Treatment Pilonidal Sinus

Pilonidal Sinus treat yourself?

From home remedies to antibiotics

Pilonidal Sinus: Alternative treatment without surgery?

Prevent, treat, avoid relapse

Therapy situations and individual measures

When the hair is removed, the fistula will heal.

1965 Peter H. Lord and Douglas M. Millar, Pit Picking Inventors

The Pilonidal Sinus heal itself? This is not to be expected. In fact, the cure of a Pilonidal Sinus can only be achieved with a surgical intervention. You can find out which surgical method is best for you and how minimally invasive surgery can take the fear out of the matter on our page on Pilonidal Sinus surgery

Nevertheless, conservative measures are of great importance. We tell you here which home remedies, behavioral tips, medications and non-surgical treatments are recommended.

  • in order to avoid a Pilonidal Sinus
  • abatement
  • to avoid complications
  • for follow-up treatment and wound care after an Pilonidal Sinus operation

Of course, the list does not claim to be complete. We are happy to receive your suggestions and proposals for improvement.

From home remedies to antibiotics
Pilonidal Sinus avoid

Prevent the inflammation

For minor ailments or cases of a Pilonidal Sinus in the family.

Preventive laser treatment?

If you want to prevent a Pilonidal Sinus altogether, you would have to start early. Probably the first "pits" develop already from the beginning of puberty. Our youngest patients are hardly older than 13 years.

An early, permanent removal of the hair of the gluteal fold by laser would possibly be a causal treatment. Unfortunately, it is not possible to reliably estimate which young people would benefit from laser epilation. Laser epilation is not covered by public health insurance. Several treatments are always necessary. A purely preventive laser epilation therefore seems to me to be justified only in the case of very pronounced hairiness or several family members affected by Pilonidal Sinus .

Pilonidal Sinus without treatment?

If you have few complaints or a painful inflammation has just subsided, the motivation for an operation is low. If you then read reports about difficult wound healing in the Pilonidal Sinus forum, you should rather postpone the topic.

On the one hand, this is not a problem, because the Pilonidal Sinus (almost) never becomes dangerous. That is why the guideline also advocates only observing the so-called "bland fistula".

On the other hand, surgery in the symptom-free interval is technically the easiest and minimally invasive surgery is the easiest to implement. At the latest when the next inflammatory episode occurs, you wish you had already had the treatment.

Don't be frightened. Most fistulas probably have a phase of development. Once the duct is encapsulated, the fistula does not grow too quickly. There is no fear of it spreading to the coccyx or rectum.

Early detection: The 6-point risk check

If you have to answer yes to several of these questions, you may be at increased risk. Then ask your doctor or another trusted person to look in the buttock crease for swelling, redness and especially openings.

  • Do you have a lot of body hair?
  • Has a Pilonidal Sinus occurred in close relatives?
  • Do you often sit for many hours without a break?
  • Do you often not have the opportunity to wash / shower thoroughly?
  • Are you professionally exposed to hair (hairdresser, contact with animal hair)?
  • Do you have pain when sitting?
Risk factors Pilonidal Sinus Check
Check your risk for a Pilonidal Sinus (© istockphoto.com)

Pilonidal Sinus: Optimize hygiene

General body hygiene

You don't get a Pilonidal Sinus because you don't wash enough. However, the deepest point of the buttock fold (in technical language: Rima ani) is often neglected. If hair fragments collect here, they can be massaged into the skin. Moisture and exfoliated horny scales of the skin form a breeding ground for bacteria and clog enlarged pores. So: when showering, hold one buttock to the side and rinse the rima ani thoroughly.

Prevention of inflammation

Cleaning with soap and water is helpful by reducing bacteria. In a Norwegian study, washing was even superior to disinfection with alcoholic solution.
 
A pH-neutral skin cleansing lotion (slightly acidic with a pH value of 5.5) made of synthetic detergents ("Syndet") is optimally suited. This will not attack the protective layer of the skin.
 
In case of frequent inflammations, the question arises whether antibacterial washing lotions for bacteria reduction ("decolonisation") are are better than a normal shower. Below you will find an overview of body hygiene and disinfection.
iStock 996105230
Don't forget the buttock crease when showering (© istockphoto.com)

Pilonidal Sinus: "Lifestyle"

Avoid sitting for long periods

Many problems with the buttocks are an indirect result of the upright gait. This created the deep fold of the buttocks with a constant contact surface of the buttocks, which in turn is the cause of moisture and friction.

In addition, modern people spend far too much of the day sitting. This already starts at school and continues with university, office and movement by car, train and plane.

Sitting is the new smoking?

That seems to me to be an exaggerated formulation. Nevertheless, it is certainly good for the musculoskeletal system, cardiovascular system and metabolism, and also for the sensitive area of the gluteal fold, if you do not sit for many hours at a stretch

The inevitable shift of weight from one buttock to the other and back results in a conveyor belt effect that can transport hair and impale it into the soft tissues.

Sitting is even more significant if there is already an as yet undetected Pilonidal Sinus and the small openings are functionally closed by the pressure when sitting. Then the persistent pressure load can become the trigger for painful inflammations.

For acute abscess

Escape emergency surgery

and thereby create optimal conditions for a gentle operation

The final exam is already in 2 weeks? The presentation for the boss is not yet ready? There are already hundreds of kilometres of motorway behind you? Your long-haul flight has just landed?

AND THEY CAN'T SIT DOWN?

These situations are typical of the acute form of Pilonidal Sinus, pilonidal abscess. The pain can become so severe overnight that you can no longer cope. Quick help is needed.

What to do with an abscess?

Severe pain is the symptom of acute Pilonidal Sinus - coccyx abscess

Pilonidal Sinus Wound not healing, bleeding, reopened?

Treatment after Pilonidal Sinus surgery

These measures are essential in our view

You have already had surgery on a Pilonidal Sinus . How should you deal with the wound now? Everywhere you hear other opinions, from doctors, acquaintances and on the Internet. After all, you don't want to make a mistake. Maybe the surgery was a few weeks or even months ago and the healing progress is stagnating?

Often it is easier than you think. Remember Dr. Peter Lord: it is the hairs that cause the fistula to develop, and it is the hairs that prevent it from healing. And maybe the numerous bacteria in that region.

With our checklist wound healing we summarise what is really important. The success or failure of an operation at Pilonidal Sinus is decided in the first 4 - 6 weeks after the procedure.

Stocktaking: Was the operation performed suitable to heal the fistula?

  • Was the Pilonidal Sinus removed or merely an abscess split? In this case, a second, usually smaller operation is absolutely necessary, even if you feel symptom-free. Otherwise the risk of new abscesses is very high.
  • Has the Pilonidal Sinus been completely removed? Carefully inspect the entire gluteal fold to see if there are still any conspicuous openings. In this case, the recurrence is pre-programmed.

These points must be observed

  • Hair removal of an approx. 2 cm wide fringe around the entire wound (shaving, possibly depilatory cream, plucking)
  • Shower at least once a day

You should omit these measures

  • Antibiotics systemically have a place only in exceptional cases.
  • Tamponades are painful and ineffective.
  • Treatment of "wild flesh" with silver nitrate pen: these so-called hypergranulations are always a sign of an obstacle to healing, usually from penetrated hairs. Doctoring around with the secondary growths is of no use at all.

Everything done right and the wound still does not heal?

This is plan B: Sometimes a wound does not heal despite inconspicuous ultrasound findings and optimal care. If no healing progress is seen for one to two months, the truth must be faced. A new operation is due, the options are a new wound cleaning or the Karydakis plastic.

Our rating

The list of possible measures

What really helps

Washing and disinfecting

Hurt? First disinfect the wound, we learn from an early age. After all, inflammations are caused by pathogens, which must be eliminated with disinfectants. Less well known is the fact that almost all disinfectants and antiseptics not only kill the bacteria but also damage the normal skin flora* as well as the cells of the body's own defence (leukocytes) and wound healing (fibroblasts).

Without a wound or with normal wound healing there is therefore no good reason for disinfection. Colonisation, i.e. colonisation, with bacteria is in any case unavoidable in the region of the gluteal fold and the anus and is also not harmful. Only in the case of infection, i.e. pathogenic bacterial growth in the wound, can antiseptics be useful in justified individual cases.

* Today, the skin flora is better called the microbiome . Flora, after the Roman goddess of flowers and youth, refers to the plant kingdom, to which bacteria do not belong.

Disinfection and antiseptics for Pilonidal Sinus
Bacteria in the Petri dish - Should you disinfect at Pilonidal Sinus ? © istockphoto.com

Cleaning and disinfection products at a glance

Creams, powders, ointments

Has a herb already grown against the Pilonidal Sinus? Germans spend almost €5 billion a year on over-the-counter medicines. 65 million packages of ointments and creams cross the pharmacy counter every year.

We have tried to clarify what you can save and which preparations have a proven benefit.

Shaving, epilating, waxing, laser?

Hair Removal

Prevention, post-operative treatment and recurrence prophylaxis

Where do the hairs come from that you find in the cave of a Pilonidal Sinus ? 

  • The hair mainly comes from hair roots in the area of the gluteal fold
  • New studies show that hair from the head can also be found in the fistula ducts, hair from the back only rarely. Short, freshly cut hair from the neck seems to penetrate the skin most easily.
  • Furthermore, it happens that deposits of keratin dandruff due to a disturbed hair formation lead to an expansion of the hair root. 

In my experience, a hair-free buttock crease reduces the risk of healing problems after surgery. Many supposed recurrences are actually poorly healed surgical scars(type IV fistulas) that probably could have been avoided by consistent hair removal in the early phase after surgery. Penetration of loose hairs from other parts of the body is most likely to be achieved by covering them with a closed dressing.

Depilation and epilation

Procedures that only remove the visible part of the hair, the hair shaft (shaving, depilatory cream) are called depilation. They last for about 2 weeks and by their very nature cannot affect the hair root in depth and thus the risk of a real recurrence. Contrary to popular belief, depilation does not change the growth rate. 

With real epilation, the hair bulb is also removed and thus an effect is achieved for about 6-8 weeks. This includes plucking, waxing, sugaring and in a broader sense also laser epilation and electrolysis.

Antibiotics

Systemic antibiotics (tablets, infusions)

Antibiotics are not treatment of first choice. They can help to contain an acute inflammation and thus save time. In the case of acute symptoms, e.g. on holiday, such treatment can sometimes bridge the time until the patient is able to return home. However, the success of antibiotic treatment is a matter of luck:

There is always a mixed spectrum of different bacteria, so that broad-spectrum antibiotics are necessary (e.g. cefuroxime, amoxicillin/clavulanic acid). However, it is quite possible that the bacteria causing the inflammation are resistant to the antibiotic used or that the antibiotic does not reach a sufficient effective level at the site of inflammation. A healing of the fistula can never be achieved with antibiotics. 

Antibiotics for Pilonidal Sinus
Antibiotics for Pilonidal Sinus
Other countries, other customs

Treatment methods from all over the world

Away from western orthodox medicine

Our recommendation traffic light

Green = recommended
Yellow = suitable under certain circumstances
Red = not recommended or not available

In no case should the following presentation serve as a guide for uncritical self-treatment. The recommendations follow to the best of our knowledge from our own experience and selected publications. They do not represent a systematic analysis of available studies. In any case, consult a specialist experienced in wound treatment before use.