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DISEASES

Pilo Nidal-sinus
 
 
  • Pilonidal means a 'nest of hairs'.
  • A sinus tract is a narrow tunnel (a small abnormal channel) in your body. A sinus tract typically goes between a focus of infection in deeper tissues to your skin surface. This means that the tract may discharge pus from time to time on to your skin.

A pilonidal sinus is a sinus tract which commonly contains hairs. It occurs under your skin between your buttocks (the natal cleft) a short distance above your back passage (anus). The sinus tract goes in a vertical direction between your buttocks. Rarely, a pilonidal sinus occurs in other sites of your body.

The exact cause is not clear. There are various theories. For example, one theory is that the problem may develop from a minor abnormality you were born with, in the skin between the buttocks. This may explain why the condition tends to run in some families. Part of the abnormality in this part of your skin may be that the hairs grow into your skin rather than outwards.

Another theory is that you develop skin dimples (skin pits) in the skin between your buttocks. These may develop as a result of local pressure or friction causing damage to the small structures below your skin which are responsible for making hairs (the hair follicles). Because of local pressure, growing hair in your natal cleft may become pushed into your skin pits.

Whatever the cause, once hair fragments become 'stuck' in your skin they irritate it and cause inflammation. Inflamed skin quickly becomes infected and so a repeated (recurrent) or persistent infection tends to develop in the affected area. The infection causes the sinus to develop which often contains broken pieces of hair.

(A similar condition can occur between the fingers of hairdressers, caused by customers' hairs entering moist, damaged skin.)

This condition affects around 26 in 100,000 people each year in the UK. It is rare in children and in people over the age of 40. It is four times more common in men than in women (as they are hairier than women).

Certain factors increase the risk of developing the condition and include:

  • A job involving a lot of sitting (a sedentary occupation).
  • Being overweight or obese.
  • A previous persistent irritation or injury to the affected area.
  • Having a hairy, deep natal cleft.
  • A family history of the condition.

This condition used to be called 'jeep seat', as it was common in army jeep drivers. This was probably a result of many hours driving and 'bouncing' on a hard seat, which caused irritation, minor injury and pressure around the natal cleft.

A pilonidal sinus may not cause any symptoms at first. You may not be aware that you have one. Some people notice a painless lump at first in the affected area when washing. However, in most cases, symptoms develop at some stage and can be 'acute' or 'chronic'.

Rapid-onset (acute) symptoms

You may develop increasing pain and swelling over a number of days as a ball of pus with surrounding skin infection (an infected abscess) develops in and around the sinus. This can become very painful and tender.

Persistent (chronic) symptoms

Around 4 in 10 people have a repeated (recurrent) pilonidal sinus. You may develop some pain which is less intense than the acute symptoms. Usually the sinus discharges some pus. This releases the pressure and so the pain tends to ease off and not become severe. However, the infection never clears completely. This can mean that the symptoms of pain and discharge can last long-term, or flare up from time to time, until the sinus is treated by an operation.