{"id":9301,"date":"2025-02-04T15:12:39","date_gmt":"2025-02-04T15:12:39","guid":{"rendered":"https:\/\/venaziel.de\/pilonidal-sinus-causes-symptoms-and-the-need-for-surgery\/"},"modified":"2026-04-09T05:40:50","modified_gmt":"2026-04-09T05:40:50","slug":"sinus-pilonidalis-operation","status":"publish","type":"post","link":"https:\/\/venaziel.de\/en\/sinus-pilonidalis-operation\/","title":{"rendered":"Pilonidal sinus &#8211; causes, symptoms and the need for surgery"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">A pilonidal sinus, also known as a coccyx fistula, is a common but often underestimated condition that occurs in the coccyx region. It mainly affects young adults, especially men, and can cause considerable discomfort such as pain, swelling or persistent pus discharge. Many patients ask themselves whether an operation is really necessary and what risks are associated with the disease. This article provides a comprehensive overview of the development, diagnosis and modern treatment options for pilonidal sinus, supplemented by the latest scientific findings.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What is a pilonidal sinus?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/venaziel.de\/phlebologie\/sinus-pilonidalis\/\" target=\"_blank\" rel=\"noopener\">Pilonidal sinus is a chronic inflammation of the skin<\/a> and subcutaneous tissue in the area of the gluteal fold. It is characterized by a cavity caused by ingrown hairs, dirt particles and dead skin cells. This cavity can become a fistula, which becomes inflamed and triggers a permanent inflammatory reaction. The term &#8220;pilonidal&#8221; comes from Latin and means &#8220;nest of hair&#8221; &#8211; an apt reference to the central role of hair in the development of this disease.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Epidemiology and risk factors<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Age and gender:<\/b><span style=\"font-weight: 400;\"> The disease is most common in young adults between the ages of 15 and 30 and affects men about twice as often as women.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Hair growth:<\/b><span style=\"font-weight: 400;\"> Dense hair growth in the buttock region favors the penetration of hair into the skin and the formation of fistulas.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Mechanical stress:<\/b><span style=\"font-weight: 400;\"> Prolonged sitting, especially among office workers, truck drivers and students, and repetitive mechanical friction increase the risk.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Hygiene and skin condition: <\/b><span style=\"font-weight: 400;\">A moist, poorly ventilated buttock crease, combined with inadequate cleaning, promotes the accumulation of hair and dirt.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Overweight:<\/b><span style=\"font-weight: 400;\"> Increased pressure and increased sweating in the coccyx region can promote the development of a pilonidal sinus.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Genetic factors:<\/b><span style=\"font-weight: 400;\"> Studies indicate that familial clusters occur, suggesting a genetic predisposition.<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Development and pathophysiology<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The development of a pilonidal sinus usually begins with ingrown hairs. These penetrate the skin and are perceived by the body as foreign bodies, which leads to an inflammatory reaction. As it progresses, a cavity (sinus) forms in which hair residue, dead skin cells and bacteria accumulate. If the condition remains untreated, the cavity can enlarge, fistula tracts can form and recurrent infections and abscesses can occur. An acute abscess can cause severe pain and fever and often requires rapid surgical relief.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Symptoms and clinical manifestations<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The symptoms of pilonidal sinus range from mild to severe and depend on the <a href=\"https:\/\/venaziel.de\/en\/proctology\/\" target=\"_blank\" rel=\"noopener\">stage of the disease<\/a>:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Early stage:<\/b><span style=\"font-weight: 400;\">  No or only minor symptoms. Those affected may notice a small, painless cavity or slight redness in the gluteal fold.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Chronic inflammation: <\/b><span style=\"font-weight: 400;\">Recurrent discharge of pus or blood from the fistula openings, accompanied by itching, pain or skin irritation.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Acute abscess:  <\/b><span style=\"font-weight: 400;\">Sudden, severe pain, swelling, redness and occasionally fever indicate an advanced infection. In these cases, rapid surgical intervention is required to control the infection.<\/span><\/li>\n<\/ul>\n<p><picture class=\"wp-picture-7573\" style=\"display: contents;\"><source type=\"image\/avif\" srcset=\"https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-1024x683-jpg.avif 1024w, https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-250x167-jpg.avif 250w, https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-768x512-jpg.avif 768w, https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-jpg.avif 1200w\" sizes=\"(max-width: 980px) 100vw, 980px\"><img data-dominant-color=\"9d9990\" data-has-transparency=\"false\" style=\"--dominant-color: #9d9990;\" decoding=\"async\" class=\"lazyload alignnone wp-image-7573 not-transparent\" src=\"https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel.jpg\" data-orig-src=\"https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel.jpg\" alt=\"gynecologist-operation-patient-in-gynecological-chair-proctologic-examination-hemorrhoids-anal-fistula-sinus-pilonidalis\" width=\"980\" height=\"653\" title=\"\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27980%27%20height%3D%27653%27%20viewBox%3D%270%200%20980%20653%27%3E%3Crect%20width%3D%27980%27%20height%3D%27653%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-200x133.jpg 200w, https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-250x167.jpg 250w, https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-400x267.jpg 400w, https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-600x400.jpg 600w, https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-768x512.jpg 768w, https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-800x533.jpg 800w, https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel-1024x683.jpg 1024w, https:\/\/venaziel.de\/wp-content\/uploads\/2024\/12\/gynecologist-operation-patient-in-gynecological-chair-proktologie-haemorrhoids-analfistel.jpg 1200w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 980px) 100vw, 980px\" \/><\/picture><\/p>\n<h2><span style=\"font-weight: 400;\">Diagnosis<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The diagnosis of a pilonidal sinus is usually made on the basis of a thorough medical history and physical examination.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Medical history:  <\/b><span style=\"font-weight: 400;\">Patients often report recurring discharge, pain and swelling in the breech region. Questions about professional activity (e.g. sitting for long periods), hair growth and family history are helpful.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Clinical examination:<\/b><span style=\"font-weight: 400;\"> The doctor inspects the gluteal fold for visible fistula openings, swelling, redness and discharge of secretions.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Imaging:<\/b><span style=\"font-weight: 400;\"> In complex or recurrent cases, imaging techniques such as ultrasound or MRI can be helpful to visualize the extent of the fistula tract and facilitate the planning of a surgical procedure.<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Treatment options: Conservative or surgical?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The treatment of pilonidal sinus depends on the severity and the individual needs of the patient. The aim is to control the inflammation, remove the fistula and prevent relapses.<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Conservative measures<\/b><\/h3>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Hair removal: <\/b><span style=\"font-weight: 400;\">Regular shaving or the use of laser technologies can reduce the risk of new inflammation.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Hygiene measures:<\/b><span style=\"font-weight: 400;\"> Thorough cleaning and drying of the gluteal fold is essential to avoid the accumulation of hair and dirt.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Antibiotics:<\/b><span style=\"font-weight: 400;\"> For mild infections, antibiotics can help in the short term, but do not eliminate the underlying fistula.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Incision and drainage<\/b><\/h3>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">In the case of an acute abscess, rapid surgical relief is required.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">The aim is to drain pus and relieve acute symptoms.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Restriction: The fistula remains, and without further measures there is a high risk of relapse.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Surgical removal<\/b><\/h3>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Open wound healing: <\/b><span style=\"font-weight: 400;\">The fistula is completely removed and the wound is left open to heal from the inside out.<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"3\"><b>Advantages: <\/b><span style=\"font-weight: 400;\">Low risk of relapse (approx. 10 %).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"3\"><b>Disadvantages:<\/b><span style=\"font-weight: 400;\"> Longer healing time (4-8 weeks), complex wound care.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Primary wound closure: <\/b><span style=\"font-weight: 400;\">The wound is closed immediately after removal of the fistula.<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"3\"><b>Advantages:<\/b><span style=\"font-weight: 400;\"> Shorter healing time (2-3 weeks).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"3\"><b>Disadvantages:<\/b><span style=\"font-weight: 400;\"> Higher risk of relapse (up to 20 %).<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Minimally invasive procedure (e.g. pit picking): <\/b><span style=\"font-weight: 400;\">Only the affected fistula openings and ducts are removed.<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"3\"><b>Advantages:<\/b><span style=\"font-weight: 400;\"> Gentle, fast recovery.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"3\"><b>Disadvantages:<\/b><span style=\"font-weight: 400;\"> Not suitable for extensive fistulas.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Long-term prognosis and relapse rates<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The relapse rate depends heavily on the chosen treatment method.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">According to a meta-analysis in Diseases of the Colon &amp; Rectum (2017), the recurrence rate with open wound healing is less than 10 %, while it is up to 20 % with primary wound closure.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Compliance with post-operative hygiene measures and regular check-ups are crucial to prevent relapses.<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">Complications of untreated pilonidal sinus<\/span><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chronic, recurring abscesses and fistulas.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Spread of deep fistula tracts into the surrounding tissue.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">In very rare cases, chronic inflammation can lead to malignant changes (squamous cell carcinoma).<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Conclusion<\/span><\/h2>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/venaziel.de\/phlebologie\/sinus-pilonidalis\/\" target=\"_blank\" rel=\"noopener\">Pilonidal sinus is a common condition<\/a> that can cause considerable discomfort if not treated properly. While conservative measures can be helpful in the early stages, most patients require surgical removal to permanently eliminate the fistula. Today, modern minimally invasive techniques offer a quick and gentle solution, although the choice of method should be made on an individual basis.<\/span><\/p>\n<p><b>Wiener Ziel &#8211; Your experts for pilonidal sinus<\/b><\/p>\n<p><span style=\"font-weight: 400;\">If you suffer from a pilonidal sinus, experienced specialists are available to you at Ziel in Vienna who can offer you precise diagnostics and modern treatment methods. Our aim is to offer you an effective and long-term solution &#8211; for your health and quality of life.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h3><b>References:<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hull TL, Wu J. Pilonidal disease. Surgical Clinics of North America. 2002;82(6):1169-1185.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Al-Khamis A, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database of Systematic Reviews. 2010;(1):CD006213.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Doll D, Krueger CM, Schrank S, Petersen S. Timeline of recurrence after primary and secondary pilonidal sinus surgery. Diseases of the Colon &amp; Rectum. 2007;50(11):1928-1934.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Bascom J, Bascom T. Utility of the cleft lift procedure in refractory pilonidal disease. The American Journal of Surgery. 2007;193(5):606-609.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Sondenaa K, Nesvik I, Andersen E, Soreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease.<a href=\"https:\/\/www.springermedizin.de\/international-journal-of-colorectal-disease\/7882680\" target=\"_blank\" rel=\"noopener\"> International Journal of Colorectal Disease<\/a>. 1995;10(1):39-42.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Akinci OF, Bozer M, Uzunkoy A, Duzgun SA, Coskun A. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. European Journal of Surgery. 1999;165(4):339-342.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Marks J, Harding KG, Hughes LE. Pilonidal sinus excision &#8211; healing by open granulation. British Journal of Surgery. 1985;72(8):637-640.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Steele SR, Perry WB, Mills S, Buie WD; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of pilonidal disease. Diseases of the Colon &amp; Rectum. 2013;56(9):1021-1027.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A pilonidal sinus, also known as a coccyx fistula, is<\/p>\n","protected":false},"author":1,"featured_media":9284,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[],"class_list":["post-9301","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-proctology"],"_links":{"self":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/posts\/9301","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/comments?post=9301"}],"version-history":[{"count":4,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/posts\/9301\/revisions"}],"predecessor-version":[{"id":29335,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/posts\/9301\/revisions\/29335"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/media\/9284"}],"wp:attachment":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/media?parent=9301"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/categories?post=9301"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/tags?post=9301"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}