Proctology
What Is a Pilonidal Sinus or Pilonidal Abscess?
A pilonidal sinus is a small tunnel that forms near the top of the buttocks (tailbone area). It often contains hair, debris, or trapped skin. If it becomes infected, it leads to a pilonidal abscess, which is painful and swollen.
Pilonidal disease: is a subcutaneous infection occurring in the upper half of the gluteal natal cleft. It occurs more commonly in young adults and teenagers. The word “pilonidal” means “hair nest”, however the disease does not appear only in hairy people, it can affect anyone.
It may present as an acute pilonidal abscess with pain, redness and induration. Or as a pilonidal sinus, which is usually a painless wound in the natal cleft line, which is not healing and can cause discomfort and fluid or blood drainage.
Clinical presentation:
1) Acute pilonidal abscess is a painful fluctuating mass under the skin, with surrounding redness and skin irritation, located near the tailbone. The onset is very rapid, and the pain is severe.
2) Chronic pilonidal sinus has a primary pit in the midline of the tailbone area. The pit will sometimes have a hair extruding from the opening. Sometimes multiple pits are present with or without hair.
3) Recurrent or complex pilonidal sinus: have multiple tracts under the skin.
The exact cause of pilonidal disease is not fully known, as it might have embryologic origins and/or acquired elements. Possible reasons of pilonidal disease:
Common Symptoms
• Pain near the tailbone
• Redness, swelling, or warmth
• Fluid or pus discharge
• Bleeding or bloody discharge
• Difficulty sitting
• Recurrent flare-ups if not treated properly
A pilonidal sinus can be acute (sudden infection) or chronic, causing repeated episodes unless treated with a long-term solution.
When Should You See a Doctor?
Seek medical care immediately if you have:
• Severe or worsening pain
• Fever
• Swelling or lump near the anus or tailbone
• Any pus or fluid drainage
• Bleeding or bloody discharge
• A history of recurrent pilonidal infections
• Difficulty sitting or performing daily activities
Early treatment prevents long-term complications and supports faster healing.
How We Diagnose Pilonidal Disease?
Our specialists begin with:
• A gentle, thorough physical examination
• Assessment of pain, swelling, and type of drainage
• Ultrasound or other modality of imaging depending on the clinical findings
• Identification of underlying causes (e.g., blocked glands, hair growth, skin anatomy)
Diagnosis is quick, respectful, and private, ensuring your comfort throughout the visit.
Pilonidal Sinus & Abscess Treatment
Management of pilonidal disease should be tailored as per the individual clinical presentation. We provide modern, effective approaches with faster healing and potentially fewer recurrences.
Drainage of Acute Pilonidal Abscess
Performed under anesthesia for immediate relief.
Minimally Invasive Surgical Pilonidal Sinus Procedures
• Laser treatment for pilonidal sinus
• Endoscopic pilonidal sinus treatment (EPSiT)
• Combined procedures
These options help avoid large wounds and support faster return to daily life.
Surgical Options for Chronic or Recurrent Cases
• Excision with or without primary closure
• En-block excision
• Flap procedures for complex or repeated infections: Rhomboid flap, V-Y flap, Z-plasty, myocutaneous flap formation or skin grafting
Your surgeon will choose the safest, most effective method based on your anatomy, clinical presentation and medical history.
Recovery & Aftercare
The patients must keep in mind that pilonidal disease has a very specific biology and has a relatively high recurrence rate of 30%, whichever procedure we do. We support your healing every step of the way with:
• Clear wound-care instructions
• Pain management
• Laser hair removal guidance for pilonidal sinus prevention
• Follow-up appointments to monitor healing
• Lifestyle advice to reduce recurrence
Most patients return to routine activities within days, depending on the procedure.
