A pilonidal sinus is a small tract at the top of the buttock cleft, usually containing hair. It recurs often after conventional excision, which is why the thread technique suits it well.
Also known as: Pilonidal cyst · Pilonidal disease · Sacrococcygeal sinus · Nadi vrana (Ayurveda)
A pilonidal sinus is a small tunnel in the skin at the top of the buttock cleft, near the tailbone. It usually contains hair and debris — the name means “nest of hair”.
It forms when loose hair works its way into the skin, and the body reacts to it as a foreign body. That reaction creates a cavity, which becomes a tract with an opening at the skin surface.
It is most common in young adults, more often in men, and more often in people who sit for long periods — drivers and desk workers in particular. Coarse body hair, a deep natal cleft and being overweight all increase the likelihood.
Many people describe exactly the same cycle as an anal fistula: swelling, discharge, relief, recurrence. The mechanism is similar, and so is the reason it does not settle by itself.
This is the crux of the condition, and worth being straight about.
The standard surgical approach is wide excision — cutting out the tract and surrounding tissue. It works, but it leaves a substantial wound in the worst possible place: an area under constant tension from sitting and walking, naturally moist, and difficult to keep still. Wounds there are slow to heal and prone to breaking down. Recurrence after excision is well documented.
That is the problem the thread technique is designed around.
The same medicated thread used for anal fistula is applied here. It is passed through the sinus tract and tied, then changed weekly in the outpatient clinic.
As the thread cuts slowly through the tract, the tissue behind it heals. The result is that the tract is dealt with without creating a large open wound — which is precisely the failure point of wide excision in this area.
Most patients keep working through treatment. Prolonged sitting is uncomfortable for the first day or two after each change.
Treatment closes the tract. It does not change the mechanism that created it, so this part matters:
Conventional wide excision removes the tract but leaves a large wound in an area that is under constant tension from sitting and movement, is naturally moist, and is close to the source of the problem — hair entering the skin. Wound breakdown and recurrence are well recognised after excision. Kshara Sutra avoids a large open wound, which is a large part of why it is used for recurrent disease.
The medicated thread is passed through the sinus tract and tied, exactly as for an anal fistula. It cuts through the tract gradually while healing behind itself, and is changed weekly in the clinic. There is no large open wound to pack and dress for weeks, and most people continue working.
It depends on the length of the tract and whether there are multiple openings. A simple sinus may resolve in 4 to 6 weeks of weekly thread changes; longer or branching tracts take more. We assess the tract first and give you a realistic estimate.
A pilonidal sinus does not close on its own once a tract has formed, and the quiet phases are just the tract not being blocked at that moment. Repeated infection makes tracts longer and more branched over time, and treatment then takes longer. Treating it during a quiet phase is easier than treating it during an abscess.
Keep the area clean and dry, remove hair from the natal cleft regularly by whichever method suits you, avoid very long uninterrupted periods of sitting where you can, and manage weight if that is a factor. These are not incidental advice — hair entering the skin is the mechanism of the disease.
Proctology & General surgery - (Shalya Tantra)
BAMS, MS(Ayurveda), PhD
Dr. NEELAMBIKA G. B. is an Ayurvedic Surgeon with special emphasis on Management of Surgical conditions through Ayurvedic approach and makes the best use of conventional clinical and diagnostic evaluations for the diagnosis and outcomes assessment.
Reg. 88606/15180 KAUP Board
