Pilonidal Sinus

Pilonidal Sinus

Pilonidal Sinus

What is pilonidal sinus disease (PNS)?

A pilonidal sinus (PNS) is a small hole or tunnel in the skin. It may fill with fluid or pus, causing the formation of a cyst or abscess. It occurs in the cleft at the top of the buttocks. A pilonidal cyst usually contains hair, dirt, and debris. It can cause severe pain and can often become infected. If it becomes infected, it may ooze pus and blood and have a foul odor.

A PNS is a condition that mostly affects men and is also common in young adults. It’s also more common in people who sit a lot, like cab drivers.

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About Iranian Surgery

Iranian surgery is an online medical tourism platform where you can find the best Iranian Surgeons in Iran. The price of a Pilonidal sinus treatment in Iran can vary according to each individual’s case and will be determined based on photos and an in-person assessment with the doctor. So if you are looking for the cost of a Pilonidal sinus treatment in Iran, you can contact us and get free consultation from Iranian surgery.

Before Pilonidal Sinus Surgery


What are the causes of pilonidal sinus disease?

The exact cause of this condition isn’t known, but its cause is believed to be a combination of changing hormones (because it occurs after puberty), hair growth, and friction from clothes or from spending a long time sitting.

Activities that cause friction, like sitting, can force the hair growing in the area to burrow back under the skin. The body considers this hair foreign and launches an immune response against it, similar to how it would react when dealing with a splinter. This immune response forms the cyst around your hair. Sometimes a person may have multiple sinuses that connect under the skin.

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Signs and symptoms

You may not have any noticeable symptoms at first other than a small, dimple-like depression on the surface of your skin. However, once the depression becomes infected, it will quickly develop into a cyst (a closed sac filled with fluid) or an abscess (a swollen and inflamed tissue where pus collects).

The signs of an infection include:

. Pain when sitting or standing

. Swelling of the cyst

. Reddened, sore skin around the area

. Pus or blood draining from the abscess, causing a foul odor

. Hair protruding from the lesion

. Formation of more than one sinus tract, or holes in the skin

You may also experience a low-grade fever, but this is much less common.

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What complications are associated with pilonidal sinus disease?

There are a number of complications that may arise from PNS. These include wound infection and a recurrence of the PNS even after surgery.

Signs that the wound is infected include:

. Severe pain

. Inflamed, swollen skin

. A temperature of 100.4°F or higher

. Blood and pus seeping from the wound site

. A foul odor coming from the wound

How can I prevent pilonidal sinus disease?

You can prevent recurrence of PNS by washing the area on a daily basis with a mild soap, making sure all soap is removed, keeping the area completely dry, and avoiding sitting for long periods.

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During Pilonidal Sinus Surgery


A pilonidal sinus that's not infected

Treatment is not needed if there are no signs of infection. A "watch and wait" approach will be recommended.

It's very important to keep the area between your buttocks clean by showering or bathing regularly.

Do not shave the affected area unless a GP advises you to.

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Treatments for an infected pilonidal sinus

Treatment for an infected pilonidal sinus will depend on:

. Your symptoms

. The size of the sinus

. Whether it's your first sinus or it keeps coming back

A pilonidal sinus abscess will need treatment with antibiotics. The pus inside will also probably need to be drained.

There are a number of treatment options for a pilonidal sinus that keeps coming back and that's painful, bleeding or leaking discharge. Your doctor will discuss these with you.

In most cases you'll be offered painkillers, such as paracetamol and anti-inflammatories to help reduce pain and swelling.

Minor operation to drain pus from sinus

. Incision and drainage

Hospital procedure for an uncomplicated abscess. A small hole is made in the abscess so the pus can be drained.

. General anesthetic or local anesthetic, depending on the size of the abscess

. Hospital stay (you can leave the same day)

. Regular (daily) dressing changes

. Recovery time is 4 to 6 weeks

Surgery to remove sinus (wound left open)

. Wide excision and open healing

Surgery for a large or repeatedly infected sinus. The sinus is cut out and some surrounding skin removed. The wound is left open to heal naturally.

. General anesthetic

. Hospital stay (you can usually leave the same day)

. Regular (daily) dressing changes

. Lowest risk of sinus coming back

. Recovery time is 6 to 12 weeks

Surgery to remove sinus (wound closed)

. Excision and wound closure, often with flattening of the groove between the buttocks.

Surgery for a large or repeatedly infected sinus. The sinus is removed and an oval-shaped flap of skin cut out on either side of it. The 2 sides are stitched together.

. General anesthetic

. Hospital stay (you can usually leave the same day)

. Stitches removed about 10 days after the operation

. Quicker recovery time than wide excision and open healing

. Higher risk of infection (the wound may need to be opened and dressings changed regularly).

Procedure to clean sinus and encourage healing

. Endoscopic ablation for a pilonidal sinus

An endoscope (a thin, flexible tube with a camera on the end) is used to give a clear view of the affected area.

Hair and infected tissue are removed, and the sinus cleaned with a special solution. Heat is used to seal the sinus.

. Spinal or local anesthetic

. Hospital stay (you can usually leave the same day)

. Less invasive than surgery as no cut needed

. Good success rate with low risk of complications

. Recovery time is about a month to completely heal (but can be quicker)

Plastic surgery is sometimes used if the area being treated is particularly large. The sinus is removed and the surrounding skin reconstructed.

Less invasive procedures, like injection with fibrin glue, are also available in some places.

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After Pilonidal Sinus Surgery

Leaving hospital

You may be able to leave hospital on the same day as your operation. It is important that you rest for the remainder of the day to recover from the anaesthetic. You will need someone to help you home and stay with you for at least 24 hours after your surgery.

Will I have a dressing?

. Removal of your pilonidal sinus with stitches to close the wound

You will have a dressing over your wound and sometimes a dressing inside your wound. Please make sure you know if your stitches are dissolvable or if they need to be removed.

If they need to come out, you will need to make an appointment with the practice nurse at your GP surgery to do this. This normally needs to be done about 14 days after your surgery. Please ask your surgical team about this. We will arrange a follow-up appointment for two to four weeks after your surgery.

. Removal of your pilonidal sinus without stitches

You will have a dressing over the wound, and this needs to be replaced each day. Your doctor and nurse should have explained this to you in detail. You will need to arrange for your GP’s practice nurse to re-dress your wound each day until the wound has healed.


Will I have any pain?

As with all surgery, you should expect some discomfort. It can be quite painful for the first couple of days and it may seem like it gets worse before it starts to feel more comfortable again, but the pain will ease. When you leave the ward we may give you:

. Painkillers, if we give you painkillers, always follow the instructions on the packet and never take more than the recommended dose.

. Antibiotics, we may give you a course of antibiotics to take after your surgery. Make sure you take them as we will give you a follow-up appointment before you prescribed and complete the course.

Keeping your wound site clean

It is important to keep the area of the operation clean. We recommend that you gently bathe your wound in a warm bath every day, if you can link this in with removal of the dressings and replacing new ones. This may also help with your pain.

Do not use soap or put salt or any perfumed Leaving hospital products in the water until your wound has healed, as these can irritate the wound site. Do not be alarmed if you notice blood in the bath, as this is quite normal and will reduce in time.

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When can I return to work?

Most people take about a week to 10 days off work. However, this depends on how you feel, how active your job is, and which operation you have had. You should avoid any strenuous activity such as lifting, exercise or running during the first week or so. Do as much as you feel able to.

You should not go swimming until your wound has healed. However, you can have sex as soon as you feel comfortable. Do not ride a bicycle for six to eight weeks after your surgery.

Will my pilonidal sinus return?

They can return; this is why it is important that you attend your follow-up appointment. We will arrange this about two to four weeks after your surgery. At this appointment, the specialist will check your wound and will give you further advice on preventing any recurrence.

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