Epithelial coccygeal passage

A pilonidal sinus (PNS), also known as a pilonidal cyst, pilonidal fistula, or “hair nest,” is a congenital defect in the form of a narrow canal (2–3 cm long) located in the soft tissues between the buttocks, above the anal opening. This canal is lined with epithelium and has primary openings through which sweat gland secretions, sebaceous gland products, and hair follicles exit. If these openings become blocked, inflammation may develop.

PNS is formed due to embryonic development disorders and affects about 5% of the population, mostly men aged 15–30. The condition often remains asymptomatic for a long time, except for occasional mild discharge or itching. However, blockage of the openings or trauma can trigger inflammation and lead to an abscess, which may rupture spontaneously. If left untreated, a chronic fistula may form, allowing continuous discharge of pus.

A pilonidal cyst is a congenital pathology that develops due to unfavorable pregnancy conditions. It may be linked to maternal trauma, an unhealthy lifestyle, hypothermia, or infections such as the flu. Initially, the cyst may not cause any symptoms, but over time, sweat, sebum, dead skin cells, and hair accumulate inside it.

Other factors contributing to PNS include:

• Sedentary lifestyle;
• Excess body weight;
• Tight-fitting clothing;
• Coccyx injuries;
• Excessive hair growth in the intergluteal area;
• Frequent hypothermia.

Anatomical features such as a pronounced gluteal area and a deep intergluteal cleft can increase the risk of developing this condition. When an infection enters the epithelial canal, it can lead to an abscess that requires urgent treatment and removal.

Signs of pilonidal sinus inflammation include:

1. Pain of varying intensity in the buttocks and coccyx region;
2. Swelling above the anal opening;
3. Redness, thickening, and swelling of tissues between the buttocks;
4. Discomfort when moving;
5. Pain while sitting;
6. Fever;
7. Purulent discharge in the affected area.

Without timely treatment, inflammation may become chronic. During remission, symptoms are minimal, with mild pain, occasional discomfort in the coccyx area, or minor discharge. However, the pathological process in the tissues continues, leading to potential flare-ups. Chronic cases are characterized by recurrent abscesses, infiltrates, and purulent fistulas, necessitating surgical removal. Delayed treatment can result in the spread of inflammation to surrounding tissues and frequent exacerbations.

If left untreated, a pilonidal cyst can become chronic and lead to severe complications:

1. The cyst may grow into adjacent tissues and organs, forming additional sinus tracts.
2. Fistulous tracts may extend into the rectum, creating extra openings.
3. The inflammatory process can affect nearby soft tissues, leading to infection and tissue damage.
4. Serious infections such as abscesses and phlegmons may develop, requiring urgent surgical intervention.
5. The infection may spread to pelvic organs and bone structures.
6. In severe cases, infection can enter the bloodstream, causing sepsis—a life-threatening condition.
7. One of the most severe complications is the development of squamous cell carcinoma.

Surgical excision of the pilonidal sinus is the only effective treatment. If any symptoms appear, it is essential to seek medical help immediately.

The treatment approach depends on the stage of the disease and the presence of complications. If the cyst is asymptomatic, active treatment may not be necessary. However, the risk of future inflammation, abscess formation, or fistulas remains, so regular monitoring is crucial.

In the early stages, when inflammation is limited to small infiltrates, antibiotics may be prescribed. However, medication only provides temporary relief and does not eliminate the root cause.

Surgical intervention is the only effective treatment for an inflamed pilonidal sinus. The main goal of surgery is to completely remove the affected tissues to prevent recurrence. The procedure is performed under local or epidural anesthesia. A contrast agent is often used to visualize the fistulous tracts before making two curved incisions to remove all affected tissue.

Modern surgical methods include:

• Laser surgery—minimizes the risk of infection and recurrence and is performed on an outpatient basis.
• Radiofrequency ablation—a minimally invasive technique with low trauma.

Full recovery usually takes 2–3 weeks after surgery.

New Life Medical Center in Kyiv provides a personalized approach to each patient, ensuring the highest level of comfort and effective treatment.

Our services include:

• Diagnostics – initial consultation, laboratory tests, ultrasound examination.
• Treatment – conservative therapy, rehabilitation programs, and surgical interventions, including laser removal of pilonidal sinus.
• Preventive care – health maintenance programs and routine check-ups.
• Aesthetic medicine – cosmetology, plastic surgery, and anti-aging procedures.

Our team consists of highly experienced doctors who use state-of-the-art medical equipment. You can schedule an appointment through our website, phone, or messaging apps like Viber.