5 typical signs

Pilonidal Sinus Symptoms

Chronic fistula and acute abscess

How does a fistula at the coccyx manifest itself?

... and how does the doctor make the diagnosis

Midline pits

Primary fistula = starting point of the fistula

Small, black dots or Openings in the centre line prove the diagnosis of the Pilonidal Sinus. These so-called pits, also called porus, are easy to overlook. Sometimes you can only find them after shaving and under magnification.

Occasionally, loose or broken hairs can be pulled out. Other pits contain a thick secretion of horny scales, similar to a "blackhead".

The pits correspond to the starting point of the fistula and are the structure to be removed during pit picking.

Secondary fistula = end point of the fistula

The fistula can break through the skin in the middle or also on the side, in most patients for an unknown reason on the left side, and empty outwards. With such an open fistula on the coccyx, the patient usually has no pain. Not all fistulas work their way to the surface; many ends are also blind under the skin.

This opening looks similar to a "pimple" and is often the first and only symptom that the patient notices. A red, slightly bleeding tissue (granulation tissue, amateurishly called "wild flesh") seems to ooze out of the opening.

More often than one might think, medical measures also focus on this eye-catching finding and neglect the actual starting point of the problem.

In our Picture gallery you can see how a Pilonidal Sinus can look like.

Pain, Induration

The most common symptom is a pain or foreign body sensation when sitting.

This is especially noticeable when sitting on an unpadded chair (school, lecture hall, training course, beer garden bench). One suspects that it is due to the uncomfortable furniture.

A recent fall from the coccyx suggests a bruise or haematoma. More often than not, there is a temporal connection between the first complaints and a trauma.

You can also feel the hardening during sporting exercises (sit-ups, bench presses, floor gymnastics).

In inflammatory episodes or pilonidal abscesses, it can become so painful that you can no longer sit.