A pilonidal sinus is inflammation with small openings or tracts in the cleft between the buttocks, usually above the tailbone. The common German term “tailbone fistula” is imprecise because bone is usually not affected. There are symptom-free findings, acute abscesses and chronically draining disease. These situations are treated differently. The aim is reliable control of inflammation with the lowest possible burden from the wound and aftercare.
Rapidly increasing swelling and pain, fever or spreading redness requires prompt or urgent medical treatment. Do not squeeze or puncture it yourself.
Causes and risk factors
Hairs can enter the skin of the buttock cleft and trigger a foreign-body reaction. Friction, pressure, a deep cleft and prolonged sitting may contribute. It is more common in young adults. It does not prove poor hygiene. The precise cause is not clear in every case. Symptoms near the anus require exclusion of other causes, because an anal fistula, for example, follows a different treatment pathway.
Typical symptoms
An acute abscess often causes rapidly increasing pain, redness and swelling; sitting becomes uncomfortable. With chronic disease, small skin openings may repeatedly discharge blood or fluid. Relatively symptom-free periods may occur between episodes. Fever or spreading redness suggests more significant infection. Small, unremarkable openings without symptoms do not automatically need treatment. Care depends on the actual condition, not just its name.
Diagnosis
History and examination are often sufficient. We assess the number and location of openings, scars, drainage and signs of an abscess. Previous treatment and recurrence also matter. An unusual location or unclear course may require additional investigations or proctology assessment. Complex imaging is not routinely necessary for a typical superficial finding. Before surgery, options and the demands of aftercare are explained.
Non-surgical treatment
An asymptomatic finding can often be observed. Gentle cleaning and avoiding unnecessary friction may help. Infection is treated according to its extent and the findings. Antibiotics alone usually do not clear a walled-off abscess; drainage may be needed. Hair-removal advice is individual rather than recommending repeated indiscriminate shaving. Recurrent drainage should be assessed surgically.
Surgical options
An acute painful abscess is generally opened and drained. Definitive treatment of a chronic sinus is planned separately. Depending on extent, limited procedures or excision with appropriate wound care may be considered. Selected pilonidal sinus operations are part of our service at the external surgical centre. The suitable technique is discussed individually. No procedure completely excludes recurrence or wound-healing difficulties.
Aftercare and rehabilitation
Aftercare depends greatly on the technique and whether the wound is closed. Open wounds need regular care; closed wounds are checked for healing and tension. Sitting, sport and work resume gradually according to tolerance. Clear cleaning and dressing instructions are important. Complete healing may take longer than initial symptom relief. Renewed drainage, increasing pain or fever should be reviewed early.
Common questions
Does the condition affect the bone?
Usually the changes are in the skin and underlying tissue of the buttock cleft. The term tailbone fistula is therefore imprecise.
Are antibiotics enough?
An abscess often requires surgical drainage. Antibiotics may supplement treatment in selected situations.
Does every small opening need surgery?
An asymptomatic finding does not automatically require a procedure. Acute inflammation and chronic symptoms are assessed separately.
Arrange a consultation
We discuss which treatment is suitable for your findings and which procedures are available within our outpatient service during a personal consultation. Outpatient operations take place at an external surgical centre.
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Further reading
Selected external resources about this condition. Some linked publications are in German.
Medical background
Sources & further information
These professional and patient resources provide further information about this condition. The text on this page is independently written.
NHS: Pilonidal sinus