A pilonidal sinus (PNS) is a small hole or tunnel in the skin that may get filled with fluid or pus, leading to the formation of a cyst or abscess. It usually affects men, in the crease of the buttocks, from the bottom of the spine to the anus. A pilonidal cyst usually contains hair, dirt, and debris. It can cause severe pain, become infected, ooze pus and blood. A pilonidal sinus may also emit a foul odor.
Risk factors for pilonidal sinus
Pilonidal sinus disease is three to four times more common among men than women. The risk of developing this condition is highest between the ages of puberty and 40, with the average age between 20 and 35. Obesity also increases the risk of developing pilonidal sinus disease. Individuals with an inactive lifestyle or those who sit for long periods, such as drivers, are more prone to developing this condition. Those who have excessive body hair or stiff and coarse hair have a higher chance of developing pilonidal sinus disease.

Causes of pilonidal sinus
While the cause of pilonidal disease is not completely known, most doctors believe it to be caused by hairs becoming embedded into the skin. The word pilonidal means “nest of hair,” and the cyst sometimes contains hair follicles.
Tight clothing, bicycling or sitting for long periods create friction and pressure. This may push the hair down into the skin. The body then responds to the hair as a foreign substance and a cyst forms around it.
Some people believe that pilonidal cysts appear after trauma to that region of the body.
If left untreated, the patient may develop a pocket of infection, called an abscess, or a sinus, which is a cavity under the skin.
Symptoms of pilonidal sinus disease

A person suffering from a pilonidal sinus disease usually experiences the following signs and symptoms.
1. Pain, redness, and swelling at the bottom of the spine. The pain may get worse when the person is sitting.
2. Bleeding or fluid drainage from an opening in the skin.
3. Foul-smelling fluid discharge.
4. Fever or nausea.
5. Hair protruding from the lesion.

Diagnosis of pilonidal sinus
A pilonidal infection is usually visible to the eye. The doctor a will confirm the diagnosis by conducting a physical exam.
Treatment of pilonidal sinus
People who are prone to pilonidal sinus must pay special attention to keeping that area clean and avoid sitting for long durations. It may also be helpful to lose excess weight. If you have had pilonidal sinus disease in the past you may want to remove hair from that area as well.
If the pilonidal sinus disease is diagnosed at an early stage, and you don’t have severe pain, the doctor will prescribe an antibiotic. While this will not heal the sinus tract, it provides relief from the infection and discomfort.
You will need to visit your doctor for follow up checks, regularly remove hair from that region, and be particularly careful about hygiene.
EPSIT (Endoscopic pilonidal sinus treatment):
This is latest technique without surgery to treat PNS, we use scop and laser.

Advantages EPSIT:
1-no pain
2- no dressing
3-no stay in hospital
4-no cutting
Lancing
In this procedure, your doctor will give you a local anesthetic and open the abscess with a scalpel. Hair, blood, and pus from inside the abscess will be cleaned. This will reduce your symptoms.
The wound will then be packed with sterile dressing and left to heal from the inside out. This process requires a longer time for healing, but the risk of the pilonidal cyst infection recurring after this is low. This wound usually heals within four weeks, and most people don’t require any further treatment for the pilonidal sinus.
Surgery
If you have a recurring Pilonidal sinus or if you have more than one sinus tract, your doctor may choose to conduct a surgical procedure.
The surgeon will open the lesions, and remove all of the pus and debris, then stitch the wound closed. This will be done under local anesthesia.

While the healing time is shorter with this option the risk of recurrence is higher. The incision to the side of the cleft of the buttocks takes particularly long to heal.

The care of the wound after the surgery and removal of hair from that region is extremely important to make a full recovery.

If you are suffering from a pilonidal sinus schedule an appointment with Dr. Khaldoun Ghareb clinic.