and extends towards the anus. Hair can fall into this region or grow inwards into the skin of this region. The movement of the buttocks can cause further penetration of this deeper into the skin especially where there maybe small pits or dimples in to the skin. Bacteria can be carried with this hair and result in infections forming of this area under the skin and result in pilonidal abscesses (collection of pus under the skin in this area).

 

Deep infections of the skin that fill with pus mixed with blood will naturally form a tract to the surface to expel the collection which is called a pilonidal sinus. With more complex disease over time, there maybe multiple tracts formed of area which may require more complex treatment. Symptoms result in recurrent infections requiring antibiotics, recurrent pain that relieves after discharge, recurrent discharge from a small sinus opening and larger collections requiring an incision and drainage of the abscess.

 

This condition mostly occurs in young men (1 in 100) and is less common in females. It is thought that hormones is a risk factor for the formation of some pilonidal sinuses.

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What treatment is available?

 

General Advice

 

• Depleting the natal cleft of hair: Regularly removing hair from the natal cleft with waxing or hair depleting creams will reduce the risks of hair penetrating the skin and causing infections.

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• Keeping the area clean: Regularly cleaning the pilonidal area and patting dry can keep the area clean reduce risks of infections.

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• Antibiotics: When there are signs of infection with pain, redness, swelling and little discharge, antibiotics can help.  This is extremely important to help keep your stools soft. Fibre and bran intake alone will constipate without adequate fluid intake.

 

 

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What happens without an operation?

 

The pilonidal disease and abscess will continue to recure and may over time become larger, cause more complex sinus tracts and sometimes cause generalised sepsis (infection spreading to the blood and rest of the body). An operation at a later time can be more extensive and have higher potential complication rates.

 

What does an Operation Involve?

 

An operation in the acute stages of an infection and abscess will be aimed at evacuating the pus which will help relieve pain, limit infection and aid interim healing. It is done under either local or general anaesthetic.

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Once under anaesthetics, the surgeon will make a cut over the abscess and drain the pus. Unhealthy tissue is removed and the abscess cavity is washed out. The skin over the abscess is removed, thereby limiting the skin regrowing too soon which will lead to the abscess reforming quickly. Once the skin is removed, packing of material is placed into the wound.

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The packing will need to be changed every 24-48 hours until healed. The aim is to allow the wound to heal from the deep base of the wound to the superficial surface and prevent the top layers closing over (which will lead to the abscess reforming within a closed cavity).

 

Before the operation ensure you tell your specialist and anesthetist about all medication you take. You will usually also have a pre-assessment appointment to ensure you are optimized before your surgery.

 

General recommendations for all operation is to reduce or stop smoking as this decreases complications of wound infections, breakdown, chest infections and longer term health problems. Regularly exercising even leading up to your operation has shown to improve on outcomes post-operatively by leading to better ‘pre-habilitation’.

 

On the day operation day.  The procedure is usually done as a day case procedure and therefore be admitted and discharged from the hospital on the same day. After the anesthetic, you will be given local anesthetic to help with any pain post-operatively and may be given antibiotics.

 

 

Potential Complications

 

Complications can be both general for any operation and specific for the particular procedure.

Complications are rare but all of the potential ones are listed below.  Your specialist will be able to go over specific ones with you.

 

General Complications:

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• Pain: Local anesthetics at the time of the operation will be given and you should take regular pain killers after the procedure.

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• Bleeding: Bleeding can happen during or after the operation and is more common if the wound is left open.  

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• Infections: This usually causes a high temperature, and possible pus from the operation site.

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• Blood clots in the legs or lungs: Keeping mobile is important to prevent this along with the use of TED stockings.

 

Specific Complications:

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• Slow healing: If the wound is packed then healing can take up to 8 weeks and sometimes longer.

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• Numbness: One in 9 people can develop numbness of this area which may start to resolve over time.

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• Recurrence: This can be reduced by using the recommendations above under general advice for management of pilonidal sinuses. Recurrence is around 1 in 9 people.

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Recovery from the Operation

 

Following the operation, you will be wake up in recovery and usually go home the same day. You will require a responsible adult to be with you at home for the first 24 hours and have access to a telephone in case you help or advice is required. It is important to continue to take regular pain killers. You may also be given antibiotics following your operation.

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It is likely that you will require definitive surgery to prevent recurrence of the infection if you have multiple flare-ups.

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Activities following surgery

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For the first 24 hours following a general anaesthetic or sedation, do not drive, operative machinery, carryout dangerous activities, drink alcohol or sign legal paperwork. You can usually start driving once you can control and make an emergency stop. Ensure you are comfortable to drive before starting.  It is important to be mobile to avoid blood clots and may need to wear stockings to prevent these. Depending on the procedure and on the type of work you do, you can usually return within 3-4 weeks. You may require some time off for packing/dressing changes.

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Regular exercise once your wound has healed will help you to return to normal activities.

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You will usually have a follow-up after your operation between 4-12 weeks depending on the operation carried out.