Symptoms
The symptoms from pilonidal disease can vary greatly from patient to patient. Common symptoms are a painful lump, bleeding, drainage, or enlarged pores in the midline of the gluteal cleft.
Some patients are prone to developing pilonidal abscesses – which are very painful, and often need to be drained (lanced) in order to get relief. Other patients develop sinus tracts, which appear off to the side of the cleft, and may intermittently drain. A third type of patient develops open wounds in the midline of the cleft, which can bleed and drain.
Diagnosis
Pilonidal disease is usually diagnosed by physical exam and history. X-ray studies are rarely necessary. There are very few diseases that show up in the gluteal crease – so anything in the gluteal crease with pain, a lump, bleeding, drainage, or a hole – is most likely pilonidal disease. There are a few diseases that can be confused, and you can read more about them here.
Treatment
The kind of treatment that is offered to patients varies greatly.
Home remedies include shaving, antiseptics, warm soaks, and wound care.
Minimally invasive surgical options include pit-picking, laser ablation, EPSIT, Fibrin Glue ablation, and other similar procedures. These may be effective, but they have about a 20-30% failure rate.
Surgical treatment is often considered the “gold standard”, but unfortunately, one of the most common surgical treatments is “wide excision”. This means the area involved is removed, and may be left open to heal secondarily, or closed – with hopes that it stays closed. In general, this type of treatment has an unacceptably high failure rate – in the 30-50% range, and a long, messy, uncomfortable recovery period
In our clinic the surgical procedure we prefer is the cleft lift. When done properly, it has the highest success rate and fastest recovery. It’s high success rate is due to the fact that it flattens the gluteal cleft, which is the basis for the problem. Recurrences are less than 5% with this operation.