5 typical signs of a pilonidal sinus

Pilonidal Sinus Symptoms

1. pits: openings in the center line

Primary fistula = starting point of the fistula

Small, black dots or openings in the midline are characteristic signs of Pilonidal Sinus. These so-called "pits" or "pores" are often easily overlooked. Sometimes they are only visible after shaving and with magnification.

Occasionally, loose or broken hairs can be removed from these pits. Other pits contain a thick secretion of horny scales, similar to a blackhead.

The pits are the origin of the fistula and represent 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.

Pilonidal Sinus with multiple primary and secondary openings

Pilonidal Sinus with 3 primary openings

Pilonidal Sinus Symptoms: numerous, small holes in the buttock crease

Pilonidal Sinus with numerous pits

Pilonidal Sinus Symptoms: Pimples on the buttocks as a SInus pilonidalis symptom

Pilonidal sinus with 3 pits (red arrows) and a secondary opening on the left (green arrow)

2. pain, hardening

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

This is particularly noticeable 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 on the coccyx suggests a contusion or bruise. A temporal connection between the first symptoms and a trauma is found disproportionately often.

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

In the event of an inflammatory episode or pilonidal abscess, it can become so painful that you can no longer sit.

Pain during sport

Pain on unpadded seats

Tailbone pain on a hard beer garden bench

Pain in the beer garden

3. bump or asymmetry

Not always in the pilonidal sinus there is a clearly visible fistula opening.

The only sign may then be an asymmetry of the gluteal fold or a visible bump on the buttocks.

The fistula capsule can be felt as a hardening that feels like bone or cartilage in a chronic form that has existed for many years. The difference can be seen when comparing the left and right sides - bones would always be symmetrical!

So if you feel something but the doctor can't find anything, seek a second opinion if in doubt. Doctors who are rarely confronted with this problem are sometimes unaware of the discreet signs.

Asymmetry of the buttock fold as a symptom

The distorted gluteal fold indicates Pilonidal Sinus

4. blood, pus, clear secretion

Some patients notice dampness, stains in the laundry or an unpleasant odor. The fistula secretion may be colorless and is often mistaken for profuse sweating.

Occasional bleeding may give the impression that blood is present in the stool. However, this bleeding comes from the granulation tissue that lines the fistula. This tissue contains many small, delicate blood vessels that can bleed easily.

Such bleeding is not dangerous. They are a sign that the body is trying to heal the wound. Healing processes require the supply of building materials, which are transported via the blood.

Purulent discharge with abscess perforation

Bleeding from secondary opening

5. general signs of illness: Fever or fatigue

In rare cases, a severely inflamed Pilonidal Sinus can cause general symptoms such as fever or fatigue. However, it is very unlikely that an abscess on the coccyx will not be noticeable mainly due to pain, as this region is very sensitive.

However, if an abscess persists for several days, remains untreated and does not rupture on its own, it is possible for bacteria to be washed in, which can lead to fever and, in rare cases, blood poisoning. However, such complicated courses are rare.

Patients often ask whether a pilonidal sinus as a chronic inflammatory process has consequences for general health. To my knowledge, there are no reliable findings on this. However, it is known that even inflammation of the gums can increase the risk of a heart attack, so it is possible that untreated Pilonidal Sinus could be harmful to health in the long term.

Coccyx fistulas are not associated with chronic intestinal inflammation such as Crohn's disease.