The information here is a guide and reflects only the views of Dr Slater, Prof. Fawcett and Dr Hodgkinson.
Literally meaning “nest of hairs”, a pilonidal sinus is a cavity under the skin that contains hairs. It most commonly occurs at the top of the natal cleft or more crudely – the butt crack. They can also occur in the belly button, between the fingers and on the sole of the feet. There are many theories as to how they occur. The most logical theory is that the hairs fall off the back and the head and land in the natal cleft. This friction and suction created here results in the hairs drilling under the skin. Over time, a small “pit” develops in the skin and continues to suck hairs into it. These sinuses are often there for years and the patient doesn’t know it. Often however, the sinus develops a bacterial infection. This results in an abscess causing pain, fever and an eventual discharge of pus from the sinus.
Pilonidal sinuses typically occur in people with course hair on their head and back. This is why they are most common in men. Women certainly do however, suffer from this disease. Sufferers tend to have a Middle-eastern or Mediterranean background. They also occur in people who work with hair e.g. hairdressers, horse workers. People that sit all day long are also at risk e.g. professional drivers – as there is a continual suction effect caused by sitting against a seat.
Interestingly, this is a disease of people between 15 and 40. The reasons for this are not known.
Often, these sinuses cause no symptoms at all. They are sometimes found during a routine medical check. More often however, they are found when they become infected. This is very painful and occurs suddenly. The patient will usually present to the emergency department.
The decision of remove an asymptomatic sinus is a difficult one and should be decided on a case by case basis. Not all sinuses will become infected. The recover from surgery can be very long, so repair of a sinus that is not causing trouble may not be attractive. Many want a pilonidal sinus repaired before they become infected, because this can occur at a very inconvenient time and has a higher risk of complications.
The treatment is different for an accidentally found, non infected pilonidal sinus and an inflamed one. An inflamed sinus requires urgent drainage done under general anaesthesia. A cut is made in the skin and the pus is drained. The cavity is then packed with absorbent material. The sinus is then allowed to heal from the bottom up. There will be a raw wound at the top of the natal cleft for many weeks. It will be quite sore for the first week and then you will be able to return to normal life wearing a pad in your underpants. A non inflamed sinus is treated by cutting out the entire sinus and closing the wound again. The aim with this closure is to flatten out the natal cleft and remove the suction effect that caused the sinus. It is common for these wounds to be infected and the stitches have to be removed early.
Like any surgery, there are small risks of severe allergy and even death during an anaesthetic. The complications specifically for pilonidal surgery are:
Every effort will be made to minimize the discomfort. Your surgeon and nurses will be monitoring your level of pain control frequently. Local anaesthetic will be used in the wound and lasts for about 12 hours. You will feel more comfortable lying on your side.
There are two major types of pain relievers after pilonidal surgery.
You will be amazed the power of regular panadol. It will cut down the need for the very strong pain pills. It does not cause constipation. Do not take more than 8 tablets a day.
Also excellent pain relievers. They do not cause constipation.Must be used very cautiously in the elderly and those with kidney problems.They may cause stomach ulcers. If you experience any pain in the upper abdomen you must stop this medication immediately and seek advice. It is uncommon to need anything stronger than panadol after you go home. Try and avoid codeine containing products – like Panadeine and Panadeine Forte, they cause constipation.
It is usual to return to a normal diet within a day of surgery. There are no restrictions. It is very common to feel slightly nauseated for 12 hours following surgery.
After any surgery a patient may have trouble passing urine. This is uncommon and usually temporary. Occasionally a catheter needs to be inserted to help you pass urine. There may be some disturbance to your bowels in the week after surgery. Discuss this with your local doctor if this occurs.
It is usual to be discharged one – two days after pilonidal sinus surgery. It is very important to begin light activity shortly after surgery. This is to prevent pneumonia, clots in the legs and loss of general condition. You should avoid strenuous activity until the sinus is healed.