Pilonidal Disease

Condition, Treatment & Procedure

Pilonidal Sinus

Pilonidal sinus most commonly affects young men, and the problem has a tendency to recur. People who sit for prolonged periods of time, such as truck drivers, are at higher risk of developing a pilonidal sinus.

Predisposing factors include:

  • Male
  • Younger age ( people in their 20s)
  • Overweight
  • Sedentary lifestyle
  • Prolonged sitting
  • Excessive body hair, people of Mediterranean heritage

This condition is relatively common; it is a problem that is particularly common in young people and manifests as a chronic condition with continuous pain and purulent discharge from the natal cleft (between the the two checks of the bottom).

In theory the disease occurs because the natal cleft is deep with negative pressure. The negative pressure and the moisture cracks in the skin leads to a raw surface that allows hairs and cloth fluff  to get implanted in the area  which causes an inflammatory reaction. Also bacterial invasion along the hairs will lead to infection and pus production, this problem is known for high risk of recurrence.


Occasionally an acute flare up of the disease takes place that leads to excessive pain associated with swelling  in that area. It may need an emergency operation.

The aim of emergency surgery is to drain the pus and it leaves an open wound . The management of the open wound requires  dressing and packing for usually a few weeks.

If there is no acute pain, the surgeon usually performs an operation to remove all the sinuses and the infected tissue in one stage and closes the wound by primary closure. The wound often heals with no need for further interventions. The risk of recurrence is relatively high, which will need a second procedure.

After surgery, your doctor may choose to:

  • Leave the wound open. The surgical wound is left open and packed with dressing to allow it to granulate and to heal from the inside out. There is a longer healing time but usually a lower risk of a recurrence.
  • Close the wound with removable sutures. The healing time is shorter with this procedure, there’s a higher risk of recurrence.

Wound care is extremely important after surgery. Your doctor will give you detailed instructions on how to change dressings and what to expect of the healing process. You may also need to shave around the surgical site to prevent hairs from entering the wound.

To help prevent pilonidal sinus recurrence:

  • Keep the area clean
  • Make sure the area is dry
  • Lose weight
  • Avoid prolonged sitting