Embarrassing Illnesses

If you develop an infection inside a pilonidal sinus, you will need to have an operation in order to open the sinus up and drain away any pus, bacteria, or other waste materials. This type of operation is known as incision and drainage.

Incision and drainage

Incision and drainage will normally be carried out at your local hospital. The operation is carried out under general anaesthetic. As the incision and drainage procedure is relatively minor, you should be able to return home once you have recovered from the effects of the anaesthetic. This will usually be on the same day as the operation.

After the operation, a dressing will be applied to the affected area in order to allow your skin to heal. You will need to arrange for your dressing to be changed daily by the practice nurse at your local GP surgery.

Treating reoccurring infection

If you have reoccurring infections in a pilonidal sinus, surgery to remove the sinus, and prevent further infections, will usually be recommended. There are two main types of operation to remove a pilonidal sinuse: wide excision and excision and primary closure.

Wide excision

In a wide excision, the surgeon will cut out the section of skin that contains the sinus. The wound is left open and packed with dressing.

The advantage of having a wide excision is that following the procedure the chances of the infection returning are low. The disadvantage is that the wound will take several weeks to heal, and your dressings will need to be changed regularly.

Excision and primary closure

In an excision and primary closure procedure, the surgeon will cut out the section of affected skin before closing and sealing the wound using stitches. The advantage of this technique is that the wound will heal quite quickly. The disadvantage is that the chances of infection coming back are higher compared with wide excision.

Before deciding which type of operation to have, you should discuss the advantages and disadvantages of each surgical technique with your surgeon in order to make sure that you understand the relevant benefits and risks.

Wound care

Whatever type of surgical procedure you decide to have, it is very important that you keep the site of the wound clean after the operation. Your surgeon will be able to give you advice about how to do this. You may be given the following advice.

• Keep the area clean by washing it in the morning and evening, and after every bowel movement (the best way to wash the area is to use a shower spray).
• Avoid using soap as this will irritate the skin (use plain water and a soft cloth instead).
• Use wet wipes to clean the area when you are away from home.
• Carefully dry the area after washing using a soft towel, but do not rub the skin. Using a hair dryer is an effective alternative method of drying the area.
• Always remove a damp or wet dressing and replace it with a dry clean one.
• Wear loose-fitting cotton underwear and avoid synthetic underwear, such as nylon.
• Eat foods that are high in fibre, such as vegetables, fruit, and bran flakes, as these foods will soften your stools and reduce any strain on your bowels.

You will also probably be advised to shave any hair growing near the site of the wound. In some cases, you may be recommended to continue to shave this area even after the wound has healed.

Contact your GP immediately if you notice any signs that your wound may have become infected. Signs of infection include:

• red swollen skin,
• pain,
• fever: a temperature of 38C (100.4F) or above,
• a feeling of heat at the site of the wound,
• fluid, or pus, leaking from the site of the wound, and
• an unpleasant smell coming from the site of the wound.