Anal Fistula
Evaluation and treatment of anal fistula, including recurrent and previously operated fistulas.
Learn morePilonidal Sinus
Pilonidal Sinus Treatment
A pilonidal sinus is a small tract or pit near the tailbone, usually containing hair and debris, which becomes repeatedly infected. It is not a fistula of the anal canal, though patients often confuse the two. Treatment depends on whether infection is active and on how much of the tract is involved.
Overview
Pilonidal disease occurs in the natal cleft, the groove above the buttocks near the base of the spine. Loose hair works its way into the skin, the body reacts to it as a foreign body, and a sinus tract forms.
The condition tends to affect younger adults, more often men, and those who sit for long hours. Episodes of painful swelling that discharge and then settle are typical, and each episode can leave the tract more established.
It is important to distinguish pilonidal sinus from an anal fistula, because the location, cause and treatment are different. An examination makes this distinction straightforward.
Common symptoms
- A painful swelling near the tailbone, above the anal region
- One or more small pits or openings in the midline of the natal cleft
- Discharge of pus or blood-stained fluid, sometimes with an odour
- Pain on sitting or on prolonged driving
- Recurrent episodes of swelling that settle and return
- Visible hair emerging from the opening in some patients
Common causes
- Loose hair penetrating the skin of the natal cleft
- Prolonged sitting, particularly in occupations involving long journeys
- A deep natal cleft with excessive local hair growth
- Friction, sweating and poor local hygiene
- Being overweight, which increases friction in the area
- Previous local infection that was drained but not fully treated
How it is assessed
- Examination of the natal cleft to identify midline pits and any secondary openings
- Assessment of whether infection is currently active
- Distinguishing pilonidal disease from an anal fistula or a simple abscess
- Imaging in selected cases where the extent of the tract is unclear
- Review of previous procedures in patients with recurrent disease
Treatment approach
- Drainage and control of infection when an acute abscess is present
- Definitive treatment of the sinus tract once infection has settled, with the options explained beforehand
- Laser-assisted approaches where the doctor considers them appropriate
- Local hair reduction and hygiene guidance, which materially reduces recurrence
- Wound care instructions and follow-up until healing is complete
When you should consult a doctor
- Painful swelling near the tailbone
- Any opening in the midline above the anus that discharges fluid
- Repeated episodes in the same area
- A wound in this region that has not healed for weeks
- Fever with local swelling and increasing pain
FAQ
Questions about pilonidal sinus
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