Conditions
Pilonidal Sinus
Quick answer
A pilonidal sinus is a small tract or pit in the skin at the top of the buttock crease, where loose hairs get trapped and cause infection. A sudden painful swelling is drained, while a long-standing sinus is removed with surgery. Modern methods such as flap repair, endoscopic and laser techniques aim to reduce recurrence and speed healing.
Medically reviewed by The Curaventa Team · Last updated 2026-10-27
Hairs are pushed into the skin of the natal cleft (the groove between the buttocks) by sitting and friction. The body reacts to them as foreign material, forming a small tunnel. This tunnel can get infected again and again, leaking pus or blood.
It mainly affects young adults, especially men with thick body hair or jobs that involve long sitting, such as driving. Treatment ranges from simple drainage to wider removal. Surgeons now prefer operations that move the wound away from the midline crease, because midline wounds heal slowly and recur more often.
Symptoms
- Pain and swelling at the top of the buttock crease
- One or more tiny pits in the skin of the crease
- Pus or blood-stained discharge
- Bad smell from the area
- Fever when an abscess forms
- Pain on sitting
Causes and risk factors
- Thick, coarse body hair
- Long hours of sitting, such as driving or desk work
- Deep buttock crease
- Excess body weight
- Sweating and friction in the area
- Family history of pilonidal disease
How it is diagnosed
- Clinical examination of the buttock crease, usually enough to confirm
- Probing of the pits to check the direction of tracts
- Ultrasound or MRI only in complex or recurrent cases
- Checking for other causes such as anal fistula or skin infection
When a procedure is needed
An acute abscess needs incision and drainage to release the pus. Surgery to remove the sinus is advised when it keeps discharging or flaring up. Choices include excision with off-midline flap closure (such as Limberg or Karydakis), endoscopic sinus treatment (EPSiT), laser closure of the tract, or pit-picking for small sinuses.
Frequently asked questions
Why does a pilonidal sinus come back after surgery?
New hairs can enter the area, and a midline wound stays moist and under friction. Off-midline flap repairs flatten the crease and lower this risk. Hair removal and good hygiene after healing also help.
Are laser and endoscopic methods better than open surgery?
They use small cuts, cause less pain and allow faster return to work. They suit many simple and some recurrent sinuses. Large or very branched disease may still need open excision with a flap. Your surgeon will choose after examining you.
How long should I stay in India?
For laser or endoscopic treatment, plan for around one week. Flap surgery needs about two weeks so the surgeon can check the wound and remove the drain or stitches. Open wounds left to heal need longer dressing care.
Will I need dressings after I return home?
With flap or minimally invasive methods, dressing needs are usually small. With an open wound, regular dressings by a nurse are needed for weeks. Your discharge notes will explain the plan for your local clinic.
What can I do to prevent recurrence?
Keep the area clean and dry, and remove hair regularly, for example with laser hair removal. Avoid sitting for long periods without breaks. Report any new swelling early.
Medically reviewed by The Curaventa Team. Last updated 2026-10-27. General information, not medical advice. Medical editorial board · Editorial policy · How we get prices
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