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Pilonidal Sinus: Causes, Symptoms, and Treatments

Pilonidal Sinus: Causes, Symptoms, and Treatments

Admin Jul 26, 2023

Pilonidal Sinus—a condition that affects many individuals worldwide. Pilonidal sinus, also known as Pilonidal cyst or sacrococcygeal fistula, is a relatively common yet often misunderstood health issue. In this article, we will explore about this condition, exploring its causes, symptoms, and available treatment options. Keep on reading to know about all of this in detail!

What is Pilonidal Sinus?

Pilonidal Sinus is a condition characterized by the formation of a small tunnel or tract beneath the skin, commonly found in the sacrococcygeal region, which is the area at the base of the spine, just above the buttocks. The term “pilonidal” is derived from the Latin words “pilus” (hair) and “nidus” (nest), highlighting the role of hair follicles in the development of this condition.

The sinus or cyst begins as a small depression or dimple in the skin, often referred to as a pilonidal dimple. Over time, this depression can become infected and fill with pus, leading to pain, swelling, and discomfort. If left untreated or in severe cases, the infection can progress to form an abscess, which is a painful, swollen collection of pus that requires medical attention.

The exact cause of pilonidal sinus is not entirely understood, but it is believed to result from the penetration of loose hair into the skin, causing an inflammatory reaction. Other contributing factors may include friction or pressure on the affected area, sedentary lifestyle, excessive sweating, and poor hygiene.

Symptoms of Pilonidal Sinus:

The common symptoms in link with it are:

Pilonidal Dimple or Sinus Opening:

The condition typically starts with the formation of a small pit or depression in the skin, often referred to as a pilonidal dimple. This opening may be barely noticeable initially but can gradually enlarge over time.

Pain and Tenderness:

As the sinus becomes infected, it can cause pain and tenderness in the affected area, which is usually located at the base of the spine, above the buttocks.

Swelling and Redness:

The skin around the pilonidal dimple may become swollen, red, and inflamed due to the presence of an infection.

Discharge of Pus or Blood:

In some cases, the sinus may produce a foul-smelling discharge, which can be a mixture of pus, blood, and fluid. This discharge may stain clothing and cause discomfort.

Itching Sensation:

Patients with pilonidal sinus may experience itching around the affected area, which can be bothersome and increase the urge to scratch, potentially leading to further irritation.

Fever and Fatigue:

In severe cases or when an abscess forms, patients may develop symptoms of systemic infection, such as fever, chills, and fatigue.

It’s important to note that the severity and presentation of symptoms can vary from person to person. Some individuals may experience mild discomfort, while others may have more pronounced symptoms that interfere with their daily activities.

Causes of Pilonidal Sinus:

The exact cause of Pilonidal Sinus is not fully understood, but several factors are believed to contribute to its development. Here are few potential causes:

Hair Follicle Irritation:

One of the primary factors in the formation of a pilonidal sinus is the irritation of hair follicles. Hair, particularly in the sacrococcygeal region, can become ingrown or embedded, leading to inflammation and the formation of a sinus tract.

Friction and Pressure:

Prolonged sitting or activities that involve repetitive friction or pressure on the lower back can contribute to the development of pilonidal sinus. It is more common in individuals who lead a sedentary lifestyle or spend extended periods sitting, such as long-distance drivers or office workers.

Excess Body Hair:

People with a higher density of body hair, especially in the sacrococcygeal area, may have an increased risk of developing pilonidal sinus. The presence of more hair increases the likelihood of hair penetration into the skin and the subsequent inflammatory response.

Genetic Predisposition:

There may be a genetic component to pilonidal sinus, as it tends to run in families. Having a family history of the condition might increase an individual’s susceptibility to developing it.

Poor Hygiene:

Maintaining good hygiene in the sacrococcygeal area is essential to prevent pilonidal sinus. Inadequate cleaning or keeping the area moist can lead to bacterial overgrowth and infection, contributing to the condition.


Although not a direct cause, obesity is considered a risk factor for pilonidal sinus. Excess body weight can lead to increased pressure and friction on the lower back, exacerbating the condition in susceptible individuals.

It’s important to note that while these factors can increase the risk of developing pilonidal sinus, not everyone exposed to these factors will necessarily develop the condition. Additionally, some cases may occur without any apparent predisposing factors. Early detection, proper hygiene, and timely medical intervention can help manage and prevent complications associated with pilonidal sinus.

Diagnosis for Pilonidal Sinus:

Diagnosing Pilonidal Sinus typically involves a combination of medical history evaluation, physical examination, and, in some cases, imaging studies. Here are common methods used for diagnosis:

Clinical Examination:

The first step in diagnosing Pilonidal Sinus is a thorough physical examination. A healthcare provider will examine the affected area, looking for signs of a pilonidal dimple, sinus tract, or abscess. They will check for redness, swelling, tenderness, and any discharge from the sinus.

Patient History:

Gathering a detailed patient history is crucial for diagnosis. The healthcare provider will inquire about the patient’s symptoms, including the duration of pain, any recent infections, and any previous occurrences of similar symptoms.

Imaging Studies:

In some cases, imaging studies may be necessary to confirm the diagnosis or evaluate the extent of the condition. Ultrasound or MRI (Magnetic Resonance Imaging) can be helpful in identifying sinus tracts, abscesses, or underlying structures involved.

Needle Aspiration or Culture:

If there is a visible abscess, the healthcare provider may perform a needle aspiration to extract fluid from the abscess for examination. This procedure helps determine the type of bacteria causing the infection and assists in selecting the appropriate antibiotic treatment.

Rule Out Other Conditions:

Sometimes, other conditions may present with similar symptoms to Pilonidal Sinus, such as an infected hair follicle or a pilonidal cyst. It’s essential to differentiate between these conditions to provide the most appropriate treatment.

After complete diagnosis, the healthcare provider will discuss the treatment options with the patient. In milder cases, conservative treatments, such as warm compresses and antibiotics, may be sufficient.

Treatment for Pilonidal Sinus:

The treatment for Pilonidal Sinus can vary depending on the severity of the condition and individual factors. Here are common treatment options:

Conservative Management:

For mild cases of Pilonidal Sinus, conservative management may be sufficient. This approach involves maintaining good hygiene, keeping the area clean and dry, and using warm compresses to reduce inflammation and promote drainage. Over-the-counter pain relievers can help manage discomfort.


If the Pilonidal Sinus is infected or there is an abscess, antibiotics may be prescribed to help combat the infection. Antibiotics can be administered orally or, in severe cases, intravenously. It’s important to complete the full course of antibiotics as prescribed by the healthcare provider.

Incision and Drainage (I&D):

When an abscess is present, it may need to be drained to relieve pain and aid in healing. The healthcare provider will perform a minor surgical procedure called incision and drainage, during which the abscess is opened, and the pus is drained. This is typically done under local anesthesia.

Laser Hair Removal:

To prevent recurrence, some individuals may opt for laser hair removal in the affected area. The procedure aims to permanently reduce hair growth and prevent hair from becoming trapped in the pilonidal sinus.

Pilonidal Sinus Excision:

In recurrent or more severe cases, surgical excision of the pilonidal sinus may be necessary. During this procedure, the sinus tract is removed, and the wound is closed. Various surgical techniques are available, including primary closure, open wound healing, or the use of flaps.


This surgical technique involves creating a small incision and suturing the edges of the wound to the skin, allowing the wound to heal from the inside out. Marsupialization is often in use for complex or large pilonidal sinuses.

Closed Excision with Flap Closure:

In some cases, a surgical technique called “closed excision with flap closure” may be employed. This involves removing the sinus tract and then closing the wound using nearby healthy tissue as a flap to promote healing.

The choice of treatment depends on various factors, such as the size and extent of the sinus, the presence of infection, and the patient’s overall health. It is essential to discuss the treatment options thoroughly with a healthcare provider to determine the most appropriate approach for each individual case.

Preventive tips from Pilonidal Sinus:

Preventing Pilonidal Sinus involves adopting certain habits and lifestyle changes to reduce the risk of hair follicle irritation and infection. Here are best preventive tips:

Maintain Good Hygiene:

Keep the sacrococcygeal area clean and dry to minimize the risk of bacterial growth and infection. Regularly wash the area with mild soap and water and pat it dry gently.

Hair Removal:

If you are prone to Pilonidal Sinus or have a history of recurrence, consider removing excess hair from the sacrococcygeal region. Shaving or using hair removal creams may help reduce the chances of hair becoming trapped in the skin.

Avoid Prolonged Sitting:

Try to avoid sitting for extended periods, especially on hard surfaces, as this can increase friction and pressure on the lower back. If your job involves sitting for long hours, take breaks and stand or walk around regularly.

Use Cushions or Support:

If sitting is unavoidable, use a cushion or support to reduce pressure on the sacrococcygeal area. Special cushions with a coccyx cutout can help alleviate pressure and reduce the risk of irritation.

Wear Loose-Fitting Clothing:

Choose loose-fitting clothing that doesn’t constrict the lower back area. Tight clothing can lead to friction and exacerbate the condition.

Stay Active:

Engage in regular physical activity to maintain a healthy weight and promote good blood circulation. Regular exercise can also help prevent the formation of Pilonidal Sinus.

Practice Good Posture:

Maintain good posture while sitting and standing to reduce pressure on the lower back. Avoid slouching or hunching over, especially during extended periods of sitting.

Inspect the Area:

If you notice any signs of a pilonidal dimple or early symptoms of Pilonidal Sinus, such as redness or swelling, seek medical attention promptly. Early detection and treatment can prevent the condition from worsening.

What is the best treatment for pilonidal sinus?

Pilonidal Sinus: पिलोनाइडल साइनस क्या है?

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What should I do to promote healing?

Keep the area dry and allow it to air out whenever possible. Wearing loose-fitting clothing can help avoid friction.

How can I manage pain and discomfort?

Over-the-counter pain relievers like ibuprofen can help ease pain and reduce inflammation. Consult a doctor for stronger medications if needed.

Should I try home remedies for pilonidal sinus?

While some home remedies may offer temporary relief, it’s best to consult a healthcare professional for proper treatment and advice.

How do I prevent pilonidal sinus from recurring?

Maintain good hygiene, avoid prolonged sitting, and consider hair removal around the affected area to reduce the risk of recurrence.

When should I seek medical attention?

If you experience worsening pain, fever, pus discharge, or any signs of infection, seek medical help promptly to prevent complications.

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