How It Is Formed

It is commonly seen in hairy men. When a person sits, buttocks takes maximum pressure. As they rub against the clothing etc, hair breaks off which gets collected in the cleft between the buttocks. These gradually penetrate the skin or enter the opening of the sweat gland forming sinus. Gradually more hairs are sucked into the sinus forming a tuft of hair.

Nearly all patients have an episode of an acute infection (the area is swollen, tender and may drain pus). After the infection settles, many patients develop a sinus, which is a cavity below the skin surface . The sinus extends into the subcutaneous planes as an infected track. There may be branching side channels that connects to the surface through one or more small openings.

Causes

The cause of these cysts is not clear. They may form when a hair is forced under the skin or when a hair follicle ruptures. Or, a person may be born with the cyst.

These cysts are often diagnosed in people between the ages of 16 and 26. But people of any age can have a pilonidal cyst. And they affect both men and women, although more common in persons having excessive hair in the gluteal folds.

Types

There are basically 2 broad groups of anal Fistula in clinical practice - simple and complex anal Fistula.

The 'complexity' of the anal Fistula is basically dependent on:

1. The amount of anal sphincter muscle involvement
2. Presence of more than one anal Fistula (secondary tract and/or with abscess cavity)
3. Anal Fistula with tracts above the anal sphincter complex or with the internal opening in the lower rectum or with the external opening further away from the anal verge
4. Anal Fistula associated with other diseases (eg. Crohn's disease, tuberculosis)

'Complex' anal Fistula is a more severe form of anal Fistula. They will definitely require more complicated treatment. Sometimes, the treatment for these Fistula is carried out in stages.

Symptoms

A Pilonidal cyst does not cause symptoms unless it becomes infected. Infection may cause the following symptoms:

1. Symptoms vary from a small dimple to a large painful mass
2. One or more Pits are formed in the skin of gluteal fold
3. Pits may be plugged with hair
4. Abscess forms when drainage of pit is blocked.
5. Pain, redness, and swelling of the cyst and area around it
6. There may be a discharge that is clear, cloudy or bloody.
7. Foul-smelling drainage from the cyst
8. Fever

Complications

If Haemorrhoides are ignored and no treatment is given to cure them, they can lead to-

Iron Deficiency Anaemia (from heavy bleeding).

Weakness.

Prolapse of whole hemorrhoidal tissue outside the anus.

Diagnosis

Diagnosis is by examination, either in an outpatient setting or under anaesthesia. The examination can be an anoscopy. Possible findings:

1. The opening of the Fistula onto the skin may be seen
2. The area may be painful on examination
3. There may be redness
4. There may be redness
5. A discharge may be seen
6. It may be possible to explore the Fistula using a Fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the Fistula
7. In complicated Fistula some invasive investigations may be advised like Fistulography, Endo-Anal Ultrasound, MRI- Fistulogram etc.

Treatment

Most pilonidal cysts are left alone, if not causing any problem. But, If a cyst becomes infected, treatment is required. It may include the following:

1. Antibiotic medications for the infection. You should know that medications do not make the cyst go away, medicines can only give temporary relief. They also won't keep a cyst from becoming infected again.
2. Hot water soaks to help draw out the infection and relieve pain and itching.
3. Incision and drainage, if needed. The cyst is cut open and pus and other infected material is allowed to drain.
4. Kshar Sutra Therapy: Kshar Sutra is placed in the whole infected tract. It helps in eliminating all the infection, hair and infected tissue. Kshar Sutra is changed at regular interval. Number of seatings and Duration of treatment depends upon the extent of infection.
5. Major Surgery: Excision of the cyst for infection that is severe, does not respond to medications, or keeps coming back. A surgeon cuts and removes the cyst and the tissue around it.

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Preventing Infection

A pilonidal cyst can easily become infected. Do the following to help prevent infections:

1. Keep the cyst and surrounding skin area clean.
2. Remove hair from the area of the cyst regularly. Ask your doctor about safe hair removal products or procedures.
3. Avoid sitting in one position for long periods of time. This helps to reduce weight and pressure on your tailbone area.
4. Sitting on a special cushion to relieve pressure on the tailbone may also help.
5. Avoid tight-fitting clothing to reduce skin irritation around the cyst.
6. If discharge is present, keep a cotton pad over the opening to avoid soiling of clothes.