Pilonidal sinus

Treating a pilonidal sinus

Treatment may not be necessary for a pilonidal sinus if it's not infected.

It's importantto keep the area as clean and dry as possible. Removing hair from the area is also advisable, usually by shaving or using hair removal creams. Thisshould reduce therisk of an infection.

If your pilonidal sinus does become infected, surgery is likely to be recommended.

Incision and drainage

Incision and drainage involves opening the sinus up and draining away the pus. This procedure can usually be carried out at your local hospital under general anaesthetic , so you will be asleep during the operation.

It's a relatively minor operation, so you should be able to return home either the same day or the day after the procedure.

After the operation, a dressing is applied to helpthe woundheal. It should be arranged for your dressing to be changed daily by the practice nurse at your local GP surgery.

Many sinuses are cured after incision and drainage.

Treating recurring infection

When there is discharge of pus from the sinus without an abscess present, antibiotics may be prescribed to keep the infection under control while you wait to see a surgeon. However, thiswill not cure the pilonidal sinus.

Ifthe pilonidal sinus keeps becoming infected, surgery may be recommended to remove the sinus and prevent further infections. This can be done in a number of ways. In most cases, operations called wide excision or excision and primary closureare used.

The treatment method should be decided jointly with your surgeon after you have discussed the options.

Wide excision

During wide excision, the surgeon cuts out the section of skin containing the sinus. The wound is left openand packed with a dressing.

The advantage of having a wide excision is that the chances of an infection returning are low.But the wound will take a long time to heal and your dressings need to be changed daily for two or three months.

Recent evidence suggestsless invasive procedures, such as off-midline primary closure or sinusotomy, may nowbe preferred.

Excision and primary closure

Duringan excision and primary closure, the surgeon cuts out the section of affected skin before closing and sealing the wound with stitches. The advantage of this technique is thatthe wound heals quickly. However, the chances of the infection returning are higherthan with a wide excision.

There are different methods of using a flap of your own skin and tissue to fill and close the wound. Your surgeon can explain the technique theywill usein more detail, but techniques where the wound is closed off the midline have found to be better.

Fibrin glue

Some pilonidal sinusescan be treated by scraping away ingrown hairs and other debris from the sinus before sealing the area with a special absorbable glue called fibrin glue.This can be done under general or Local anaesthetic , depending on your preference.

The advantage of this treatment is you don't need any dressings and there is little pain. You will probably be able to return to normal activities within a week. The risk of infection is similar to excision and primary closure. However, thisprocedure is relatively new and may not beavailable in your local area.

Aftersurgery

You may feel some discomfort after your operation. You should be given pain relief, and youmay also be givenpainkillers to take at home.You will usually be discharged on the day of your operation.

After your operation, you will probably need time off work, although this depends onhow you are feeling and the type of work you do. Avoid strenuous work for up to two weeks.

You can start to exercise andplay sport as soon as you feel able to. However, if you have stitches, you may need to avoid activities that could disrupt the stitches for two to four weeks.

Wound care

Whatever type of operation you have, it is important to keep the site of the wound clean. Your surgeon can offer adviceon how to do this, which may include the following:

Have a shower or bath at least once a day if your wound is being left open and packed with a dressing.
If your wound is closed with stitches, avoid having a bath. You may be advised to keep the wound completely dry for the first few days. Ask your surgeon for advice.
When washing the wound, do not use soap because this will irritate your skin. Use plain water and a soft cloth instead.
Do not use talcum powder.
Carefully dry the area after washing using a soft towel, but do not rub the skin. Using a hair dryer is a good way of drying the area.
Always remove a damp or wet dressing and replace it with a dry clean one.
Wear loose-fitting cotton underwear and avoid synthetic underwear, such as nylon.
Eat high-fibre foods to help soften your stools and reduce any straining when you go to the toilet.