Pilonidal Sinus, Cysts and Abscesses.
Pilonidal disease. Pilo (pilus) means “hair”. Nidal, (from Nidus or center), means “nest”. What does this mean? Pilonidal disease is centered around a hair or a group of hairs and other infected material located near the tailbone. As can be seen by the names of the diseases beginning with the word “pilonidal”, pilonidal disease can consist of an asymptomatic sinus tract, a cyst (cavity) or an abscess (an infected cavity). Pilonidal disease is one of the more common entities seen by the colon and rectal surgeon, also known as a proctologist.
Pilonidal disease is the source of much discomfort, time away from work or other daily activities, and recovery time for those requiring operative intervention. In Los Angeles, pilonidal disease occupies much of the time spent by physicians evaluating and treating the disease. The disease occurs over the sacrum, the area next to the tailbone.
Causes. Many. Answers. Few.
Theories abound as to the cause of pilonidal disease. Is it brought on by a single cause or by a group of causes? Nobody knows for sure, but here are some of the theories:
- Congenital. You were born with it.
- Genetic. An inherited, or genetic mutation caused the disease.
- Ingrown hair. A hair in the area of the problem became infected, precipitating the problem.
- Trauma. An accident precipitated the disease.
Diagnosis. Look “Down There”. Treatment. Treat “Down There”
As pilonidal disease begins over the sacrum (near the tailbone), a simple visual inspection of the area will usually yield the diagnosis. Symptoms may include pain, a purulent (pus) discharge, fever, and erythema (redness). Blood tests and x-rays are of little value.
If found early, if the patient visits the proctologist as soon as symptoms begin, antibiotics may help reverse the symptoms. However, if the disease progresses with or without antibiotics, a drainage of the pus becomes necessary. This may be done in the office, or, if too severe, in a surgical center or the outpatient department of a hospital such as Cedars-Sinai Medical Center. This will not cure the disease. For cure, an operation must be performed which removes the entire area. Although straightforward, the operation often yields an incision which may be slow to heal. Additionally, despite the surgeon’s best efforts, pilonidal disease may recur. Attempts have been made to move the incision site away from the midline, and toward the side. It is thought that putting less stress (stretching) on the incision allows for more adequate healing. This is where the specialist, the proctologist is important. Experience in treating pilonidal disease is important in promoting a good outcome.