Pilonidal sinus surgery: options, wound care and recurrence

The name means a nest of hairs. A Milton Keynes leaflet describes a sinus tract that commonly contains hairs, beneath the skin between the buttocks. It is most common in teenagers and young adults, particularly men, and it is linked with obesity, sedentary work, family history and previous skin irritation or injury in the area.

The NHS says most people do not notice a sinus unless it becomes infected, which causes pain and swelling at the top of the cleft and sometimes a pus-filled abscess. Repeated infections lead to ongoing discomfort, discharge or bleeding.

A sinus that has never caused problems may need no treatment. An abscess is usually dealt with by incision and drainage: the NHS describes a small cut to release pus, typically as a same-day procedure under local or general anaesthetic with daily dressing changes. This treats the infection but does not always remove the sinus.

Surgery to remove the sinus is considered when infections recur or the sinus keeps discharging. Hair removal, hygiene advice and weight management are used alongside, since the aim is both to heal the wound and to stop another one forming.

Your own anatomy, previous surgery and wish for a quicker return to normal life all influence the recommendation.

General anaesthetic is given for most operations; the Milton Keynes leaflet describes it being given in the anaesthetic room after monitoring is attached. Follow fasting instructions, and ask whether the area should be shaved beforehand. Bring loose cotton underwear and dressings or pads you can use afterwards.

Discharge is typically the same or next day according to that leaflet, with an adult to take you home.

The Milton Keynes leaflet lists pain, bleeding or bruising, wound infection and scarring, while also describing the surgery as usually very safe and effective. Recurrence is the main concern with every technique, and the choice of technique, hair control and hygiene all affect it. Wounds left open need weeks of dressings and can feel slow.

No dependable percentages appeared in the pages used, so none are quoted. Ask your surgeon about recurrence figures in their practice for your chosen technique.

A Dudley trust leaflet advises washing after each bowel movement and each morning and night with plain water and a soft cloth, avoiding soap and talcum powder, drying gently, and changing damp dressings promptly. It says you will be given a date for a wound check, normally with the practice nurse.

The NHS advises no heavy lifting for a week and no cycling for 6 to 8 weeks, with swimming only once the wound has fully healed. It says stitches come out at about 10 days with a follow-up at about 6 weeks. Milton Keynes says no driving for 48 hours and gives 2 to 4 weeks for return to work.

The Milton Keynes leaflet recommends keeping the area as free of hair as possible by shaving or other hair removal. The NHS advises loose cotton underwear and keeping the area clean. Avoiding long periods of sitting, where practical, and staying active are sensible additions.

• Contact your GP if the wound becomes swollen, hot, red or painful, or if you have a high temperature, as the Dudley leaflet advises.

• Ask who to see if a new lump or discharge appears after healing.

Availability of endoscopic treatment and flap techniques differs between hospitals, in both the NHS and private sectors. Ask what follow-up, dressings and repeat procedures are included in any private price.

• Which technique do you recommend for me, and why?

• How long might dressings continue?

• What is the plan for hair control?

• Do you offer endoscopic treatment?