Pilonidal Sinus Treatment

A pilonidal sinus can lead to severe pain and may get infected. If it gets infected, it may cause oozing of pus and blood, and have a foul odor.
A pilonidal sinus is a skin condition that occurs when there is too much pressure and friction in the anal region, causing the hair between the buttocks to get pushed inwards. This may occur due to the hair growing around the buttocks or due to the loose hair that is shed from the area of the buttocks gathering around the cleft and getting into the pilonidal sinus.

Causes:
The causes of pilonidal sinus include:

• Prolonged periods of sitting
• Ingrown hair
• Hairy skin
• Excessive sweating
• Friction from clothes 
• Changing hormones

Risk factors:
The following factors may increase the risk of developing pilonidal sinus:

• More common in men
• Young adults
• Obesity
• Sedentary lifestyle
• Occupation requiring prolonged sitting
• Stiff or coarse body hair
• Excessive body hair

Symptoms

The following symptoms may be associated with pilonidal sinus:

• Pain near the tailbone
• Sore skin
• Reddening
• Skin swelling near the tailbone
• Skin irritation 
• Tenderness
• Pus discharge
• Bleeding
• Foul smell 
• Fatigue
• Nausea
• Fever

Diagnosis

1. Physical examination: The doctor will examine the patient and ask about the symptoms, medical history, and family history of the patient.
2. Digital rectal examination: The doctor will insert a lubricated, gloves finger into the rectum to check for any abnormal growths that may be present. The test also aids the doctor in confirming the depth of the tunnel and how severe the condition is.
3. Visual inspection: The lower rectum is examined using a proctoscope, a sigmoidoscope, or an anoscope. The doctor will carefully examine the lining of the anal tissues using any of these devices and check the growth and severity of the tissues.
4. Lab swab test: The doctor will excise the tissues from the affected area and send them to the laboratory for evaluation, known as a biopsy. This test is performed to check if the tissues have turned cancerous and determine the best line of treatment.

Treatment

The different types of treatments for pilonidal sinus include:

1. Non-surgical treatment:

This form of treatment is provided when there is no sign of infection or inflammation, and may include-

Broad-spectrum antibiotic: It is used for treating a wide range of bacterial infections. The antibiotic ointments provide help in relieving pain and infection due to pilonidal sinus but do not treat the condition.

2. Surgical treatment:

The different types of surgeries that can be used to treat pilonidal sinus include:

a) Lancing:
This procedure is performed under local anesthesia, that is, the treatment area is numbed before the procedure.
A scalpel is used to open the abscess and clean the blood, dirt, hair, and debris.
After the cleaning is completed, the doctor covers it with a sterile dressing and allows it to heal from the inside.
Complete healing may take up to four to six weeks.

b) Open surgery: This procedure may be performed in two ways:
Incision and drainage:

• It is performed when the cyst gets infected.
• The procedure is done under local anesthesia.
• An incision or cut is made in the cyst to drain the infectious pus and fluid.
• The hole is then packed with gauze and left open to heal.
• Complete healing may take four to six weeks.
• The gauze should be changed periodically during the healing period.

Pilonidal cystectomy:

• This procedure is done for a recurring cyst and involves the removal of the entire pilonidal cyst.
• The procedure is done under general anesthesia, that is, the patient is put to sleep before the surgery.
• An incision is made by the surgeon to remove the affected skin along with the underlying tissues, dead cells, and hair follicles.
• Depending on the size of the cyst excised, the doctor may or may not pack the treatment area using surgical gauze.
• If the infection is severe, the doctor will place a tube to drain the fluid from the cyst. 
• The tube will be removed after the fluid has been entirely collected from the cyst, reducing the chances of recurrence.

c) Laser pilonidal sinus treatment:

• A high-intensity laser beam is used for closing off the sinus.
• The doctor will ensure that the entire pit of the pilonidal sinus is removed to prevent the recurrence of infection.
• The procedure offers greater accuracy and precision than other forms of treatment. It also has rapid healing compared to the other surgical methods that may be used.

Risks

The complications of pilonidal sinus treatments include:

• Poor wound healing
• Pain
• Bleeding
• Numbness around the wound area
• Scarring of the wound
• Blood clot formation
• Infection
• Allergic reaction to the anesthesia, medications or surgical equipment used
• Recurrence of pilonidal sinus 

After Procedure

• If you have had pilonidal sinus surgery, you can usually return home on the same day of the surgery.
• You will most likely be able to resume your work two to three weeks after the surgery.
• The doctor will advise you when it is safe to return to daily activities and exercises again.
• Avoid strenuous activities till recovery is completed.
• Follow-up appointments with the doctor are not to be missed.
• You need to keep the wound dry and clean or use dressings for an open wound.
• Use a doughnut-shaped cushion to sit on.
• Do not sit on hard surfaces for prolonged periods of time.
• Take all your prescribed medications regularly.
• You need to keep the crease of the buttocks and the wound area free of hair. You may need to remove the hair every two to three weeks till you reach 30 years of age, when the hair may thin out and soften.
• Contact the doctor immediately if you notice any pus drainage, redness, increased pain, increased swelling, or feeling of warmth at the treatment site.

Home remedies:

The following home remedies can help in relieving the symptoms associated with pilonidal sinus:

• Use a mild antibacterial soap for bathing and then thoroughly dry the area in the cleft.
• Avoid trauma by driving, riding, or prolonged sitting.
• Use a hair removal method that does not irritate the skin in the buttock area.
• Wear loose-fitting clothes to allow drainage and provide relief.
• Apply a topical antiseptic in the gluteal crease (the groove between the buttocks).
• Apply warm, moist heat four times a day for 15 minutes each to help in draining an abscess.
• Exercise regularly to improve the blood flow to the area which is affected and help in the healing process.
• Use zinc and vitamin C supplements to help in faster healing.
• Castor oil application helps in reducing pilonidal cyst swelling.
• Tea tree oil helps in soothing the cyst and fighting infection.
• Baking soda can be applied along with vinegar to soothe irritated skin and manage swelling.
• Apple cider vinegar helps in maintaining the pH levels of the skin and removing toxins from the pilonidal cyst.

Cost of Pilonidal Sinus Treatment in India- 

The cost of pilonidal sinus treatment in Mumbai is between INR 40,000 to INR 55,000.
The cost of pilonidal sinus treatment in Delhi is between INR 35,000 to INR 50,000.
The cost of pilonidal sinus treatment in Bangalore is between INR 35,000 to INR 50,000.
The cost of pilonidal sinus treatment in Chennai is between INR 30,000 to INR 45,000.