Pilonidal sinus

What is a pilonidal sinus?

A pilonidal sinus is a painful abscess that occurs near the top of the buttocks. It occurs when body hair is forced into the skin by friction and the area becomes infected.

It is most common in teen boys, but teen girls can get it too. A doctor will diagnose a pilonidal sinus after examining your child and asking them questions.

Pilonidal sinus

Treating the abscess

Usually your child will need surgery (an operation) to open the abscess, drain the pus and remove the hair from the area. In most cases, the operation is a day procedure. This means that your child does not need to stay in the hospital overnight.

The abscess can sometimes drain on its own, but it will come back as long as hair is in the skin cavity. Removing hair from the area will relieve the infection and help relieve the pain.

During the surgery

Your child will be taken to the operating room and placed under a general anaesthetic. This will make sure they sleep through the operation and do not feel any pain.

The surgeon will open the cavity and, in most cases, clean it out. Your child's wound will be left open to allow it to heal from the inside. Sometimes this wound can be large.

Your child will usually stay a short while in the hospital before going home later the same day.

Taking care of the wound

Your child's wound should be cleaned and packed (dressed with a bandage or other material) every day using the numbered steps below. The hospital will give you detailed instructions and, if needed, will arrange for a homecare nurse to help you and your child.

1. Consider having your child take some pain medication an hour before the dressing is changed. This will make it more comfortable.
2. Gather the dressing supplies before the wound is cleaned. This will let you dress it immediately afterwards. Several types of packing and dressing material are available for these wounds. Be sure to get specific instructions for the materials you will use.
3. Once you remove the old dressing, the wound can be cleaned while your child is showering or bathing.

The wound must be cleaned and dressed until it heals completely. You will have appointments to see the surgeon to check how your child's wound is healing and might receive different care instructions during these appointments.

Vacuum assisted closure

Some children may need a special type of dressing called vacuum assisted closure (VAC). This is a dressing that is attached to your child's wound with a device that makes sure the wound is completely sealed.

This type of dressing is usually changed twice a week by a nurse who comes to your home. Your surgeon will tell you if your child needs this.

Life after surgery

Activities

Your child can continue doing all their usual activities after surgery.

Medicine

Your child is usually prescribed antibiotics after the abscess is drained. Sometimes they are also prescribed pain medicine. Please get the prescriptions filled and follow any medicine instructions carefully.

Returning to school

Your child should be able to return to school once they feel able.

Long-term effects of pilonidal sinus

Sometimes a pilonidal sinus can return, even after it is removed during surgery. Some people consider laser hair removal as a way to prevent future sinuses.

When to call a doctor

Call the surgeon's office if:

• your child has a fever of 38°C (100°F) or higher
• there is increased pain, redness, swelling or drainage around the wound
• there is pus or a foul odour (bad smell) from the wound
• the wound is bleeding
• your child is vomiting (throwing up), especially when taking medications.