Pilonidal sinus refers to the condition when small opening which is present in the skin, usually in gluteal cleft (in between the buttocks) to form the tract which is called as sinus. This sinus will eventually fill with fluid or pus and form a cyst/ abscess (a sac of fluid)
These sinus can discharge pus or blood contained in it and produce bad odour. This condition is more common in males, especially during puberty.
There are various theories described in literature about the cause of the sinus. However, skin rubbing against a hard object or other skin, sitting in a particular position for a long period of time, riding a bicycle, tight clothes or other such friction or pressure may be a cause of pilonidal sinus. This friction can give arise the hair follicle infection which penetrated eventually deeper in to the skin and fat of the tissue. This sinus tract usually grows towards anal region and can take multiple directions.
A person would not see any symptom initially except a small, painless lump. Although, if the lump gets infected, then it may turn into a cyst or an abscess (both are a kind of sac pack with fluid/pus). Apart from this, some symptoms may appear very late, that too can be chronic or last only for a short time. Such complexity can lead to a confusion and delay the treatment.
Below are some signs which can be noticed when the lump gets infected:
- Prominent swelling of cyst
- Redness around the infected area
- Low- fever
- Pain while standing or sitting
- Formation of many sinus track/hole.
- Smell caused by draining of blood/ pus
Usually after or during puberty, many males face this problem, taking care of hygiene and exercising regularly may reduce the chance of getting Pilonidal sinus. However, below factors may increase the risk of this condition:
- Sitting for prolonged period
- Bad personal hygiene
- Excess sweating
- Male sex
- Excessive growth of body hair
Diagnosis and investigations
The diagnosis of the pilonidal sinus is clinical diagnosis on our patient basis by the surgeon. Routinely once the diagnosis is ascertained the patients are advised blood investigations and magnetic resonance imaging of the pelvis to know the extent of the sinus tract especially in chronic and recurrent sinus disease. This helps the surgeons to plan surgery.
The mainstay of the management of the pilonidal sinus is surgery. The surgery is done using various techniques and methods. The aim of the surgery is to remove the entire diseased tract of the sinus to prevent the recurrence of the disease/ The commonly performed methods for surgery are pilonidal sinus excision using conventional open surgery, Laser ablation of the sinus and injection of the glue. The gap created after open surgery takes time to heal and many surgeons prefer to close the gap by using various flap techniques.
The advantages of laser ablation surgery for pilonidal sinus are early recovery, minimal wound and can be performed as day care surgery.
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