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Pilonidal Sinus: Symptoms, Abscess, Laser & Surgery

  • Prof. Dr. Zahid Mahmood
  • August 10, 2026

Pilonidal Sinus: Symptoms, Abscess, Laser & Surgery

Medically reviewed by Prof. Dr. Zahid Mahmood, MBBS, FCPS — General, Laparoscopic & Laser Surgeon, Lahore.

A pilonidal sinus is a small pit or tunnel in the skin at the top of the cleft between the buttocks, usually over the tailbone. Loose hairs can enter the skin and cause inflammation, repeated discharge or a painful abscess.

A quiet sinus without infection may need only observation and careful hygiene. A painful abscess usually requires drainage, while repeated or persistent disease may be treated by a minimally invasive procedure, excision, open healing or an off-midline flap operation.

Why does a pilonidal sinus develop?

Pilonidal disease is generally considered acquired rather than something present from birth. Friction, pressure and movement within a deep buttock cleft can push loose or broken hairs into small midline skin pits. The body treats the hair as a foreign material, producing inflammation and sometimes infection.

Factors associated with pilonidal disease include:

  • Thick or coarse body hair
  • A deep or narrow buttock cleft
  • Prolonged sitting, friction or sweating
  • Young adulthood, particularly in men
  • Higher body weight
  • Previous pilonidal abscess or surgery
  • Hair and debris collecting in the cleft

It is not caused by poor character or personal failure, and it is not a sexually transmitted infection.

Symptoms

A non-infected pit may cause no symptoms. When inflamed or infected, symptoms can include:

  • Pain or tenderness near the tailbone
  • A lump or swelling at the top of the buttock cleft
  • One or more small midline openings
  • Intermittent pus or blood-stained discharge
  • Unpleasant smell, itching or skin irritation
  • Difficulty sitting comfortably
  • Fever or feeling unwell with a larger infection

What is a pilonidal abscess?

An abscess is a sudden collection of pus that causes increasing pain, redness and swelling, often over a few days. It may burst and drain, temporarily relieving pain, but the underlying pits or sinus can remain.

A painful pilonidal abscess needs prompt surgical assessment. The usual treatment is incision and drainage through a small opening. Antibiotics alone generally cannot empty a walled-off collection, although they may be added when there is spreading skin infection, fever, impaired immunity or another specific reason.

When should you seek urgent help?

Seek urgent medical care for rapidly increasing pain or swelling, fever, chills, spreading redness, heavy bleeding, difficulty walking or sitting, or feeling seriously unwell. People with diabetes or reduced immunity should seek advice early.

How is it diagnosed?

Diagnosis is usually made by examining the buttock cleft and identifying midline pits, discharge, hair or a tender abscess. Scans are not routinely required for typical disease.

If the opening is unusually close to the anus, lies far to one side, repeatedly fails to heal or has no typical midline pits, the doctor may consider anal fistula, hidradenitis suppurativa, a skin cyst or another condition. Selected atypical or recurrent cases may need imaging.

Does every pilonidal sinus need surgery?

No. A sinus that has never been infected and causes no symptoms can often be observed. Keep the cleft clean and dry, avoid prolonged pressure when possible, and follow professional advice about hair control.

Treatment is considered when there is an abscess, repeated pain or discharge, chronic non-healing disease, difficulty with daily activities or recurrence after previous treatment.

Treatment options for chronic or recurrent disease

No single procedure is best for every patient. The number and position of pits, side tracks, previous operations, active infection, time away from work and likelihood of wound care all influence the choice.

Pit-picking and limited procedures

For selected limited disease, small midline pits can be removed through tiny openings and the underlying cavity cleaned. Recovery is usually quicker than after wide excision, but persistent or branching disease may recur and require another procedure.

Laying open or excision with open healing

The sinus and infected tissue are opened or removed and the wound is left to heal from the base. This avoids trapping infection beneath a closed wound, but regular dressings are needed and complete healing may take several weeks or longer.

Excision with wound closure

Closing the wound can provide faster initial healing than leaving it open, but infection or wound separation can occur. When closure is chosen, current colorectal guidance generally favours placing the scar away from the deep midline cleft rather than closing directly in the midline.

Off-midline flap or cleft-lift procedures

Karydakis, Bascom cleft-lift and Limberg flap operations remove or control the diseased area and flatten the deep cleft, placing the final wound to one side. They are particularly useful for extensive, recurrent or non-healing disease and may reduce recurrence compared with a midline closure. They create a larger operation than minimally invasive methods and require appropriate surgical expertise.

Endoscopic pilonidal sinus treatment (EPSiT)

EPSiT uses a fine camera to inspect the tracts, remove hair and unhealthy tissue, and treat the cavity through small openings. It offers less tissue damage and often a faster recovery, but suitability depends on disease anatomy and long-term results vary.

Laser treatment

Laser treatment uses a fibre to deliver energy inside a cleaned sinus tract, aiming to close it with small wounds and less postoperative pain. It can be useful in selected simple or moderately complex disease. However, laser is not automatically the best treatment for every pilonidal sinus. Large abscesses must be drained, extensive side branches may be unsuitable, and recurrence can require repeat laser or conventional surgery.

How is the right treatment chosen?

Your surgeon will consider:

  • Whether there is an acute abscess or quiet chronic disease
  • The number of midline pits and lateral openings
  • The size and branching of the sinus cavity
  • Whether this is a first episode or recurrence
  • Previous scars and non-healing wounds
  • Available help with dressings
  • Work, study and activity requirements
  • The trade-off between faster recovery, wound burden and recurrence risk

Preparing for surgery

Tell the surgical team about diabetes, smoking, allergies, blood-thinning medicines and previous pilonidal operations. Do not stop prescribed medication unless instructed. Arrange help with transport and dressings if required. The team will advise whether and how hair should be removed; avoid cutting or damaging inflamed skin yourself.

Recovery and wound care

Recovery depends greatly on the procedure. A drained abscess or minimally invasive operation may allow earlier activity, whereas an open wound or flap needs longer care.

General advice includes:

  • Take prescribed pain relief
  • Keep the wound clean and follow the dressing plan
  • Shower as advised and dry the cleft gently
  • Wear loose, breathable clothing
  • Walk regularly but avoid strenuous exercise until permitted
  • Avoid prolonged direct pressure on the wound
  • Do not swim until the wound has healed and the surgeon agrees
  • Attend follow-up even if discomfort improves

Contact the surgical team for fever, worsening pain, spreading redness, increasing swelling, foul or heavy discharge, persistent bleeding, wound separation or difficulty passing urine.

Hair removal and recurrence prevention

Keeping loose hair and debris out of the cleft is important, especially during wound healing. The best method and timing vary. Clipping, depilatory products or laser hair reduction may be considered after professional advice; shaving can irritate or cut the skin if done incorrectly.

Other helpful measures include:

  • Regular gentle washing and thorough drying
  • Avoiding long uninterrupted sitting where practical
  • Reducing friction and sweating
  • Maintaining a healthy weight
  • Following the complete postoperative plan until fully healed

Recurrence can still occur after any treatment. It may result from persistent midline pits, retained hair, side tracks, infection, a deep cleft or a wound that fails to heal.

Possible complications

  • Wound infection or abscess
  • Bleeding or fluid collection
  • Wound separation
  • Delayed or incomplete healing
  • Persistent discharge
  • Recurrence and the need for another operation
  • Uncommonly, numbness, troublesome scarring or chronic pain

Cancer developing in longstanding pilonidal disease is exceedingly rare, but an unusual growth or repeatedly non-healing wound should be assessed and may need biopsy.

Common questions

Is a pilonidal sinus the same as an anal fistula?

No. Pilonidal disease usually begins in the skin over the tailbone and does not connect to the bowel. An anal fistula connects the anal canal to nearby skin. Openings close to the anus may need careful assessment to distinguish them.

Can I squeeze or burst an abscess myself?

No. This may push infection deeper or delay proper drainage. A painful swelling should be assessed by a clinician.

Can antibiotics cure it?

Antibiotics may help selected infections but do not reliably remove trapped pus, hair or chronic sinus tracks. An abscess usually needs drainage.

How long will the wound take to heal?

Healing ranges from a few weeks after a limited procedure to several weeks or months after a large open wound. The surgeon can give a more useful estimate after assessing the operation and wound.

Can pilonidal sinus return after laser?

Yes. Laser reduces tissue injury but does not guarantee cure. Recurrence depends on anatomy, side branches, hair control, infection and healing.

Key message

Pilonidal sinus is a hair-containing tunnel in the buttock cleft. An acute painful abscess needs drainage; symptom-free disease may only need observation; and chronic or recurrent disease has several operative options. Good treatment matches the procedure to the extent of disease while considering healing time, wound care and recurrence.

Pilonidal sinus treatment in Lahore

Prof. Dr. Zahid Mahmood assesses acute and recurrent pilonidal disease and discusses abscess drainage, limited procedures, laser treatment, open healing and off-midline flap surgery according to each patient’s condition.

For an appointment, call 0300 413 0159 or visit professorzahid.com.

This article provides general education and does not replace personal medical assessment. Fever, rapidly worsening pain, spreading redness or a painful swelling requires prompt medical care.

Medical references

  1. Williams NS, O’Connell PR, McCaskie AW, editors. Bailey & Love’s Short Practice of Surgery. 28th ed. CRC Press; 2023. Chapter 80, “The anus and anal canal,” pp. 1423–1424.
  2. European Society of Coloproctology. Guidelines for the management of pilonidal disease. British Journal of Surgery. 2024.
  3. NHS. Pilonidal sinus: symptoms, causes and treatment.
  4. NICE. Endoscopic ablation for a pilonidal sinus.

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