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

A comprehensive guide for patients and professionals

What is a Pilonidal Sinus?

The coccyx fistula often occurs in the gluteal fold. It occurs when hair grows 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. These ducts open through the skin to the outside and release secretions.

A coccyx fistula usually occurs in the gluteal fold. This region has a lot of friction, moisture and hair. It is more common in men than in women and the peak incidence is between the ages of 15 and 35.

Causes and risk factors

The exact cause of coccyx fistula is not yet entirely clear. Experts believe that mechanical and anatomical factors are jointly responsible. The most common causes and risk factors are summarized below:

1. hair growth and hair distribution

The main characteristic of coccygeal fistula 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 a Pilonidal Sinus. Friction can cause hair to penetrate deeper into the skin, which promotes an inflammatory reaction.

3. overweight and obesity

Overweight people have a higher risk of developing a coccyx fistula. This is because their skin folds in the buttock area are more pronounced. This leads to more friction and more 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 coccyx fistula (pilonidal sinus)

The symptoms of coccyx fistula (pilonidal sinus) can vary. They depend on the severity of the disease. The symptoms range from mild irritation to severe infections and abscesses. The most common symptoms are

• 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.
• Discharge of secretions: Pus or bloody secretions often come out of 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 coccyx fistula (pilonidal sinus)

A coccyx fistula is usually diagnosed by a clinical examination by a proctologist or surgeon. The doctor will examine the affected area for signs of swelling, redness and fistula openings. In advanced cases, it may be necessary to use imaging techniques such as ultrasound, MRI or CT scans. These help to determine the extent of the disease and the depth of the fistula tract.

Treatment options

The treatment of Pilonidal Sinus depends on the stage of the disease and the inflammation. The needs of the patient also play a role. 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 removal: To avoid ingrown hairs, shaving or laser hair removal in the buttocks area can be helpful.
• Avoid prolonged sittingPatients should avoid hard surfaces and move regularly.

2. surgical intervention

In many cases, especially with repeated infections or abscesses, surgical treatment is necessary to ensure complete healing. There are different surgical approaches depending on the patient’s condition:

• 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 suture: Once the inflamed tissue has been removed, the wound is sutured immediately. This can shorten the healing time. However, the recurrence rate is higher with this method.
• Flap techniques: Flap techniques can help with recurring or large fistulas. This involves covering the wound with the patient’s own tissue. This supports the healing process.

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 procedures: Endoscopic techniques involve inserting a small instrument into the fistula tract. This allows the inflamed structures to be removed from the inside. This minimizes 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 removal: To avoid ingrown hairs, those affected should shave the crease in their buttocks regularly. Permanent hair removal, such as laser, can also be a good option.
• Good hygieneThorough cleaning of the buttocks area helps to minimize the risk of infection.
• Weight management: Overweight patients should try to lose weight. This helps to reduce friction and sweating in the gluteal fold.
• Avoid sitting for long periods: Take regular breaks when you are sitting. Use soft seat cushions. This will reduce pressure and friction on the gluteal fold. For people with sedentary jobs, it is important to move regularly. This can reduce the strain.

• Wear breathable clothing: Loose-fitting, breathable clothing can help. It reduces moisture and friction in the crease of the buttocks. Materials that are better at wicking away sweat, such as cotton or special functional clothing, are ideal.
• Regular check-ups: After treatment of a Pilonidal Sinus, check-ups are important. This ensures that healing is progressing well. You can also check that there are no signs of recurrence.

Forecast

The prognosis for patients with coccyx fistula 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. The choice of treatment depends on the severity of the condition. It should be discussed with an experienced proctologist.

The relapse rate depends 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 usually less than 10%. With open wound healing or primary sutures, the recurrence rate can be much higher. This is particularly true if aftercare is not well observed.

When is a visit to the doctor necessary?

It is important to act quickly at the first sign of a Pilonidal Sinus. This can 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 is your specialist for proctology. We offer modern treatment methods for the pilonidal sinus. These include minimally invasive laser therapies. These ensure rapid healing and a low recurrence rate. We tailor our treatment to the individual needs of each patient. With good aftercare, we help you to regain your quality of life quickly.

If you have any questions about the diagnosis or treatment of Pilonidal Sinus, we will be happy to help you. You can also request a personal consultation at VenaZiel Berlin MVZ. Our experts are always available to accompany you on your path to recovery.