Pilonidal sinus
This is an abnormal scarred tunnel in the skin between the buttocks, often associated with hair and skin debris.
They can discharge fluid, and can become troublesome if they block and cause an abscess.
It is thought to be due to a disorder of the skin glands, and is more common in hairy people, those who spend time sitting (taxi or truck drivers, IT experts), and those who are obese.
Can it be treated?
Yes, though surgical wounds in this area can be difficult to heal.
Treatment aims are two-fold:
- to treat your symptoms
- to maintain soft tissue coverage over your tail bone.
Treatment options
If the sinus causes you no problems, it is best to stay as you are, avoiding the risks of an operation
The only way of curing this condition is with surgery, normally performed as a day case.
There are a few different approaches:
- Lay open
A superficial sinus can sometimes be opened up to the surface with an incision, letting it heal from the base outwards. This leaves a scar.
- Endoscopic laser treatment
Some tracts may be suitable for keyhole treatment to clean out the tract. This avoids the need for large incisions, and recovery is usually very quick. This can reduce the discharge from the tract and cause it to scar and shrink.
- Excision and closure
Some tracts are large and complex, and may require excision of the affected skin and fat to treat them. The incision will be closed in a specialised fashion to reshape the contour of the buttock crease. This will leave a scar. You may have a small drain left in the wound for a week.
The main risk of this surgery is failure of the wound to heal, and can happen in up to 40% of cases. Healing is then very difficult, can take a long time, and may require further surgery to correct.
Laser ablation of pilonidal sinus
Laser treatment can help close the sinus and stop the problem from returning.
It is a simple surgical procedure. It is normally done under general anaesthetic as it is uncomfortable, but can be done under local if requested.
The tract is cleaned and washed out, and then a thin laser fibre is placed into the sinus opening. The laser light heats and destroys the inner lining of the sinus. The sinus then heals from the inside out, leaving a scar.
The treatment usually takes less than 1 hour.
I've had an operation
You will usually be sent home the same day, with instructions.
It is likely that you will have local anaesthetic around the wound, so some areas may be numb. This will wear off, and it is important to take regular paracetamol and/or ibuprofen for the first 5 days.
It is important that you follow instructions about wound care, and when to have the dressing removed, changed or checked.
You may go home with a surgical drain, which is a sterile tube allowing fluid to escape from underneath the wound. It is normally removed in clinic one week after the operation. If it falls out, then discard it.
Follow instructions about activities to avoid. Sometimes you might be asked to avoid sitting for 2 weeks after the operation, particularly if you have had a large incision and flap reconstruction. In this case, lying or standing will be perfectly safe.