INTRODUCTION:

Pilonidal sinus is a chronic inflammatory condition commonly affecting the sacrococcygeal region, characterized by the formation of a sinus tract or cyst containing hair and debris. It is frequently encountered among young adults, especially males, and is often associated with prolonged sitting, deep natal cleft, obesity, and poor local hygiene. The term ‘pilonidal’ is derived from Latin, meaning “nest of hairs,” reflecting the characteristic presence of hair within the sinus cavity (Hull and Wu, 2002).¹

The condition is believed to be acquired rather than congenital, resulting from hair penetration into the subcutaneous tissue, leading to a foreign body reaction and secondary infection. According to Hull and Wu (2002), pilonidal sinus predominantly affects young men between 15–30 years of age, with an estimated incidence rate of 26 per 100,000 population.1 Karydakis (1992) proposed that the combination of local mechanical forces, hair insertion, and vulnerability of the natal cleft skin contributes to the pathogenesis of the disease.²

Pilonidal sinus presents significant clinical challenges due to its high recurrence rate and postoperative complications. Despite advances in surgical techniques, recurrence rates remain variable. A systematic review by Al-Khamis et al. (2010) reported recurrence rates ranging between 10–30%, depending on the surgical method employed.³ Recent evidence from Dessily et al. (2019) suggests that minimally invasive approaches, such as laser-assisted closure and phenol application, can reduce postoperative morbidity and improve patient satisfaction compared to traditional excision methods.⁴

The persistence and recurrence of pilonidal sinus significantly affect patients’ quality of life, productivity, and psychological well-being. Therefore, continued research into predisposing factors, effective surgical and non-surgical management strategies, and comprehensive nursing interventions is essential. The present study aims to explore and evaluate approaches that can improve postoperative outcomes and minimize recurrence among patients with pilonidal sinus.

Definition:

A pilonidal sinus is a small epithelial-lined tract or cavity that usually contains hair and skin debris, occurring most commonly in the natal cleft (sacrococcygeal region), and often associated with chronic infection and discharge.⁵

Background:

Pilonidal sinus disease (PSD) is a chronic inflammatory condition that commonly occurs in the sacrococcygeal region, near the cleft of the buttocks. It is characterized by the presence of one or more small openings or sinus tracts that may discharge pus or blood. The condition is believed to result from hair penetration into the subcutaneous tissue, followed by a foreign body reaction and secondary infection. Although benign, the disease causes significant discomfort, pain, and absenteeism from work or studies.⁶

In India, pilonidal sinus disease is seen more frequently in young adults, particularly in males between 15 and 35 years of age. Factors such as excessive body hair, obesity, poor hygiene, prolonged sitting, and tight clothing have been associated with its development. The problem is often observed among students, drivers, and office workers who sit for long hours. In a study conducted at a tertiary care hospital in South India, the majority of patients were males with sedentary occupations and poor local hygiene.⁷

The burden of pilonidal sinus disease in Maharashtra reflects a similar pattern. Clinical observations from teaching and district hospitals in both urban and rural regions suggest a steady rise in the number of young male patients presenting with sacrococcygeal abscesses and recurrent sinus formation. Sedentary habits linked to two-wheeler riding, especially in urban centers like Mumbai, Pune, and Nashik, have been noted as significant local risk factors. Environmental conditions such as humidity, tight clothing, and limited awareness of personal hygiene also contribute to recurrence.⁸

Globally, pilonidal sinus disease continues to pose a surgical challenge due to its high recurrence rate and prolonged wound healing. Various surgical techniques, including excision with primary closure, flap procedures, and minimally invasive approaches, have been tried, but none have completely eliminated recurrence. The recurrence rate in Indian hospitals ranges between 10–30%, often due to inadequate wound care or poor post-operative hygiene practices.⁹

Given the increasing incidence among young adults and the recurrence burden observed in Maharashtra, there is a pressing need for studies focusing on preventive measures, patient education, and comprehensive post-operative care. Understanding the demographic profile, occupational risks, and lifestyle factors contributing to PSD in the Indian population can help formulate more effective management strategies and improve patients’ quality of life.

Epidemiology and Demographics:

Pilonidal sinus disease predominantly affects young adults, with a peak incidence between 16 and 25 years. A study in South India reported a prevalence of 6.6% in the general population, with males being more commonly affected than females.¹⁰ In Maharashtra, a retrospective study involving 52 patients treated with a rotation flap technique indicated a male-to-female ratio of 2.2:1, with an average age of presentation at 21 years for men and 19 years for women.¹¹

Etiology and Risk Factors:

1. Hair Penetration: Embedded hair follicles in the natal cleft can lead to inflammation and sinus formation.

2. Mechanical Trauma: Repeated friction or pressure in the intergluteal region may predispose individuals to the condition.¹²

3. Poor Hygiene: Infrequent bathing and inadequate cleaning can increase the risk.

4. Obesity: Excess body weight can create deeper natal clefts, facilitating hair entrapment.

5. Sedentary Lifestyle: Prolonged sitting, especially in occupations like driving, is a significant risk factor.

6. Family History: Genetic predisposition may play a role in some cases.¹⁰

Clinical Presentation:

1. Pain and Swelling: Localized discomfort in the sacrococcygeal region, often exacerbated by sitting.

2. Discharge: Pus or blood from one or more sinus openings.

3. Recurrent Abscesses: Repeated episodes of infection leading to the formation of new sinuses.

4. Chronic Symptoms: Intermittent pain and drainage, especially in untreated or inadequately treated cases.¹¹

Management Strategies:

Conservative Treatment: Involves good hygiene practices, hair removal, and antibiotics for acute infections.

Surgical Interventions:

Incision and Drainage: Used for acute abscesses but associated with high recurrence rates.

Excision with Primary Closure: Involves removing the sinus tract and suturing the wound; however, recurrence rates remain significant.

Flap Procedures: Techniques like Limberg flap and rotation flap have shown promising results in reducing recurrence and improving healing times.¹¹

Laser Pilonidotomy: A minimally invasive approach that has demonstrated effectiveness in treating primary pilonidal disease with lower complication rates ¹³

Ayurvedic Treatments: Traditional methods, such as the use of Kshara Sutra, have been explored as alternative therapies, though more research is needed to establish their efficacy^.¹³

Diet:

· High-fiber foods – to prevent constipation (whole grains, vegetables, fruits, legumes).

· Plenty of fluids – 8–10 glasses of water daily.

· Protein-rich foods – to promote wound healing (dal, eggs, fish, chicken, paneer, milk, curd, soy, nuts).

· Iron-rich foods – if blood loss occurred (green leafy vegetables, jaggery, dates, pomegranate).

· Vitamin C and Zinc – for tissue repair (citrus fruits, guava, amla, tomatoes, pumpkin seeds).

· Avoid spicy, oily, junk foods that may irritate the digestive system.

· Limit red meat and fried foods as they can cause constipation.

· Avoid alcohol and smoking – they slow down healing.¹⁴

Complications and Recurrence:

Complications:

· Infection and abscess

· Pain, swelling, pus discharge

· Chronic sinus with multiple tracts

· Cellulitis

· Delayed wound healing

· Scarring

· Rare: malignant change.¹⁵

REFERENCES:

1. Hull, T. L., and Wu, J. Pilonidal disease. Surgical Clinics of North America. 2002; 82(6): 1169–1185. (https://doi.org/10.1016/S0039-6109(02)00057-3] (https://doi.org/10.1016/S0039-6109%2802%2900057-3)

2. Karydakis, G. E. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Australian and New Zealand Journal of Surgery. 1992; 62(5): 385–389. [https://doi.org/10.1111/j.1445-2197.1992.tb07208.x] (https://doi.org/10.1111/j.1445-2197.1992.tb07208.x)

3. Al-Khamis, A., McCallum, I., King, P. M., and Bruce, J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database of Systematic Reviews. 2010; 1: CD006213. [https://doi.org/10.1002/14651858.CD006213.pub3] (https://doi.org/10.1002/14651858.CD006213.pub3)

4. Dessily, M., Charara, F., Ralea, S., and Allé, J. L. Pilonidal sinus destruction with a radial laser probe: Technique and first Belgian experience. Acta Chirurgica Belgica. 2019; 119(1): 24–28. [https://doi.org/10.1080/00015458.2018.1471835] (https://doi.org/10.1080/00015458.2018.1471835)

5. Bailey and Love’s Short Practice of Surgery, 28th Edition, Chapter 73 The Anus and Anal Canal, p. 1425.

6. Kumar and Nair, 2021, Journal of Clinical and Diagnostic Research] (https://www.jcdr.net/article_fulltext.asp?id=14815))

7. Garg et al. 2019, Indian Journal of Surgery(https://link.springer.com/article/10.1007/s12262-019-01948-1))

8. Patil et al. 2020, Maharashtra University of Health Sciences Journal of Health Sciences(https://muhs.ac.in/))

9. Suresh et al., 2022, International Surgery Journal] (https://www.ijsurgery.com/))

10. Rajasekharan, D., et al. Pilonidal sinus in South India: A retrospective review. Indian Journal of Clinical Practice. 2019; 30(2): 129-132. [Link](https://journals.lww.com/ijcr/fulltext/2019/02030/pilonidal_sinus_in_south_india__a_retrospective.5.aspx)

11. Mistry, A., et al. Outcome of surgical management of sacrococcygeal pilonidal sinus disease with rotation flap in 52 patients: A retrospective study. Indian Journal of Plastic Surgery. 2021; 54(2): 163-167. [Link](https://pubmed.ncbi.nlm.nih.gov/34239238/)

12. Shinde, P. Pilonidal sinus (Nadi vrana): A case study. Journal of Ayurveda and Integrative Medicine. 2010; 1(2): 93-95. [Link](https://pmc.ncbi.nlm.nih.gov/articles/PMC2996578/)

13. Sahasrabudhe, P., et al. Study of laser treatment in primary pilonidal disease. MedPulse International Journal of Surgery. 2012; 2(11): 1-4. [Link](https://medpulse.in/Surgery/html_19_1_1.php)

14. Smeltzer, S. C., Hinkle, J. L., Cheever, K. H., and Bare, B. G. Brunner and Suddarth’s Textbook of Medical-Surgical Nursing. 14th Edition. Wolters Kluwer, Philadelphia. Pages: 415–418 and 436–438

15. Williams, N. S., O’Connell, P. R., and McCaskie, A. W. Bailey and Love’s Short Practice of Surgery. 27th Edition. CRC Press / Taylor and Francis.Pages: 1337–1339

Received on 30.12.2025 Revised on 24.01.2026

Accepted on 19.02.2026 Published on 05.05.2026

Available online from May 09, 2026

A and V Pub J. of Nursing and Medical Res. 2026;5(2):80-82.

DOI: 10.52711/jnmr.2026.16

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