Patient guide
Pilonidal sinus surgery: treatment options and recovery
By the SkinOps team · Updated · 2 min read
Based on information from the NHS website. This guide is waiting for review by a clinician and is not medical advice.
A pilonidal sinus is a small hole or tunnel in the skin at the top of the bottom, where the buttocks meet. Many people have one without ever knowing. It usually only becomes a problem if it gets infected.
Signs of an infected pilonidal sinus
- pain and swelling at the top of the cleft between your buttocks
- a painful lump full of pus (an abscess) that can come on quickly
- finding it hard or painful to sit down
- ongoing discomfort, discharge or bleeding if the problem keeps coming back
Who gets them
Pilonidal sinuses are more common in men, probably because they tend to have more body hair. Sitting for long periods also raises the risk. The exact cause is not certain, but it is thought that hair gets pushed into the skin by friction or pressure.
When to get help
Ask for an urgent GP appointment or contact NHS 111 if
you have a small lump at the top of your bottom, between your buttocks, that is painful, bleeding or leaking pus.
Treatment options
If a sinus is not infected, it may just need watching and keeping clean. Do not shave the area unless a doctor tells you to. If it is causing problems, there are several types of surgery:
- Incision and drainage: a small cut is made to let the pus out. You usually go home the same day, and the wound needs its dressing changed daily while it heals. It can be done under local or general anaesthetic.
- Wide excision with open healing: the sinus and some surrounding skin are removed and the wound is left open to heal. This takes longer but has the lowest chance of the sinus coming back.
- Excision and closure: the sinus is removed and the skin is stitched closed, sometimes using flaps of skin. Recovery is quicker, but there is a higher chance of infection. Stitches usually come out after about 10 days.
- Endoscopic ablation: a thin tube with a camera is used to clean out the sinus and seal it with heat. It is less invasive and the area usually heals in about a month.
Your surgeon will explain which option suits your situation and the pros and cons of each.
Recovering after surgery
- keep the area clean
- wear loose cotton underwear
- eat plenty of fibre
- avoid heavy lifting and strenuous exercise for about a week
- avoid cycling for 6 to 8 weeks
- do not go swimming until the wound has healed
Most people are back at work within 2 weeks. Before you go home, ask how to look after your wound and who to call if you have any concerns.