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Patient Information -  Pilonidal Sinus

  

 

 

1. What is a pilonidal sinus?
A sinus is a blind ended channel, a bit like a cul-de-sac. Pilonidal is the medical term for hair. A pilonidal sinus is therefore a channel in the skin that contains pieces of hair. They are most commonly found between the buttocks of people with hairy bottoms. They can occur in the hands of people who handle hair e.g. hairdressers. This information sheet concentrates on pilonidal sinuses of the bottom.


2. How do pilohidal sinuses form?
This is not fully understood but this is Mr Braithwaite's explanation: The cleavage between the buttocks is one of the few places in the body where the skin is attached to the skeleton. The attachments are tough bits of fibrous tissue between the skin and the sacrum (lower end of the spine). This means the skin here does not move much. When people with hairy buttocks walk, or move, the buttock cheeks rub together. Some of the hair gets pulled off by this movement and gets pushed into the skin of the cleavage. If you look at hair under the microscope, it looks a bit like a pine cone. The root of the hair gets driven into the skin but cannot come out as the 'leaves' of the hair keep it trapped, a bit like the barb of a fish hook. This means the hair gets pushed deeper into the skin. This forms the cul-de-sac containing hair - a pilonidal sinus.


3. What can happen to a pilonidal sinus?
Most of the time these sinuses cause no problems. They can sometimes be seen as pits in the buttock cleavage (natal cleft). The bottom is not a clean area so bacteria can get into the sinuses and cause an infection

Infection of a pilonidal sinus can cause problems:

a)     A smelly discharge 

b)    Bleeding

c)    Pain

d)    An abscess that may need to be drained or lanced in hospital


4. What treatment is available?
If you have a pilonidal sinus then you may need to see your doctor. If you have an abscess you may need an operation to drain the pus. Sometimes a course of antibiotics is all that is necessary.

If you have bad symptoms then you may benefit from removal of the sinuses and an attempt at correction of the underlying problem. There are various operations that have varied success and potential problems:

a)   Excision of the sinuses. This is the traditional treatment where the sinuses are excised. The wound is often large and can take many months to heal. During this time some people cannot return to normal activities.

b)  Bascom's procedure. This is the operation favoured by Mr Braithwaite. It can be done as a day case and does not normally leave a large wound. The success rate is about 80%.

c)  Karydakis procedure. This involves a plastic surgical type of operation and has about the same success as Bascom's Procedure.


5. What can I do if I have a Pilonidal sinus?
Do not worry. Many people have the problem. The best advice is to keep the butock cleavage area clean by regular bathing on a daily basis. It is the hair that causes the problem so removal is best. Either use a hair removing cream or get a partner or parent to shave the hair from the cleavage and about 5cm either side on the buttocks. Some people have had electrolysis to remove the hairs.

If you are bothered by the symptoms of a pilonidal sinus, discuss them with your doctor or arrange an appointment with Mr Braithwaite.