Pilonidal (sinus) disease

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Pilonidal (sinus) disease. General information.

The pilonidal sinus presents at the lower back of the spine, causing an internal inflammation which often may last many years. In fact, it is an internal tearing or opening of the skin (tunnel) that often gives the impression of a hollow under the skin surface. Pilonidal sinus usually occurs in young aged people rather than in elderly one, the majority of whom are male. Several sedentary occupations, such as those requiring long driving hours and office jobs, appear to be able either to cause or to assist in the formation of the pilonidal sinus.

Causes of pilonidal sinus.

Till now the causes which make a pilonidal sinus appear, are not entirely clear. Previously, it was thought that the creation of pilonidal sinus was mainly related to genetic and hereditary characteristics. After years of observation and research, it has been found out that several factors and habits can cause or accelerate the creation of pilonidal sinus. Currently, it is know well that hairs at the area play a definite role as they penetrate into the skin surface by piercing it and finally causing the inflammation. Usually, during the surgical incision of a pilonidal sinus, we will find a large number of hair that create contamination and inflammation. Intense hair growing is not the only issue. People who are overweight and have a sedentary life are prone to have a bigger problem. This is due to the fact that in a seated position, the pressure caused by the lateral movements can tear the skin. When this pressure is combined with the rubbing of the buttocks that are applied to the seat, then situation is getting even worse. The irritation of the region from all the above factors also contributes at the aggravation of the problem.

Symptoms of pilonidal sinus.

The symptoms of the condition are in correlation with the clinical condition or stage of the pilonidal sinus. Many times it does not cause symptoms for many years, and the patient either does not understand or get used to it. When an abscess has been created there, then the pilonidal disease is at its acute phase and the symptoms that are present are usually the pain (especially when the patient is trying to sit), irritation, blushing and itching. If the pilonidal sinus is drained through holes from which runs fluids (usually may be blood with pus), the patient often finds his undergarment wet and dirty. On the other hand, when the abscess is closed and cannot be drained (it fills with pus), the symptoms are more intense and accompanied by malaise and fever. In this case, the abscess may “erupt” and can be created a permanent tunnel beneath the skin (fistula), which necessitates surgical operation to be treated and get well. Patients who have a pilonidal sinus for many years usually mention that there is a simple bloating at the area, which during its inflammation (acute phase), it prevents their movements. Fever, that is high and cannot be retreated easily, is a sign that we need to visit a doctor. It is important not to carry on any final treatment, if we are not sure that inflammation has been firstly cured.

Treatment.

There are several treatment options for pilonidal sinus. Each operation is designed according to the stage of the pilonidal sinus. In case of a very large abscess that causes pain and fever, it is urgent to perform drainage of pus through surgical incision and then a very good wound debridement. This fact will relieve the patient, while it may be necessary to administer some antibiotics at the same time, in order to prevent the recurrence of the infection. However, antibiotics do not permanently solve the problem but simply “cover up” the situation by making milder the symptoms. In small cysts that do not inflame, a temporary solution is to remove the hairs that have been inserted with forcipes, while it is advisable that the area should be depilated. Depilation is a preventive measure because the hair are likely to cause the same problems again in the future.

However, the definitive solution is the total removal of the pilonidal sinus, especially in patients who have been suffering for many years. There are three surgical options: the closed method (by suturing the surgical wound), the semi-closed and the open (preferred when there is a fistula at the area) where no sutures are put and the wound remains open. At the last technique, wound has to be changed for several days (at least 1 month). Returning to patients’ activities is immediate especially when the open method is chosen. One of the benefits of the open method is that it reduces the likelihood of recurrence of the fistula on the contrary with the other two. In recent years, the surgical laser (Filac) method, which is widely advertised by most surgeons, is applied with good results, especially for the fact that it does not leave large incisions or scars. Sometimes the surgery must be repeated. Nevertheless, both doctor and patient should be very careful before choosing any of the currently present methods, considering primarily the clinical features of the pilonidal sinus (depth, width) and secondly the aesthetic part of the situation or the economic benefit.

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