Treatment of pilonidal sinus

What is a pilonidal sinus and how is it treated?

A pilonidal sinus is a small pit or tunnel in the skin at the top of the buttock crease (the natal cleft), just above the tailbone. Loose hairs can work their way into it, and the body reacts to them, which can lead to inflammation, infection and a painful abscess. It is most common in teenagers and young adults, and a little more common in those with coarse body hair, who sit for long periods, or who have a family history.

If it flares up into an abscess (a hot, painful, swollen collection of pus), the first treatment is usually to drain it, sometimes with antibiotics, to settle the infection. Removing or treating the sinus itself is then planned later once things have calmed down.

Treatment of the sinus ranges from minimally invasive keyhole techniques (such as PEPSiT, using a tiny telescope to clean out the tunnel) to cutting out the affected skin and either stitching it closed or leaving it open to heal gradually from the bottom up. There is no single 'best' operation, and each has trade-offs between recovery time and the chance of it coming back.

An important point for young people: pilonidal sinus disease comes back more often in teenagers than in adults, whatever operation is used. Keeping the area clean and removing hair long-term is a key part of treatment, not an optional extra.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your surgery

• Ask which operation is planned and what the realistic recovery and dressing care will involve, as this varies a lot between techniques.
• Follow the fasting (nil by mouth) instructions before a general anaesthetic.
• Start the hair-removal and washing routine you are advised to use before surgery, as this is important for healing and reducing recurrence.
• Tell the team about any medicines, allergies, skin infections or bleeding tendencies.
• Arrange time off school, college, sport or work to match the operation and wound type.
• Plan how dressings will be managed at home or by a practice/district nurse, especially for an open wound.
• Have any prescribed antimicrobial wash, dressings and painkillers ready, and note who to contact with problems.

What happens

Most operations are done under general anaesthetic, so the young person is asleep and feels nothing, and usually take around 30 to 60 minutes.

With a keyhole approach such as PEPSiT, the surgeon passes a tiny telescope into the tunnel, removes the trapped hair and inflamed lining, and seals the cavity, leaving only very small wounds. With an excision, the affected skin and tunnel are cut out; the wound is then either stitched closed or, in the open technique, left open with a dressing to heal gradually from the base.

Most young people go home the same day, though a larger open operation may occasionally need a short stay. Before discharge you are shown how to care for the wound, keep the area clean, and continue hair removal, and given a plan for dressing changes and follow-up.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The two issues to understand clearly are healing time and recurrence. An open wound can take weeks to months to heal and needs committed dressing care; and pilonidal disease comes back more often in teenagers than adults whatever the operation. Ask your surgeon which technique they recommend and why, what their recurrence rate is, and exactly what the wound care will involve at home.

Published figures to discuss

Recurrence is the key figure for pilonidal disease, and it is genuinely higher in young people than in adults, rising the longer they are followed up. Reported rates vary widely between studies and techniques, so the figures below are cautious ranges and your own surgeon's results matter more than any single number.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery depends heavily on the operation. Keyhole techniques usually mean small wounds and a quicker return to activity, while an open wound needs regular dressings and can take much longer to heal.

• Soreness when sitting for the first days to weeks
• Some discharge from the wound, especially with open healing
• A wound that heals slowly over weeks to months with the open technique
• Tiredness and reduced activity while healing
• Needing regular dressing changes for an open wound

Aftercare

• Use the prescribed painkillers regularly at first, especially before sitting for long.
• Follow the dressing plan exactly, whether changed at home or by a nurse, particularly for an open wound.
• Keep the area clean and use any antimicrobial wash or spray as directed.
• Continue long-term hair removal (shaving, creams or laser as advised) to reduce recurrence.
• Avoid prolonged sitting, cycling and heavy activity until the team says it is safe.
• Watch for signs of infection or the wound not healing, and attend follow-up.
• Keep the contact number for the surgical team or nurse specialist to hand.

• Painkillers at home
• Prescribed antimicrobial wash or spray collected
• Dressings and a plan for who changes them
• Hair-removal routine agreed and supplies ready
• Time off school, college, sport or work arranged
• Early wound-check and follow-up appointments noted
• Surgical team / nurse specialist number saved

Scars and how they heal

Keyhole techniques such as PEPSiT leave only small wounds and minimal scarring. Excision leaves a scar in the buttock crease; a stitched wound leaves a line, while an open wound heals to a scar over weeks to months. Scars here can be tender when sitting at first. Ongoing hair removal helps keep the area healthy and reduces the chance of the problem returning.

⚠ Get urgent help if…

• Spreading redness, heat and swelling, or pus, around the wound (infection)
• A high temperature or feeling generally unwell
• Increasing rather than easing pain after the first days
• Heavy or persistent bleeding from the wound
• A stitched wound that opens up
• An open wound that stops healing or starts discharging more
• A new painful swelling suggesting the abscess or sinus is returning

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result is a healed wound, no more painful flare-ups, and a return to normal activity. Keyhole techniques such as PEPSiT report high success and quick healing in many young people, while excision aims to remove the problem more completely at the cost of a longer recovery.

No operation guarantees a cure, and recurrence is genuinely more common in teenagers than in adults. Long-term hair removal and hygiene are part of the result, not an afterthought. Your surgeon should explain the realistic chance of recurrence for the chosen technique rather than promise it will never come back.

Even after successful treatment, pilonidal disease can return, and it does so more often in younger people. Reported recurrence in children and adolescents rises over time — roughly one in ten within two years and considerably higher by five years in some studies — and is higher again in older teenagers. Sticking with long-term hair removal and good hygiene is the main thing that helps keep it from coming back.

Combining with other procedures

If there is an abscess, draining it and treating the infection comes first, with definitive treatment of the sinus planned later. Hair-removal measures, including laser hair removal in some services, are used alongside surgery rather than instead of it. Your surgeon will set out the order of treatment for your situation.

Follow-up & long-term care

Follow-up usually includes an early wound check (often around day 5), then further reviews while the wound heals, which may involve a nurse specialist for dressings, and a later check once healed. Long-term, the focus shifts to hair removal and watching for any recurrence. You should always have a clear contact route if the wound is not healing or symptoms return.

• Long-term hair removal of the area (shaving, hair-removal creams or laser, as advised)
• Keeping the natal cleft clean and dry
• Prompt review of any new pain, swelling or discharge
• Attending follow-up until the wound is fully healed

Revision and secondary surgery reality

• Recurrence is common in young people and may need a further procedure, sometimes a more involved one.
• A stitched wound that breaks down may need to heal open instead, lengthening recovery.
• An abscess may need draining before, and sometimes again after, definitive treatment.
• Long-term hair removal reduces, but does not remove, the chance of needing further treatment.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• A clear, written wound-care and dressing plan, with named support (often a nurse specialist) for an open wound.
• An agreed long-term hair-removal and hygiene routine, including advice on laser where available.
• Early and ongoing wound checks until healing is complete.
• A reliable contact route and clear warning signs for infection or recurrence.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Which operation is used (keyhole versus open excision versus closure)
• Surgeon's fee and the anaesthetist's fee
• Theatre and facility costs, plus any short stay
• Dressings and the number of dressing changes for an open wound
• Nurse appointments for ongoing wound care
• Long-term hair removal, including laser if used
• Follow-up appointments and management of any recurrence

• The surgeon's fee and the anaesthetist's fee
• Theatre/facility fee and any overnight stay
• What is included for dressings and ongoing wound care, especially for an open wound
• Whether follow-up appointments are covered
• Whether any hair removal (including laser) is included or extra
• What happens, and what it would cost, if the sinus recurs or a wound breaks down
• The cancellation policy

On the NHS? Pilonidal sinus disease is treated on the NHS, including in young people; private care is sometimes used for choice of technique or speed rather than because the NHS does not provide treatment.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Which operation do you recommend for us, and why that one?
• What is the realistic healing time and dressing care for that technique?
• What is your recurrence rate, especially in teenagers?
• Do we treat an abscess first and the sinus later?
• What hair-removal routine should we follow, and is laser available?
• What are the signs it is coming back, and who do we contact?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for treatment of pilonidal sinus

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: Cambridge University Hospitals — PEPSiT for children (parents and carers) Cambridge University Hospitals — PEPSiT for young people North Tees and Hartlepool NHS — Excision of pilonidal sinus Paediatric pilonidal sinus recurrence vs adults (PMC) Paediatric pilonidal sinus: early recurrences, multicentre analysis (PMC) British Association of Paediatric Surgeons (BAPS)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.