Pilonidal sinus disease

Pilonidal sinus disease is a fascinating condition, and Dr Morris has a special interest in minimally invasive treatments of this condition. 

It is a common condition effecting the skin in the crease of the buttock (gluteal cleft). It involves the development of tiny midline holes (pits) which collect hair and debris. This debris then results in an infective and inflammatory process beneath the skin, and this may progress to an acute pilonidal abscess, chronic pain or tenderness, or a discharging wound in the buttock crease. 

It most commonly affects young men and women in adolescence and early adulthood. 

We still don’t know precisely what causes pilonidal sinus disease, but it is a disease that tends to resolve with increasing age. It likely occurs as a result of the combination of the shape of the buttocks and the buttock crease, local skin integrity and moisture leading to skin fragility, and the nature of an individual’s hair. 

The condition mostly gained attention after it affected many ‘jeep drivers’ during World War II, leading to long periods of illness and wound care.  It can be more common in those who need to sit for long periods, such as truck drivers.

The priority for a pilonidal abscess is to drain the infection. A pilonidal abscess will be red, sore and swollen, with swelling usually occurring just off to one side of the buttock crease. The treatment principle here is to drain the abscess with an incision. These incisions don’t require packing, but will leave a small open wound which the body will heal with time.

The pits are the culprit of this disease, and may be dealt with at the time of the inital infection, or after the infection has resolved. The chance of a second infection is roughly 30-50%. 

Treatment of pilonidal disease is surgical. Pilonidal sinus operations are NOT all the same, and your surgeon should have multiple techniques available to tailor specifically to your individual problem. 

Dr Morris is an enthusiast for minimally invasive interventions for pilonidal sinus disease, and many patients are able to return to work after day case intervention, with no packing or difficult wound aftercare. 

More complex cases of pilonidal sinus disease may require more extensive surgery, with excision of the pits and tracts, and a possible flap repair using neighbouring healthy tissue to help the wound heal.