What is pilonidal disease?

Learn more about diagnosis and treatment options for pilonidal disease, available at Cromwell Hospital.

Mr Nikhil Pawa, Consultant General and Colorectal Surgeon at Cromwell Hospital, explains what pilonidal disease is and the different treatment options available.

What is pilonidal disease?

The pilonidal sinus is a small hole at the top of the buttocks, where they divide. Sometimes, the sinus becomes infected, which is when treatment is needed.

An infection in the pilonidal sinus is also referred to as pilonidal disease.

What causes pilonidal disease?

It’s not clear what causes pilonidal disease, but it can be due to:

  • a hair follicle that has become irritated due to tight clothing, or sweating
  • hair growth or an ingrown hair
  • changing hormones

Pilonidal disease symptoms

If the sinus becomes infected, you may have the following symptoms:

  • redness or swelling
  • pain
  • pus or blood coming from an abscess
  • fever symptoms

Pilonidal disease risk factors

Factors that might increase your risk of a pilonidal cyst include:

  • being a young adult male
  • being overweight
  • being inactive and sitting for long periods of time
  • thick body hair
  • smoking
  • diabetes mellitus

Pilonidal disease treatment

Treatment is only needed if there are signs of infection.

The treatment will depend on your symptoms, the size of the sinus, and if you are having recurrent infections.

First infection

Usually, you will be treated with antibiotics, and the pus may need to be drained. This involves a hospital appointment, where a small hole will be made in the abscess. Depending on its size, you may be given a local or general anaesthetic. You can go home the same day and recovery takes between four to six weeks.

Recurrent infections

For recurrent infections, it may be recommended to have the sinus removed.

This may involve excision (removal) with either open healing or a closed wound.

When the wound is left open, the surgeon packs it with dressing. This allows the area to heal from the inside out. Recovery is longer, but the infection is less likely to return.

The surgeon may close the wound with stitches. This surgery has a shorter recovery time, but there is a greater risk of the cyst coming back or the wound opening.

You may also be recommended for EPSiT (endoscopic pilonidal sinus treatment). Your surgeon will use an endoscope (a thin, flexible tube with a camera on the end) to look inside your pilonidal sinus.

Alongside the endoscope, your surgeon will use small instruments to clean and treat the area. This is a minimally invasive procedure, where only small incisions are made, so there is less discomfort and recovery is quicker, with significantly less input required from community nurses.

About the consultant

Mr Nikhil Pawa’s special interests lie in the management of bowel cancer, diverticular disease, and other colorectal conditions, such as inflammatory bowel disease (Crohn’s disease and ulcerative colitis), rectal bleeding, haemorrhoids, anal fissure, anal fistula, and minimally invasive management of pilonidal disease (EPSIT procedure).

View Mr Nikhil Pawa's profile >

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