Pilonidal sinus: causes, symptoms, diagnosis and modern treatment approaches

A comprehensive guide for patients and professionals

What is a pilonidal sinus?

A pilonidal sinus is a chronic inflammation in the area of the gluteal fold caused by hair growing into the skin. The hair leads to a foreign body reaction, which results in inflammation and the formation of pus. At an advanced stage, a pilonidal sinus can form fistulous ducts that open through the skin to the outside and secrete secretions.

A pilonidal sinus typically occurs in the gluteal fold as this is an anatomical region where friction, moisture and hair penetration are favored. It is more common in men than women and the peak incidence is between the ages of 15 and 35.

Causes and risk factors

The exact cause of pilonidal sinus is not yet fully understood, but experts believe that a combination of mechanical and anatomical factors are responsible for its development. The most common causes and risk factors are summarized below:

1. hair growth and hair distribution

The main feature of pilonidal sinus is the presence of hairs in the affected region. These hairs can penetrate through the skin into the subcutaneous tissue and cause a foreign body reaction. People with heavy hair growth in the area of the lower back and buttocks are particularly susceptible.

2. mechanical irritation

Mechanical stress, such as that caused by sitting for long periods or wearing tight clothing, increases the risk of developing a pilonidal sinus. Friction can cause hair to penetrate deeper into the skin, which promotes an inflammatory reaction.

3. overweight and obesity

Overweight people are more susceptible to developing a pilonidal sinus, as the skin folds in the buttock region are more pronounced in them, which leads to increased friction and increased sweating.

4. poor hygiene and sweating

Excessive sweating and inadequate personal hygiene promote the growth of bacteria in the gluteal fold, which increases the risk of infection.

5. inheritance

A certain degree of genetic predisposition may also play a role, with certain families being affected more frequently.

Symptoms of a pilonidal sinus

The symptoms of pilonidal sinus vary depending on the severity of the condition and can range from mild irritation to severe infection and abscess formation. The most common symptoms include:

• Pain in the gluteal foldEspecially when sitting or moving, pulling or stabbing pain may occur.
• Swelling and rednessThe affected area is often swollen and reddened, which indicates inflammation.
• Leakage of secretionIn many cases, pus or bloody secretions are discharged from one or more small openings in the skin.
• Formation of an abscessIn the case of serious infections, a painful abscess can develop which must be treated surgically.
• Chronic wound healingThis often results in a protracted and poorly healing wound that repeatedly causes inflammation.

Diagnosis of the pilonidal sinus

A pilonidal sinus is usually diagnosed on the basis of a clinical examination by a proctologist or surgeon. The doctor will examine the affected region for signs of swelling, redness and fistula openings. In advanced cases, it may be necessary to perform imaging procedures such as Ultrasound, MRI (magnetic resonance imaging) or CT scans (computed tomography) to determine the extent of the disease and the depth of the fistula tracts.

Treatment options

The treatment of pilonidal sinus depends on the stage of the disease, the severity of the inflammation and the individual needs of the patient. There are various treatment approaches, ranging from conservative measures to surgical interventions.

1. conservative therapy

In mild cases, where the inflammation is not yet very advanced, conservative therapy may be sufficient. This includes

• AntibioticsIn the case of bacterial infections, antibiotics can be used to combat the inflammation.
• Local careRegular cleaning of the affected area with antiseptic solutions can help to control the inflammation.
• Hair removalShaving or laser hair removal in the buttocks area can be useful to prevent hair from growing in.
• Avoid prolonged sittingPatients should avoid hard surfaces and move regularly.

2. surgical intervention

In most cases, especially with recurrent infections or abscesses, surgical treatment is necessary. There are various techniques for this:

• Incision and drainageIn the case of acute abscesses, the affected area is opened to allow the pus to drain. This provides the patient with immediate relief, but does not heal the underlying fistula.
• Excision and open wound healingThe entire fistula and the inflamed tissue are surgically removed. The wound remains open and heals slowly from the inside out. This method requires regular aftercare and dressing changes.
• Excision and primary sutureAfter removal of the inflamed tissue, the wound is sutured directly, which can shorten the healing time. However, the relapse rate is higher with this method.
• Flap techniquesIn the case of recurrent or extensive fistulas, so-called flap techniques can be used, in which the wound is covered with the body’s own tissue to support healing.

3. minimally invasive procedures

Today, minimally invasive procedures offer a gentler alternative to conventional surgical interventions. These include:

• Laser treatmentThe use of lasers allows fistula tracts to be removed precisely while sparing the surrounding tissue. This method leads to faster healing and less pain.
• Endoscopic proceduresEndoscopic techniques involve inserting a small instrument into the fistula tract to remove the inflamed structures from the inside. This minimizes the damage to the surrounding tissue and enables a faster recovery.

Aftercare and prevention of relapses

Aftercare following treatment of pilonidal sinus is crucial to prevent relapses. Important measures for relapse prevention are

• Regular hair removalIn order to prevent ingrown hairs, those affected should regularly shave the buttock crease or consider permanent hair removal, e.g. by laser.
• Good hygieneThorough cleaning of the buttocks area helps to minimize the risk of infection.
• Weight managementOverweight patients should try to lose weight to reduce friction and sweating in the gluteal fold.
• Avoiding prolonged sittingRegular Taking breaks while sitting and using soft seat cushions can help to reduce pressure and friction on the gluteal fold. For people with sedentary jobs, it is advisable to move regularly to minimize the strain on the affected area.

• Wear breathable clothingWearing loose-fitting, breathable clothing can help to reduce moisture and friction in the gluteal fold. Materials that are better at wicking away sweat, such as cotton or special functional clothing, are ideal.
• Regular check-upsIt is advisable to attend regular check-ups after treatment of a pilonidal sinus to ensure that healing is progressing correctly and that there are no signs of recurrence.

Forecast

The prognosis for patients with pilonidal sinus is generally good, especially with early diagnosis and appropriate treatment. Minimally invasive techniques and modern surgical procedures have significantly improved cure rates and reduced recurrence rates. However, the choice of the correct treatment method depends on the severity of the condition and should be made in consultation with an experienced proctologist.

The relapse rate varies depending on the form of therapy used. Conservative treatments tend to have a higher relapse rate than surgical or minimally invasive procedures. With minimally invasive procedures such as laser therapy, the relapse rate is generally less than 10%, whereas with open wound healing or primary sutures, the relapse rate can be significantly higher if insufficient attention is paid to aftercare.

When should you see a doctor?

It is important to act quickly at the first signs of pilonidal sinus in order to prevent the condition from worsening. Patients should always consult a doctor if:

• Persistent pain or swelling in the area of the gluteal fold.
• secretion escapes from fistula openings.
• Repeated infections or abscesses occur.
• The wound heals poorly or is constantly re-inflamed.

A timely visit to the proctologist can help to avoid more serious complications and initiate effective treatment.

Conclusion

Pilonidal sinus is a condition that is particularly common in young adults, but can be treated effectively with modern diagnostic and treatment procedures. While conservative treatments may be sufficient for mild cases, in many cases surgical or minimally invasive therapy is required to completely eliminate the condition. The choice of treatment should always be made in close consultation with an experienced specialist.

VenaZiel Berlin MVZ offers you as specialists in the field of proctology state-of-the-art treatment methods for pilonidal sinus, including minimally invasive laser therapies that ensure rapid healing and a low recurrence rate. With a focus on individual patient needs and comprehensive aftercare, we ensure that your quality of life is quickly restored.

If you have any questions about the diagnosis or treatment of pilonidal sinus or would like a personal consultation, we are at your disposal at VenaZiel Berlin MVZ at your disposal. Our experts will support you on the way to a quick and lasting recovery.