Table of ContentsView AllTable of ContentsFactors Influencing TreatmentTreatment OptionsCausesSelf-Care in HealingWarning Symptoms and Risks
Table of ContentsView All
View All
Table of Contents
Factors Influencing Treatment
Treatment Options
Causes
Self-Care in Healing
Warning Symptoms and Risks
Apilonidal cystis a pus or fluid-filled sac that develops just above or inside the groove between the buttocks. In some cases, it can lead to the creation of a tunnel called apilonidal sinus.
This article will give an overview of pilonidal sinus disease (PSD), including what may cause it, potential treatments, and how patients can care for themselves to avoid complications or recurrence.
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Factors Influencing Pilonidal Sinus Treatment
Pilonidal sinus disease can be a mild inconvenience that doesn’t cause many symptoms, or it can be quite painful and significantly affect quality of life.The condition may be complicated or uncomplicated. The individual and their healthcare provider will decide on the type of treatment necessary based on several factors.
Cyst Size
A pilonidal cyst can range in size. It may start small and get larger.
Some people seek treatment based on the size of the cyst. A small cyst that causes no symptoms usually can be treated at home.
A person might seek a surgical option for a larger cyst. A large cyst could affect a person’s quality of life, especially if it causes pain or other symptoms.
Pain
Pilonidal sinus disease often causes pain. In some cases, the pain may be significant, such as when there is an infection or an abscess (a pocket of infection) at the pilonidal sinus. The pain may be one reason for getting treatment or having a more invasive type of surgery.
PSD is considered benign, meaning that it doesn’t usually go on to cause other problems. However, it can be chronic (long-lasting). In addition, the pain affects quality of life and can be a reason that people are absent from school or work.
How to Relieve Tailbone Pain
Infection
In some cases, a pilonidal cyst can become infected. The symptoms of an infected cyst include:
When the pilonidal cyst is infected, surgery is used more often and may be preferable to home or less invasive treatments. However, the exact type of surgical technique that’s most effective is still being debated.
Pilonidal Sinus Treatment Options
The firsttreatment option for a pilonidal cystmight be to watch and wait. In some cases, a cyst or a sinus might resolve on their own. It is not recommended that people try to pop or drain a cyst at home. If a sinus does form, there may be a need for surgery to remove it.
Another level of treatment for a cyst would be to open it and drain it. Local anesthetic is used to manage pain, and a small incision is made at the site of the cyst. This will allow any pus or other fluid to drain. Antibiotics might be used in some cases after a procedure to open up the cyst.
When there continues to be an infection in the area or when an abscess forms, surgery might be used to treat it. A bigger incision is made to open up the sinus and/or the abscess. The tissue that is affected or inflamed will be removed.
The chance of a good outcome and recovery is better when all of the sinus tract is removed. The incision may be closed or left open. Closing the incision may increase the risk of a later infection.
Leaving the surgical site open to close and heal on its own might be preferred for a better chance of healing well. The decision of open vs. closed will depend on a number of reasons, so the surgeon and the person will decide together which option is best.
Causes: Why Do Pilonidal Sinus Cysts Form?
It has been a longstanding theory that people with pilonidal sinus disease may sweat more than other people. However, this may not be true.
A study showed that people with PSD didn’t sweat more than anyone else. Instead, the study authors suggest that contributing factors may include dry stiff cut hairs finding their way into the groove between the buttocks (such as after a dry haircut). However, the study was only done in people in Germany.
Other factors that may increase the risk of developing pilonidal sinus disease include being male, having a deep intergluteal cleft (area between the buttocks), and coarse body hair.
In addition, being sedentary, having obesity, and prolonged sitting are other risk factors. It’s also thought that friction or pressure in the gluteal area and a traumatic tailbone injury could also make the condition more likely.
HirsutismA person who is hirsute has more body hair in certain areas, particularly in areas where there is usually little hair. Having a lot of hair in the area between the buttocks may contribute to the development of pilonidal sinus disease. This is because a hair may grow inward and lead to an infection and the development of a cyst or an abscess.
Hirsutism
A person who is hirsute has more body hair in certain areas, particularly in areas where there is usually little hair. Having a lot of hair in the area between the buttocks may contribute to the development of pilonidal sinus disease. This is because a hair may grow inward and lead to an infection and the development of a cyst or an abscess.
Self-Care During Pilonidal Sinus Healing
While a pilonidal sinus tract is healing, some measures can be taken at home to be more comfortable andpromote healing. A healthcare provider can offer suggestions on how to keep the area clean, such as the choice of soaps and how often to wash the area.
After surgery, the surgical site will also need care, often with changing the dressings two or three times a week. A topical antiseptic can be prescribed and applied to the area at each dressing change.The surgery site will also need to be watched carefully for any signs of infection.
Anopen surgical sitemight be packed with gauze and adrainmay be placed. The surgeon and/or other healthcare providers will give instructions on how to manage these aspects of recovery from surgery.
Healthcare providers may suggest lifestyle changes that may help heal or prevent recurrence.
Activities and occupations that require sitting for long periods of time, such as long-distance truck driving, may be a risk factor for developing pilonidal sinus disease. Avoiding sitting for too long.
Certain types of sports, such as swimming, running, soccer, hockey, and baseball, may also worsen pilonidal sinus disease. This may be due to these sports' movements, such as deep knee bends and repeated stopping and starting. Modifying physical activity or switching to walking or yoga for a time might help.
Bathing is important, but tub baths aren’t appropriate during healing. Instead, shower daily with a handheld shower head that can direct the water to the area to be cleaned. Showering daily is often recommended. Antimicrobial soap might be recommended to help keep the area clean and avoid the risk of infection.
Keeping clean after bowel movements is also important. Using a bidet or personal care wipes may be helpful when a handheld shower head isn’t available.
Regularhair removal, such as depilatories (hair-removal creams), shaving, plucking, or laser hair removal, may help prevent recurrence.Shaving the area to remove hair at least weekly is also suggested. People may want to choose razors with narrow heads, such as those marketed for removing hair from the bikini line. Shaving should be done in the direction of hair growth, not against it, and care needs to be taken to avoid damaging the skin.
Laser hair removal might also be a good option. It can help reduce the need to shave. But it is expensive, takes several appointments to work, and won’t remove all the hair.
Avoidingconstipationis also important to manage healing.Eating enough fiberanddrinking waterare important in avoiding having hard stools. People should ask their healthcare provider about the use ofstool softeners.
If there are symptoms such asfever, weeping or oozing of fluid, extreme pain, and swelling or redness, that is a reason to seek help from a healthcare provider.
After a procedure or surgery for a pilonidal cyst or sinus, healthcare providers will give instructions on how to avoid complications. This includes keeping the area clean, changing dressings, and attending to other aftercare instructions.
Serious complications are not common. The most common problems areinfections, recurrence of the cyst, and the development of an abscess. Drainage from the area, which can affect quality of life, is also a common occurrence.
Cyst vs. Boil vs. AbscessAcystis a cavity on the skin or in the body that is filled with pus. If it’s on or under the skin, it may feel like a lump. Aboilis from an infection of a hair follicle. It appears as a red lump on the skin. Anabscessis a pocket of pus that is from an infection. It can be inside body tissue, or it may involve the skin. A boil may progress to an abscess.
Cyst vs. Boil vs. Abscess
Acystis a cavity on the skin or in the body that is filled with pus. If it’s on or under the skin, it may feel like a lump. Aboilis from an infection of a hair follicle. It appears as a red lump on the skin. Anabscessis a pocket of pus that is from an infection. It can be inside body tissue, or it may involve the skin. A boil may progress to an abscess.
Summary
The causes of pilonidal sinus disease are not well understood but may have to do with ingrown hair or hair that finds its way under the skin, causing a cyst to form. Other factors may contribute to the problem, such as prolonged sitting, having obesity, and having coarse hair.
PSD doesn’t always become serious or cause a lot of pain and distress, but when it does, there may be a need for surgery. Keeping the area clean, shaving, and watching for signs of infection are all important to avoid recurrence and complications.
10 Sources
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Harries RL, Alqallaf A, Torkington J, Harding KG.Management of sacrococcygeal pilonidal sinus disease.Int Wound J. 2019;16:370-378. doi:10.1111/iwj.13042
University of Texas at Austin.Pilonidal cyst.
Bi S, Sun K, Chen S, Gu J.Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis.Sci Rep-uk.2020;10:13720. doi:10.1038/s41598-020-70641-7
Gabor S, de Lima Favaro M, Pimentel Pedroso RF, et al.Pilonidal cyst excision: primary midline closure with versus without closed incision negative pressure therapy.Plast Reconstr Surg Glob Open. 2021;9:e3473. doi:10.1097/GOX.0000000000003473
American Society of Colon and Rectal Surgeons.Pilonidal disease.
Doll D, Brengelmann I, Schober P, et al.Rethinking the causes of pilonidal sinus disease: a matched cohort study.Sci Rep. 2021;11:6210. doi:10.1038/s41598-021-85830-1
Harris C, Sibbald RG, Mufti A, Somayaji R.Pilonidal sinus disease: 10 steps to optimize care.Adv Skin Wound Care. 2016;29:469-478. doi:10.1097/01.ASW.0000491324.29246.96
MedlinePlus.Surgery for pilonidal cyst.
Michalopoulos N, Sapalidis K, Laskou S, Triantafyllou E, Raptou G, Kesisoglou I.Squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report.World J Surg Oncol. 2017;15:65. doi:10.1186/s12957-017-1129-0.
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