Playing sports with sinus pilonidalis?

Treatment coccygeal fistula and sports

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Are athletes more susceptible to coccyx fistula?

Sports and other injuries

Friction, sweating and bruising do not play a crucial role in the development of a pilonidal sinus. This condition, also known as Pilonidal Sinus , is usually caused by the ingrowth of hair in the coccyx area. Although external factors such as friction or bruising can aggravate the condition, they are not the main cause of the development of a Pilonidal Sinus. Nevertheless, proper care and hygiene of the coccyx area is important to relieve discomfort and prevent recurrence.


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Anatomy of skin and subcutis with sweat gland (yellow)
Anatomy of skin and subcutis with sweat gland (© istockphoto))

Friction and textile fibers

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Is it allowed to do sports with Pilonidal Sinus ?

Can athletic stress worsen a Pilonidal Sinus ?

Despite a Pilonidal Sinus , it is possible to play sports in many cases as long as certain precautions are observed. The choice of sport plays a crucial role. Sports that generate little pressure and friction in the coccyx area, such as swimming or cycling, are often better tolerated. However, it is advisable to always consult with a physician before continuing or starting any sports activity to ensure that there are no risks or concerns in your individual case. Proper care and hygiene of the affected area and wearing loose, non-restrictive clothing can also help minimize discomfort during exercise. In any case, it is important to listen to your body and consult a physician immediately if you experience pain or problems.

Sport after coccygeal fistula surgery

When is it allowed to return to physical work, sports and sex after the operation?

In general, it can be said that sport is beneficial for health, also for patients after surgery. The Fast Track concept for rehabilitation in surgery is based on this.

We have learned that bed rest, plaster casts, and dietary restriction may not promote healing but may compromise it (inactivity atrophy, catabolic metabolic state).

But how great is the risk of reopening the wound?

To answer this question, it is important to understand the two types of wound healing. In primary wound healing, as is aimed for after surgical interventions with wound closure, the wound edges are joined together in the first step by suturing, stapling or gluing.

Only in the second step does stabilization take place through the formation of connective tissue fibers. For this reason, such wounds should not be subjected to tensile stress for the first two weeks. This "grace period" applies to surgery of a pilonidal sinus with "mattress suture" or reconstruction according to Karydakis.

Sport is also allowed during convalescence
Sport is healthy

In the "butcher's method" and in pit picking, the process of secondary wound healing is used, which corresponds to the natural mechanism of healing an injury.

Here, the wound slowly fills with granulation tissue to eventually reach the skin level. The skin then gradually begins to grow over the wound from both sides at a rate of about 1 mm per week. Only when the wound is completely closed will it stop weeping. It does not "air dry." With this type of wound healing, the progress achieved remains stable at all times, and physical rest does not provide any additional benefits.

However, if secondary wound healing is disturbed, usually caused by hair in the context of coccygeal fistulas, the granulation tissue remains unstable, proliferates beyond the boundaries of the wound ("wild flesh") and may bleed at the slightest touch. Normally, even in this case, a delicate skin layer forms over this tissue. Nevertheless, the scar remains unstable, regardless of how much you take it easy. Only when the disturbing factor, namely the hair, is removed, a firm and bleeding-free scar can develop.

Green = recommended

Open wound treatment: sport allowed without restrictions Closed wound treatment: Sport after 2 weeks

Literature: Coccygeal fistula and sports

What science says

Doll, D., Brengelmann, I., Schober, P., Ommer, A., Bosche, F., Papalois, A., Petersen, S., Wilhelm, D., Jongen, J., & Luedi, M. (2021). Rethinking the causes of pilonidal sinus disease: a matched cohort study. Scientific Reports, 11(1)

Karydakis,G.E. (1992). Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust. N. Z. J. Surg. 62, 385-389 .