Pilonidal (sinus) disease. General information.

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

Causes of pilonidal sinus.

Till now the causes which make a pilonidal sinus appear, are not entirely clarified. 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 responsable for 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 find a large number of hair that cause 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 on the seat, making the situation 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 the stage of pilonidal sinus. Many times it does not cause symptoms for many years, and the patient either does not understand them or he get used to these. When an abscess has been created there, then the pilonidal disease is at its acute phase and the main symptom that it is present is 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 by itself (it fills with pus), the symptoms are more intense and accompanied by malaise and fever. In this case, the abscess may “erupt” and can create a permanent tunnel beneath the skin (fistula), which necessitates surgical operation in order to 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, which it is usually 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 at this moment, if we are not sure that inflammation has been firstly treated.

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 with the use of forcipes, while it is advisable that the area should be depilated. Depilation is a preventive measure because 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 later technique, wound has to be changed for several days (at least 1 month). Returning back to patients’ every day 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 rest of the techniques. 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 scars. Sometimes, the procedure must be repeated again. 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), secondly the aesthetic part of the healing and the economic benefit of the technique.