Pilonidal sinus disease

Pilonidal sinus disease is a common condition that can affect both genders but is most common in males. It is a chronic skin infection in the groove between the buttocks (natal cleft) near the tailbone (coccyx). The most common cause for this is the blockage of a hair follicle or the trapping of loose hair in the area causing the formation of a cyst. It is more common in people that sit for prolonged periods of time.

Symptoms

The cyst can give you symptoms of:

• discomfort or pain at the base of the spine especially while sitting,
• a swelling or discharge through the skin leading to the formation of chronic tracts called sinuses which can intermittently discharge pus or blood.

On occasions an abscess can form becoming a surgical emergency potentially requiring surgical drainage of the abscess. If pilonidal sinus disease is not treated the symptoms become chronic and do not improve on their own.

Diagnosis

A history of your symptoms will be taken at the clinic and the diagnosis is usually confirmed through clinical examination of the relevant body area. On occasions further tests may be required such as a MRI or a flexible sigmoidoscopy or examination under anaesthesia in order to confirm the diagnosis and exclude other conditions that may mimic pilonidal sinus disease such as hydradenitis suppurativa, anal fistula or Crohn’s disease.

Treatment options

The only successful way of treating this is through surgery. The surgical option will depend on a number of factors including whether you present as an emergency with an abscess, or with a long standing problem for the first time or after previous surgery (recurrence). These include incision and drainage of the abscess, cleft closure or a Limberg flap. The various treatment options will be discussed with you at an individual basis.