Pilonidal Sinus

Question 1

What is a pilonidal sinus caused by?

Answer 1

• caused by forceful insertion of hairs into skin of the natal cleft in the sacrococcygeal area
• Promotes inflammation and causes a sinus

Question 2

What is the epi of PS?

Answer 2

80% males

16-40

Question 3

What are RF for pilonidal sinus?

Answer 3

1. Young male
2. Stiff hair
3. Hirtuism

Question 4

What is the presentation of pilondial sinus?

Answer 4

• SACROCOCCYGEAL:
  1. Discharge – offensive, staining underwear
  2. Pain – worst on sitting down
  3. Swelling

Question 5

What is the investigation of Pilonidal sinus?

Answer 5

• 1st line + Diagnostic = CLINICAL DIAGNOSIS
• History
• • Visualise lesion on examination

Question 6

What is the management of a symptomatic patient?

Answer 6

• Surgical treatment – excision of pilonidal cyst + sinus
• • AB
• • Hair removal (laser)
• • Local Hygiene advice

Question 7

How do you treat asymptomatic patients?

Answer 7

Remove hair (laser, shaving) + local hygiene advice

Question 8

How do you describe perianal lesions?

Answer 8

• Using a clock format
• “Fissure at 3 o’clock”
• 12 o’clock is anteriorly (umbilicus)
• 6 o’clock is posteriorly (buttocks)

Question 9

What is healthy bowel habit advice for patients

Answer 9

1. Increase liquid uptake
2. Increase fibre uptake
3. Use wipes instead of tissue paper
4. Pat gently (don’t wipe)
5. Wipe from back to front
6. Do not strain
7. Do not spent excessive amounts of time on the toilet
8. Use foot stool to enhance opening angle