Service
Pilonidal sinus
- Section
- Services
- Specialist
- Op. Dr. Dilara Hasanova
- Clinic
- Modern Hospital, Baku
- The doctor's practice — examinations and treatments Dr. Hasanova performs herself
- General information — educational text about diseases and methods
What is a pilonidal sinus?
Short answer
A pilonidal sinus is a chronic inflammatory disease that develops in the sacrococcygeal (tailbone) area, in the cleft between the buttocks, when hairs and skin particles get under the skin. It shows itself as small openings in the skin, pain, swelling and a foul-smelling discharge. In everyday speech it is sometimes also called a “dermoid cyst,” but medically it is a different disease from a true dermoid cyst.
Who is it more common in?
- More often in young people and in men
- In people who sit for long periods (drivers, office workers, students)
- In people with dense hair growth
- In people who are overweight and in those who sweat a lot
- In people with a family history of this disease
Symptoms
- One or more small openings in the cleft between the buttocks, sometimes with a hair coming out of them
- Pain in the sacrococcygeal area, discomfort when sitting
- Swelling, redness
- Foul-smelling discharge containing pus or blood, soiled underwear
- With an abscess: severe pain, fever, inability to sit
The disease can take different forms
| Form | What is observed? | What is usually done? |
|---|---|---|
| Silent openings | No symptoms at present (there may have been mild symptoms in the past); one or more small openings are present | Observation, hygiene, hair removal; re-examination if symptoms develop |
| Acute abscess | Pain, swelling and redness that increase over a few days; sitting is difficult | Urgent drainage |
| Chronic sinus | Persistent or periodic discharge; the most common form | Planned surgery |
| Abscess with blocked discharge | The discharge has stopped, but pain and swelling have increased | Urgent intervention |
| Wound that does not close after surgery | The wound does not heal for a long time | Re-evaluation, repeat surgery when needed |
| Recurrence | Discharge or an abscess again some time after healing | Repeat examination and surgery |
Diagnosis
The diagnosis is made mainly by clinical examination. The doctor assesses the sinus openings and the inflamed area. In complex and recurrent cases, ultrasound or MRI may be used.
Treatment
General information
- For an acute abscess: the abscess is opened and the pus is released (drainage). After the inflammation subsides, the main operation is planned. Antibiotics alone do not cure an abscess.
- For a chronic sinus: the diseased tissue is removed (excision). The wound may be left open to heal, or it is closed away from the midline. One such closure technique is the Limberg flap: a diamond-shaped skin-and-fat flap is turned (by transposition) and moved into the defect area. With this technique the cleft between the buttocks becomes shallower and the risk of recurrence decreases.
- In selected cases, minimally invasive methods are also used.
- For small openings that cause no symptoms, observation and hygiene alone are sometimes enough. When there is pain, discharge or an abscess, the lasting treatment is surgical.
The doctor's practice
Examinations and treatments Dr. Hasanova performs herself
- For an acute pilonidal abscess, she performs drainage.
- In chronic pilonidal sinus, she removes the diseased tissue and either lets the wound heal open (open technique) or closes it with a Limberg flap.
After the operation
- The first dressing change is usually done after 24 h.
- It is important to follow wound hygiene and dressing-change instructions.
- Sitting is resumed gradually, in stages.
- Regular hair removal in the area reduces the risk of recurrence. Consult your doctor about the method (for example, laser hair removal).
- The healing time depends on the technique chosen.
Frequently asked questions
Will a pilonidal sinus go away with medication?
Medication can reduce the inflammation temporarily, but it does not remove the sinus tract. When there is pain, discharge or an abscess, the lasting treatment is surgical. For small openings that cause no symptoms at all, observation alone is sometimes enough.
What is a Limberg flap?
A Limberg flap means that, after the diseased tissue has been removed, the wound is closed with a diamond-shaped flap made from nearby healthy tissue. The suture line stays away from the midline, and the cleft between the buttocks becomes shallower. This is aimed at reducing the risk of recurrence.
When can you sit after the operation?
This depends on the surgical technique and the condition of the wound. Sitting is resumed gradually, in stages. The doctor determines the exact time at follow-up visits by checking how the wound is healing.
Can a pilonidal sinus come back after surgery?
Yes, recurrence is possible. The risk depends on the surgical technique chosen, wound care, and hair removal in the area. After the operation, hygiene and regular hair removal reduce the risk of recurrence.