Cause and origin
Pilonidal Sinus - Cause and origin
One Pilonidal Sinus (sinus pilondalis) is not only an unpleasant medical problem, but also a condition that often occurs unexpectedly and severely affects the lives of those affected. Young, athletic men in particular are affected and suffer from the painful symptoms. But how does Pilonidal Sinus actually develop and what are the exact causes? Knowing how it develops and the risk factors can help you to better understand the condition and identify possible triggers at an early stage. Timely treatment can be crucial in reducing the level of suffering and avoiding long-term complications.
Pilonidal SinusDevelopment, risk factors and forms of progression
Most people will probably only come across this diagnosis when they themselves or a relative is affected. An inconspicuous small opening in the buttock crease (the pit) is often the first sign. Hair enters the subcutis through this hole. Pilonidal Sinus Sometimes several of these openings can be observed, which all lead into the same fistula cavity and thus make the Pilonidal Sinus recognizable.
Hair is made of keratin. Although the body is able to produce keratin, it is not able to break it down. This leads to hair being treated as a foreign body in the body. Experts agree that ingrown hairs are the cause of coccyx fistulas.
A sheath of scar tissue forms, which forms the fistula capsule. This capsule prevents the chronic inflammatory process from spreading. Experts speak of a foreign body granuloma. The following factors essentially play a role in the development of painful fistulas:
- Ingrown hairsThe most common cause of pilonidal sinus is ingrown hairs in the gluteal fold. These drill deep into the subcutaneous fatty tissue and cause inflammation.
- Mechanical friction and pressureSedentary activities, tight clothing or prolonged sitting increase friction in the gluteal fold, which irritates the skin and causes minor injuries.
- Increased sweat productionMoisture and sweat in the gluteal fold promote the growth of bacteria and encourage inflammation of the skin.
- Hormonal changesEspecially during puberty, increased sebum production and hair growth lead to increased problems with ingrown hairs.
- Genetic predispositionIn some cases, a family history can favor the development of coccyx fistulas.
These factors lead to hairs drilling into the skin and damaging the tissue. This creates tiny openings in the skin, known as pits, through which bacteria can penetrate and cause inflammation.
Can a Pilonidal Sinus be dangerous?
Pilonidal fistulas are unpleasant and painful, but they are not associated with other serious fistulas, such as intestinal, bone or spinal fistulas. A Pilonidal Sinus is specifically limited to the gluteal fold. It is caused by mechanical stimuli and ingrown hairs and is not due to congenital malformations or embryonic developmental disorders. It is therefore a localized and independent disease, which does not spread to other areas of the body
Risk of confusion with other diseases
Due to its similar appearance, a fistula on the coccyx can easily be confused with other diseases, in particular with acne inversa or anal fistulas. A precise diagnosis by a specialist is therefore essential.
- Acne inversaThis disease often affects the armpits, groin and genital region, but can also occur in the buttocks. In contrast to pilonidal sinus, acne inversa is a chronic skin disease caused by inflamed hair follicles and sebaceous glands. It often occurs in smokers and leads to recurring abscesses and fistula formation in the affected skin regions.
- Anal fistulasThese fistulas occur in the area of the anal canal and are caused by inflammation of proctodeal glands (small glands in the anal canal). They are not related to coccygeal fistulas, although both conditions can involve fistula tracts and abscess formation.
Complications with pilonidal sinus
Even if coccyx fistulas do not usually lead to life-threatening conditions, they can lead to the following complications if they are not treated:
- Chronic inflammationRecurrent inflammation can permanently damage the affected skin and surrounding tissue.
- Abscess formationAn untreated pilonidal sinus can lead to painful accumulations of pus, which must be surgically removed.
- Increased risk of recurrenceWithout complete removal of the fistula tract, there is a high risk of recurrent fistulas, which may require further surgery.
Although coccygeal fistulas do not spread to serious fistulas in other areas of the body, they should not be left untreated to avoid complications. If you notice symptoms, have the diagnosis confirmed by a specialist to ensure that there is no confusion with other conditions and that the appropriate treatment is initiated.
Schematic drawing: Emergence Pilonidal Sinus
Where does the hair in the Pilonidal Sinus come from ?
The "pit" - cause of the pilonidal sinus
At Pilonidal Sinus , there are so-called "patches" created by the British surgeon John P. Lord called pits. These are openings or entry ports found in the middle of the gluteal fold. They are also called porus (lat. passage, gate) or primary fistula. They tend to be hidden in the depth of the fold. The presence of pits reliably identifies Pilonidal Sinus.
Some patients have only a few, others a large number of these pearl-like openings. The size of these pits ranges from barely visible black dots to holes several millimeters in size. Sometimes broken, loose hairs are stuck in them, and some can be seen like a blackhead (comedo) a whitish, pasty secretion can be squeezed out.
The pits are lined with skin and can therefore no longer close on their own. They become an entry point for bacteria and thus the cause of recurring inflammation. The German surgeon Karl Heinz Ardelt discovered that primarily anaerobic and gram-negative bacteria play a role and that aerobic and gram-positive bacteria play an increasing role in recurrences.
Thus, the ... pilonidal sinus, despite differing opinions... is an infected foreign body granuloma.