How do I know if I have pilonidal disease?
The symptoms are not the same from patient to patient, but fall into a few distinct categories. The most common symptoms are pain in the buttock crease area, associated with a tender lump. There may be visible open pores in the midline of the crease that can range from pinpoint to the size of a dime. There may be bleeding or drainage from these pores. There can also be an opening that develops away from the midline crease, and that is called a sinus opening. It also may intermittently drain or bleed.
One of the more dramatic symptoms is the development of an acute abscess. This may have been preceded by a lump and mild discomfort for weeks or months, which suddenly becomes red, warm, and extremely painful.
If you look at the area you may see:
That the buttock crease is very deep, and requires prying it apart to see the base. There may be enlarged pores or even actual open wounds deep in that crease, with blood or drainage coming from them. You may see that the skin on both sides of the crease is slightly darker than the surrounding skin, and there may be a visible lump, or openings off to the side.
How is this treated?
This is where the situation starts getting complicated. The basic treatment options are:
Home remedies, which consist of keeping the area clean and dry, applying antiseptics, and placing gauze in the gluteal crease to spread it apart a bit, and allow air circulation.
Antibiotics and surgical drainage: These can be used for infections and acute abscesses. The may help get through a painful flareup, but do not prevent future problems.
Excisional procedures: The most common operations consist of removing (excising) the area and either suturing it closed or leaving it open. These operations have a difficult recovery and a very poor success rate, and are not recommended.
Minimally invasive procedures: There are various operations which use small incisions to clean out the cyst, sinus tracts and remove the midline pores. These have at least a 30% failure rate and can be attempted, but are not necessarily definitive. Examples of these operations include pit picking, Gips procedure, Lord-Millar procedure, EPSIT or laser surgery.
Off Midline Closure Flaps: This includes the Bascom Cleft-Lift and the Karydakis procedure. These procedures remove all the disease and flatten the cleft so the problem does not recur. When done properly, these are considered the “gold standard” for surgical treatment of pilonidal disease.
More complex flaps: These have names like Limberg Flap, rhomboid flap, VY-Plasty and Z-Plasty. They are difficult to perform properly and leave very unsightly scars and disfigurement. They are not an improvement over the cleft-lift procedure.