15400 Pilonidal Disease

Overview

Pilonidal disease is a skin condition that happens when loose hairs get trapped in the crease between the buttocks. This can form a small pit or tunnel in the skin, which may become infected and painful. The name comes from Latin and means 'hair nest.'

It's fairly common. Many cases are mild and never diagnosed. It tends to affect around 1 in 5,000 people each year.

Most often, it affects men in their teens and 20s. People who sit for long hours, have a deep groove between the buttocks, or have coarse body hair are more likely to develop it.

Symptoms

Common symptoms

• A tender lump (abscess) in the crease of the buttocks
• Redness and swelling
• Pus or blood draining from the area
• A sore that opens up and oozes
• Discomfort when sitting or bending

Symptoms in children

• Rare, but if it happens, it looks like a painful red lump at the back
• Children who sit for long periods on hard surfaces may be more at risk

Symptoms in older adults

• May be less painful and often slower to heal
• Can appear as a small, painless pit that drains occasionally

Causes

Main causes

• Hairs pushing into the skin, which your body then reacts to as if they were an infection
• Pressure and friction from sitting for long periods
• The exact reason is not fully understood, but it may be partly due to the shape of the buttock crease

Risk factors

• Being male and young (teens to 30s)
• Having a deep natal cleft (the crease between the buttocks)
• Having thick or coarse body hair
• Sitting for many hours a day (for example, while driving or studying)
• Being overweight
• A family history of the problem

When to see a doctor

See a doctor urgently if:

• If you have a painful, swollen lump in the buttock crease that is getting bigger
• If you have a fever along with the symptoms
• If the area becomes red, hot, and tender to touch

Book a routine appointment if:

• If you notice a small pit or dimple in the crease, even without pain
• If you have mild discomfort or a little discharge that lasts more than a few days

Diagnosis

A doctor can usually diagnose pilonidal disease by looking at the area. They may press gently around the lump to see if there is any discharge.

Tests that may be done

• No tests are needed in most cases.
• If the area is infected, a small swab may be taken to check for bacteria.
• In rare cases, an ultrasound or MRI is used to see how deep the tunnels go.

What to expect at your appointment

You'll be asked to lower your trousers and underwear, and you may be asked to lean forward or lie on your side. The examination is quick and shouldn't hurt, though it may be a little uncomfortable if there is an abscess.

Treatment

First, the goal is to clear any infection and relieve pain. Then, the aim is to stop the condition coming back. Treatment ranges from simple hygiene steps to a minor procedure or surgery.

Self-care at home

• Gently clean the area with warm water and mild soap every day.
• Keep the area dry. After showering, pat it dry carefully.
• Use a cushion or ring when you have to sit for long periods.
• Take breaks from sitting every hour or so.
• If you have hairy skin, careful hair removal with guidance from your doctor may help.

Medical treatments

If there is an abscess (a collection of pus), a doctor may drain it under local anaesthetic. Draining usually brings instant relief. Sometimes antibiotics are needed for an active infection. Your doctor may also recommend a procedure called 'pit-picking' or a laser treatment to close the pits. These are done in clinics and are less invasive than full surgery.

When is surgery considered?

Surgery is usually offered if the problem keeps coming back, or if there is a chronic sinus (a small tunnel that keeps leaking). There are different surgical techniques. The simplest is to lay the sinus open and let it heal. More complex procedures may flatten the area or move a small piece of skin over it. A surgeon will discuss which is best for you.

Living with this condition

Most people manage with good hygiene and a few lifestyle tweaks. Avoid sitting for hours without a break. If you work at a desk, try a standing desk for part of the day. Keep the area clean, especially after exercise or hot days.

Lifestyle tips

• Keep body weight in a healthy range.
• Wear loose-fitting cotton underwear to reduce friction.
• Shower after heavy sweating and dry the area well.
• If you have a pilonidal pit, consider gentle hair removal every few weeks (ask your doctor for the best way).

Diet and exercise

A healthy diet rich in fibre and enough water help keep your weight stable and prevent constipation, which can reduce pressure on the area. Regular exercise is good, but avoid excessive cycling or rowing if they irritate the region.

Mental health and emotional wellbeing

Having a problem in such a personal area can feel embarrassing or isolating. You might worry about odour, discharge, or how it looks. These feelings are very normal. Talk to a trusted friend or your doctor. Sometimes simply understanding the condition helps reduce the worry.

Prevention

You can't fully prevent it if you are prone to it, but you can reduce your chances by keeping the area clean and dry, trimming hair if it's very thick, losing weight if needed, and taking sitting breaks.

Complications

If left untreated

• The infection can spread to the surrounding skin, causing a painful abscess.
• An abscess may burst and release smelly pus.
• A long-standing sinus can produce a constant discharge, making daily life uncomfortable.
• In very rare cases, the infection can travel to the bloodstream, which is a medical emergency.

Long-term outlook

With the right care, most people recover well. Even if it comes back, there are several effective options. Many people who have surgery have no further problems. The key is to seek help early and follow the aftercare advice you are given.

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