WHAT IS A PILONIDAL SINUS ?

A pilonidal sinus, also known as a pilonidal cyst or sacrococcygeal fistula, is a small tunnel or tract that forms under the skin, usually at the base of the spine near the tailbone (coccyx) or in the cleft between the buttocks. It typically occurs as a result of hair penetration into the skin, leading to inflammation, infection, and the development of a cyst or sinus.

WHY DO  PILONIDAL SINUS OCCURS

The exact cause of pilonidal sinus is not entirely clear, but it is believed to develop due to a combination of factors, including:

1. Hair Penetration : One of the primary contributing factors is the penetration of hair into the skin in the coccygeal or sacrococcygeal area (near the tailbone). Loose or ingrown hairs can enter the skin and trigger an inflammatory response.

2. Friction and Pressure : Pilonidal sinuses are more common in people who spend extended periods sitting or engage in activities that involve a lot of sitting, leading to increased friction and pressure in the buttock area. This may contribute to the formation of the sinus.

3. Heredity : Some individuals may have a genetic predisposition to developing pilonidal sinuses, as a family history of the condition is often observed.

4. Poor Hygiene : Inadequate hygiene in the affected area can also play a role in the development of pilonidal sinuses, as sweat, dirt, and bacteria can accumulate and lead to infection.

5. Obesity : Being overweight or obese can increase the risk of pilonidal sinus, as excess body weight can lead to more pressure on the buttocks and coccygeal area.

6. Tight Clothing : Wearing tight or restrictive clothing that rubs against the area may contribute to irritation and the formation of pilonidal sinuses.

TYPES OF PILONIDAL SINUS 

Pilonidal sinuses can vary in terms of their presentation and characteristics. There are a few different types or forms of pilonidal sinus, including:

1. Pilonidal Abscess : This is a painful, swollen lump or collection of pus that forms in the pilonidal sinus or the surrounding area. An abscess may develop when there’s a significant infection in the sinus, causing a localized, painful swelling.

2. Acute Pilonidal Sinus : In this form, the pilonidal sinus becomes infected and inflamed suddenly. It often results in symptoms such as pain, redness, and swelling.

3. Chronic Pilonidal Sinus : A chronic pilonidal sinus is one that persists over a long period. It may be characterized by recurrent episodes of infection, abscess formation, and drainage of pus or blood. Individuals with chronic pilonidal sinuses often experience ongoing discomfort.

4. Primary Pilonidal Sinus : This is a form that occurs without a prior history of pilonidal disease. It typically develops as a result of hair penetration and other contributing factors.

5. Recurrent Pilonidal Sinus : Some individuals experience the recurrence of pilonidal sinuses, meaning that the condition returns even after treatment. This is more common in cases of chronic or complex pilonidal disease.

SYMPTOMS OF PILONIDAL SINUS  

Pilonidal sinus (also known as pilonidal cyst or sacrococcygeal fistula) can cause a range of symptoms, which may include:

1. Pain : Pilonidal sinuses often cause pain in the lower back, near the tailbone (coccyx), or in the buttock area. The pain can vary from mild discomfort to severe, acute pain.

2. Swelling : The affected area may become swollen and tender to the touch.

3. Redness : Redness may develop around the pilonidal sinus, indicating inflammation.

4. Drainage : Pus, blood, or a foul-smelling discharge may drain from the sinus. This discharge can soil clothing and may be noticeable on bedsheets or underwear.

5. Itching : Itching in the area of the sinus can be a common symptom, especially as the area becomes moist due to drainage.

6. Fever : If the sinus becomes infected, it can lead to a fever, along with other signs of infection, such as chills or general malaise.

7. Difficulty Sitting : Pain and discomfort often make it difficult to sit for extended periods, especially for individuals with pilonidal sinuses.

8. Skin Changes : Over time, the skin in the affected area may become discolored or exhibit inflammation due to recurrent episodes of infection.

Treatment of Pilonidal Sinus

 The treatment of a pilonidal sinus (also known as pilonidal cyst) can vary depending on the severity of the condition and the presence of symptoms. Treatment options include:

1. Abscess Drainage : If an abscess has formed, the initial step is usually to drain the pus and relieve pain and pressure. This is typically done under local anesthesia in a healthcare provider’s office or a hospital.

2. Antibiotics : If there is an infection, antibiotics may be prescribed to help clear the infection and prevent its recurrence.

3. Incision and Drainage (I&D) : In some cases, a healthcare provider may perform a minor surgical procedure to create an incision and drainage, allowing the sinus to drain and heal.

4. Wound Care : After drainage, it’s essential to keep the area clean and dry to promote healing. Dressings and proper wound care may be necessary.

5. Laser or Radiowave Treatment : Some healthcare providers use laser or radiowave treatments to remove the sinus and affected tissue. These methods may result in less pain and a faster recovery.

6. Excision Surgery : For recurrent or chronic cases, or when other treatments are not effective, surgical excision of the pilonidal sinus and any affected tissue may be necessary. Several surgical techniques can be employed.

7. Healing by Secondary Intention : In some cases, rather than closing the surgical wound, it is left open to heal naturally, which may reduce the risk of recurrence.

8. Hair Removal : Preventive measures include keeping the area clean, shaving the area to prevent hair from entering the sinus, and avoiding prolonged sitting.