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Pilonidal Sinus
and Abscess
Learn symptoms, causes, management of pediatric pilonidal sinus and abscess, and when to contact a pediatric surgeon in Singapore.
What Are Pilonidal Sinus and Abscess in Children?
Pilonidal sinus and abscess are conditions involving the development of an abnormal tract or cavity in the skin near the tailbone (coccyx). While these conditions are more commonly seen in adults and adolescents, they can also occur in younger paediatric patients.
A pilonidal sinus is a small tunnel in the skin that may contain hair and skin debris, while a pilonidal abscess is a painful, infected collection of pus that develops when the sinus becomes blocked and infected.
These conditions require specialized children pilonidal care to prevent recurrence and ensure proper healing. Without appropriate treatment, the condition can become chronic and significantly impact a child's quality of life.
Common Symptoms of Pilonidal Sinus and Abscess
Children with pilonidal sinus or abscess may experience various symptoms depending on whether the condition is acute (infected abscess) or chronic (persistent sinus tract).
Acute Abscess Symptoms
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Severe pain in the lower back or near the tailbone, especially when sitting or lying on the back
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Visible swelling or lump that appears suddenly and grows rapidly
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Redness and warmth over the affected area indicating active infection
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Tenderness that makes sitting or any pressure on the area extremely uncomfortable
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Fever and malaise as the body fights the infection
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Spontaneous drainage of pus or blood-tinged fluid if the abscess ruptures
Chronic Sinus Symptoms
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Drainage of clear fluid, pus, or blood from one or more small openings (pits) in the skin
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Recurrent pain and swelling that comes and goes with periods of infection
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Persistent moisture in the tailbone area
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Unpleasant odor from the draining fluid
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Multiple sinus openings that may develop over time
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Discomfort when sitting for extended periods
When to Seek Treatment
Seek children pilonidal care if your child complains of persistent pain near the tailbone or has difficulty sitting comfortably. Check for any swelling, drainage in the area, or signs of infection such as fever or spreading redness.
Contact healthcare professionals immediately if the condition recurs after previous treatment. Early pilonidal sinus treatment prevents complications and provides better outcomes.
What Causes Pilonidal Sinus and Abscess in Children?
The exact cause of pilonidal sinus and abscess is not fully understood, but research suggests they result from a combination of factors affecting the tailbone region.
Hair Follicle Irritation and Penetration
The primary mechanism involves hair penetration into the skin. Hair follicles in the area between the buttocks may become inflamed or irritated, leading to the formation of a sinus or abscess. Loose hairs from the scalp, back, or surrounding areas can accumulate here and penetrate the skin through friction and pressure.
These embedded hairs trigger a foreign body reaction, causing inflammation and infection. The body's immune response attempts to wall off these foreign materials, creating a pilonidal sinus tract that may extend several centimeters beneath the skin surface.
Ingrown Hairs
Hairs that grow back into the skin instead of outward contribute significantly to causing pilonidal disease. In children experiencing hormonal changes, increased hair growth and thicker hair texture can worsen this problem.
The curved anatomy of the area between the buttocks creates an environment where hairs can easily become ingrown, and repeated movement and friction pushes these hairs deeper into the tissue.
Friction and Pressure
Constant friction or pressure in the tailbone area also plays a big role in forming the pilonidal sinus. Prolonged sitting, particularly during school hours or when using electronic devices, creates pressure on the tailbone area. Poor posture that places excessive pressure on the tailbone may also be a contributing factor.
Repetitive activities in sports can irritate the area and contribute to sinus development. Tight clothing that rubs against the lower back increases friction and hair penetration.
Consequences of Untreated Pilonidal Sinus and Abscess
Failing to seek appropriate pilonidal sinus treatment can lead to several complications that affect both physical health and quality of life.
Acute Complications
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Severe infection: Untreated pilonidal abscess can expand, causing extensive tissue destruction and severe pain
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Cellulitis: The infection may spread to surrounding skin and soft tissues
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Sepsis: In rare cases, bacteria from the abscess can enter the bloodstream, causing life-threatening infection
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Multiple abscess formation: The infection can create additional pockets of pus requiring multiple procedures
Chronic Complications
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Recurrent infections: Without proper pilonidal sinus treatment, the condition tends to recur repeatedly, requiring multiple episodes of pilonidal abscess drainage
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Complex sinus tracts: Chronic disease can lead to extensive branching sinus networks that are more difficult to treat
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istula formation: Abnormal connections may develop between the sinus and surrounding structures
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Chronic pain: Persistent inflammation and infection cause ongoing discomfort that interferes with daily activities
Beyond physical complications, untreated pilonidal disease significantly affects a child's overall well-being. Chronic pain makes sitting during school classes extremely difficult, potentially affecting academic performance. The persistent drainage and odor from the sinus can cause embarrassment and social isolation.
Recurrent infections lead to frequent school absences and missed activities. The visible signs and discomfort can impact self-esteem and emotional health during your child’s critical developmental years.
How to Treat Pilonidal Sinus and Abscess in Children
Effective pilonidal sinus treatment requires a tailored approach based on whether the condition presents as an acute abscess or chronic sinus. At The Little Surgery, Dr. Ong Lin Yin provides comprehensive children pilonidal care with expertise in both conservative management and surgical intervention.
Conservative Management
For small, uncomplicated pilonidal sinus or early-stage disease, conservative management may be attempted initially. This approach focuses on preventing infection and promoting natural healing.
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Hygiene measures are essential for children pilonidal care. Keep the area clean and dry, washing gently with mild soap and water daily. Remove any visible hair from the natal cleft area regularly through careful shaving or trimming. Ensure thorough drying after bathing to prevent moisture accumulation that promotes bacterial growth.
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Warm compresses applied to the affected area several times daily can promote drainage of small accumulations and increase blood flow to aid healing.
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Topical treatments using antibacterial or antiseptic creams can help prevent infection in small sinus openings. However, creams alone are rarely sufficient for established pilonidal disease.
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Lifestyle modifications include reducing prolonged sitting when possible and maintaining a healthy weight to decrease pressure and friction in the area. Wearing loose-fitting clothing reduces irritation.
Incision and Drainage of Pilonidal Abscess
When a pilonidal abscess develops and causes significant pain and swelling, incision and drainage pilonidal procedures become necessary. This is often the first-line treatment for acute abscesses requiring immediate relief.
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The procedure involves administering local anesthesia to ensure your child's comfort. A surgical incision is made to release the accumulated pus. The abscess cavity is thoroughly irrigated with sterile saline to remove all debris. The wound is explored to identify and drain any loculations (separate pockets within the abscess).
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Post-procedure care is critical for healing. The wound is typically left open rather than sutured closed, allowing drainage to continue and healing to occur from the inside out. Packing and dressing sinus wounds helps maintain drainage and prevents premature closure of the skin before the deeper cavity has healed.
Packing and Dressing Sinus Care
Proper packing and dressing sinus technique is essential for successful healing after pilonidal abscess drainage. We provide detailed instructions for wound care that parents can manage at home or with nursing assistance.
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Initial packing involves placing sterile gauze strips into the wound cavity to keep it open and absorb drainage. The packing is changed daily or as directed, with each change involving gentle removal of the old packing, cleansing the wound, and insertion of fresh packing material.
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Progressive management requires gradually reducing the amount of packing as the wound heals. Regular assessment ensures the wound is healing properly without premature skin closure that could trap infection inside.
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Duration of care varies depending on the size of the original abscess, typically requiring 2-4 weeks of packing and dressing for complete healing. Our team provides ongoing support and follow-up to monitor progress.
Sinus Excision
For recurrent or chronic pilonidal disease that doesn't respond to the measures above, sinus excision becomes necessary.
This procedure involves surgical removal of the entire sinus tract, along with any associated debris, infected tissue, and hair follicles. The extent of excision depends on the complexity of the sinus tract, with simple cases requiring limited removal and complex cases needing more extensive excision.
After excision, the wound may be left open to heal by secondary intention (gradual healing from the bottom up) or closed primarily with stitches or other closure techniques, depending on the size and location of the wound.
Why Choose The Little Surgery for Children Pilonidal Care
The Little Surgery provides specialized treatment with expertise in pilonidal abscess incision and drainage, with thorough packing and dressing sinus care.
Expert Pediatric Surgical Care
Dr. Ong Lin Yin brings over 20 years of experience in paediatric surgery, including management of complex pilonidal disease in children and adolescents. As the former Head of Department of Paediatric Surgery at KK Women's and Children's Hospital, she has successfully treated numerous cases of pilonidal sinus and abscess.
Child-centered Care
Understanding that pilonidal disease can be embarrassing and uncomfortable for children and adolescents, we provide sensitive, age-appropriate care. Dr. Ong ensures clear communication with both parents and patients and supportive follow-up for recovery.
Comprehensive Treatment
We offer the full spectrum of children pilonidal care, from initial pilonidal abscess drainage for acute infections to surgical excision for chronic disease. Our approach includes thorough evaluation, skilled surgical technique, detailed wound care instruction for packing and dressing sinus management, and long-term follow-up to prevent recurrence.
Contact The Little Surgery Today
If your child is experiencing symptoms of pilonidal sinus or abscess, immediate professional care prevents complications and recurrence.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.