A pilonidal sinus is a small lump in the skin that usually develops just below the tailbone. In some cases, it can become infected and may require surgical treatment.
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A pilonidal sinus is a small lump in the skin that usually develops in the area at the top of your bottom, just below your tailbone. In most cases it doesn’t cause symptoms and treatment is usually required if a cyst develops and becomes infected.
It’s not clear what causes a pilonidal sinus, but it often forms when hairs curl over and grow into your skin. This could be due to factors like a skin problem, pressure or friction that causes the hair between the buttocks to be pushed inwards.
Pilonidal sinuses are most common in young adults and teenagers and are rare in children and people over 40. They are also more common in men because males tend to have more hair in the buttock area.
In most cases, a pilonidal sinus won’t cause any symptoms so doesn’t require treatment. However, treatment is required if a cyst develops and becomes infected.
If hair becomes trapped in a pilonidal sinus, it can lead to a pilonidal cyst. This is a small, painless lump at the top of the cleft of your buttocks, which you might notice when washing yourself.
If a pilonidal cyst develops and then becomes infected, an abscess will develop.
If you have a pilonidal abscess, the swelling at the top of your buttocks will likely be painful and pus-filled skin. This can sometimes develop quickly making it painful to sit down. You may also notice that the abscess starts to regularly ooze blood or pus.
If there are no signs of infection, a "watch and wait" approach will be recommended to monitor a pilonidal sinus. In some cases, however, it’s recommended to remove any hair from the area to prevent it from curling over and growing into the skin to reduce the risk of a cyst forming.
If there is an infection, antibiotics are usually prescribed and painkillers can also be taken to reduce any discomfort. If your symptoms are very bad, if the abscess is large or if the infection keeps coming back, your consultant may recommend surgery.
The surgical treatment options for pilonidal sinus are:
Incision and drainage - a small cut is made in the abscess and any fluid is drained. This can be done under a local or general anaesthetic, depending on the size of the abscess. This is usually required only if an abscess has developed.
Wide excision and open healing - the sinus is cut out, some surrounding skin is also removed and the wound is left open to heal naturally. This can be done under a local or general anaesthetic and this type of surgery has the lowest risk of pilonidal sinus recurrence
Excision and Limberg flap reconstruction - the sinus and some surrounding tissue are removed and healthy skin is taken from another area of the bottom to cover the wound
EPSiT (endoscopic pilonidal sinus treatment) - a thin camera (an endoscope) is used to look inside the pilonidal sinus. Small instruments are then inserted through the endoscope to treat and clean the area. Heat is often used to close the wound and support healing. Sometimes this procedure is combined with laser treatment to achieve better results.
At OneWelbeck, all pilonidal sinus surgeries are performed on a day surgery basis, so you can return home as soon as the anaesthetic has worn off.
If your surgery requires stitches, they will be removed at a consultation around 10 days after your procedure. Complete healing takes around one month but can be quicker.
When surgery is not necessary, antibiotics may be prescribed and may be effective in treating the sinus.
At OneWelbeck, our consultants always aim to use minimally invasive approaches as the first line of treatment, to prevent the need for surgery as much as possible.
At OneWelbeck, our team of leading consultants offer world-class expertise and care in the diagnosis and treatment of pilonidal sinuses, cysts and abscesses.
With a focus on minimally invasive techniques, our specialists deliver patient-centred care within our state-of-the-art facilities to provide you with the best possible outcome.
While a pilonidal cyst can sometimes drain and disappear on its own, a pilonidal sinus will not close on its own.
No, not everyone has a pilonidal sinus. This condition affects around 26 in 100,000 people in the UK each year.
Yes, unfortunately, a pilonidal sinus can come back after surgery. The recurrence rate is around 15%, but this depends on the severity of the area affected and on the surgical technique used.
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