A pilonidal sinus is an infected tract under the skin between the buttocks. Treatment commonly involves an operation. After the operation you should keep the area free of growing hair by regular shaving or other means of hair removal.Ksharasutra therapy is another kind of treatment for pilonidal sinus without surgery with high success rate.
What is a pilonidal sinus?

  • Pilonidal means a ‘nest of hairs’.
  • A sinus tract is a small abnormal channel (like a narrow tunnel) in the body. The tract may discharge pus from time to time onto the skin.

A pilonidal sinus is sinus tract which commonly contains hairs. It occurs under the skin between the buttocks (the natal cleft) a short distance above the anus. The sinus track goes in a vertical direction between the buttocks. Rarely, a pilonidal sinus occurs in other sites of the body. This condition used to be called ‘jeep seat’ as it was common in army jeep drivers.

What causes a pilonidal sinus?
The exact cause is not clear. There are various theories. For example, one theory is that the problem may develop from a minor congenital or hereditary abnormality in the skin of the natal cleft. This may explain why the condition tends to run in some families. Part of the abnormality in this part of the skin may be that the hairs grow into the skin rather than outwards.

Another theory is that you develop skin dimples (skin pits) in the skin between the buttocks. These may develop from damaged hair follicles (the small structures under the skin that make the hairs) due to local pressure or friction. Because of local pressure, growing hair in the natal cleft may get pushed into the skin pits.

Whatever the cause, once hair fragments become ‘stuck’ in the skin they irritate the skin and cause inflammation. Inflamed skin quickly becomes infected and so a recurring or persistent infection tends to develop in the affected area. The infection causes the sinus to develop which often contains broken pieces of hair.

Who gets pilonidal sinus?
Most cases occur in young adults or teenagers. It is rare in children and in people over the age of 40. It is much more common in men (as they are more hairy than women).
Certain factors increase the risk of developing the condition and include:

  • Sedentary occupation (sitting a lot).
  • Obesity.
  • A previous persistent irritation or injury to the affected area.
  • A family history of the condition.

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

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. So, typically the symptoms of pain and discharge can persist long-term, or flare up from time to time, until the sinus is treated.

What is the treatment for pilonidal sinus?

In most cases an operation will be advised. There are various operations which are done to cure this problem. The options include the following.

Wide excision and healing by secondary intention. This operation involves cutting out the sinus but also cutting out a wide margin of skin which surrounds the sinus. The wound is not stitched but just left to heal by normal healing processes (healing by ‘secondary intention’). So, the wound can take several weeks to heal, and requires regular dressing until it heals.
Excision and closure. This means taking out the section of skin which contains the sinus. This is done by cutting the skin either side of the sinus (to form an ellipse shape around the sinus), taking out the sinus, and stitching together the two sides of the ellipse. However, the risk of a recurrence, or of developing an infection of the wound after the operation, is higher than the above procedure.

In some cases where the sinus recurs or is extensive, a plastic surgery technique may be advised to remove the sinus and refashion the nearby skin.

There are variations on the above procedures which may be suggested by the surgeon, depending on your circumstances, the size and extent of the sinus, and whether it is a first or recurrent problem.

After any operation
Surgeon will usually advise the wound be kept clean and any hair growing near to the wound should be shaved or removed by other means. Some surgeons recommend that even when the wound is healed, you should keep the area free of hair growing by shaving every few weeks, or by other methods to remove the hair. This reduces the chance or a recurrence of the problem.

Recurrence after surgery
The reported rate of recurrence of pilonidal sinus varies widely in the literature from 0% to 43%.19

A simple treatment mentioned in a surgical text book of Indian system of medicine– Sushrutha Samhitha. The disease is called nadee vrana. Treatment is called Ksharasutra chikitsa.

A malleable probe to be passed, its tracts to be identified carefully, and then a medicated thread to be inserted to tract. This is to be changed every week. This helps effective curettage and drainage facilitates healing without recurrence.
Ksharasutra therapy – Advantages over surgery

  • Only five minute’s procedure
  • No need of surgery
  • No anesthesia
  • No hospitalization
  • No pain, No need of rest
  • OPD procedure
  • Can do any kind of work during treatment
  • No pain
  • No tissue loss, No ulcer or wound
  • No foul smell, wound dressing
  • No recurrence- it will not come again

Ksharasutra treatment is boon to the patients with pilonidal sinus, which is also a non-surgical and non-excision treatment.