Pilonidal sinus - Treating a pilonidal sinus

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

It's important to 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. This should reduce the risk 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 help the wound heal. 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, this will not cure the pilonidal sinus.

If the 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 closure are 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 open and 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 suggests less invasive procedures, such as off-midline primary closure or sinusotomy, may now be preferred.

Excision and primary closure

During an 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 that the wound heals quickly. However, the chances of the infection returning are higher than 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 they will use in more detail, but techniques where the wound is closed off the midline have found to be better.

Fibrin glue

Some pilonidal sinuses can 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, this procedure is relatively new and may not be available in your local area.

After surgery

You may feel some discomfort after your operation. You should be given pain relief, and you may also be given painkillers 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 on how you are feeling and the type of work you do. Avoid strenuous work for up to two weeks.

You can start to exercise and play 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 advice on 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.

Complications

Several complications can occur as a result of surgery for a pilonidal sinus. These include:

• a pilonidal sinus returning after treatment (recurrent pilonidal sinus)
• infection at the site of the wound during or after surgery

Contact your GP immediately if you notice any signs of infection, such as:

• pain
• red, swollen skin
• a high temperature of 38C (100.4F) or above
• a feeling of heat at the site of the wound
• fluid, pus or blood leaking from the site of the wound
• an unpleasant smell coming from the site of the wound