A day of hot summer (2010) when I got up from my bed in hot -turning-cold morning which was usual in my high school days I noticed something unusual giving a little pain to me above my hips. I usually ignore such small things and the same I did on that day. Well I went for shower and was rubbing my whole body to put down the dirt of last day’s physical activities I did in District Stadium. I again felt a bit of pain on same place, I pressed the part and realized that its a bump or cyst beneath my skin. I should have taken more care of it but since I was already 35 minutes late for my school, I skipped everything.
Within a day or two I just forgot the pain and the cyst too. Time passed on and some eight months later I was hit by a rod due to false sitting. Pain came up on the same place. After touching the part gently I realized that its just same thing which was eight months before. I again refused to go to doctor. Pain was a little sharp so I took a pain killer (usually I don’t but it was my exam after a day). Well pain killer worked and everything just seemed normal to me. Some more weeks passed. I felt it again. Everything was same like before, Went away. Well when I felt it 4th time I realized that it came back to me because of 3 hours flight journey and 6 hours Train journey I did last day.
My mind said, “Don’t worry Gagan, Its just a tissue rupture always when you sit for long. Avoid sitting for long duration” . It was not first time my mind said something and I accepted, I usually do that (I always act like a Doctor to my body itself as I was a medical student in by High school.) Well I again refused meeting a doctor. Was that a right decision? Who knows until Sept 2013.
I remember the day, 02 Sept 2013. It was raining outside and sun was nowhere in sky though clock was showing 10:30 am. I was with my roommate in balcony having a cup of coffee in hand. I said, “Ravi, I am feeling pain above my buttocks. The same place where it comes every time”. He took a long breath and turned his chair towards me from a great panorama of city Under rain. He started instructing me like a grandpa, says “Gagan, You should go to doctor now. You are facing this from last 3 years and ignoring it as if it is a joke. Either you go to a doctor or stop complaining me about it”.
Well packed a few cloths in the evening and went to my native town to meet my parents a discuss it with them. When I reached my problem was the first thing I discussed with them (my parents) after touching their feet (Its a tradition in India). My parents are very sensitive for me. Both mother and father said “Go to Dr. Jain’s clinic tomorrow itself”. Dr. Jain was a famous doctor in our area, but for bones related problem : An orthopedic. Next morning I visited him and he just told me I a tissue rupture due to tail bone (which I was thinking from last 2 years). Well I came out with few medicine and great proud (as I was proved right by doctor).
It was 11th of same month, my pain was in no mood to leave my body. I decided to go to best hospital of Province. Doctors in that government hospital were too busy but still somehow my turn came. I discussed everything to the doctor (though he listed half, I think) and he gave me some more round piece of colored capsules and a Diclofenac Gel BP to apply it over affected area. In the night while applying the ointment I realized the cyst turned more than the expectation. I Decided to check the new treatment for a day.
Nothing was fine until 13th morning. The pain was so worst that I hardly adjusted on my bed whole last night. I checked my bank balance which was enough for the treatment in a big private hospital. I asked my friend to move to a big hospital. I reached to best private hospital of the capital city the same day and went to a general surgeon. It was Dr. Uma K Raghuvanshi. She asked me my problem and without even looking the cleft of my upper buttocks, guessed it as Pilonidal Sinus. She asked me to lay half naked in near by cabin. I did, she examined and said that its was a deep Pilonidal Sinus only which is lacking many symptoms.
Well I asked her to remove it and she said they will operate me for that. I agreed. I further asked how long I will be I hospital and how long it will take recover completely. She said minimum 3 days after the operation I will have to stay in hospital and if everything went as per the plan I will be allowed to run and jump in next 40 days.
Then my discussion with doctor started. Here are my Questions which were solved by doctor.
Q. What is Pilonidal Sinus ?
Its a cyst or say abscess on the starting cleft of your Buttocks over the tailbone and often contains hairs over it.
Q. How do it occurs ?
Plionidal is a Latin word which mean nest of hair. It starts due to ingrown hair below the skin which start growing after its breaks from top of the skin but have perfect joint on its root. It keep growing in sprawling manner and affect nearby tissues. As a result of hairs and tissue interaction pus is formed below the skin.
Q. What are its Symptoms ?
Pilonidal sinus do not show any symptoms in starting time. When pus cells increase in number and push the nearby tissue to get out of body pain starts. In many cases a tiny hole is formed above the skin which reaches to whole affected area. A regular discharged flow out through it. Pain will be very less if discharge occur regularly. But still while sitting patient feel it a bit.
Q. What are its causes ?
A person with hairs on his/her buttocks gets it generally. A ingrown hairs mostly grow after getting break from tip below the skin or after getting detached from the root a bit. This condition usually observed in those who do prolong sitting, drive long, sit on hard jumping surface etc. Earlier it was a myth that this is a men’s disease but in today’s generation it is common in Girls too.
Q. What are the prevention and cures ?
This can be prevented. Yes, You need to take care of a few things like keeping cleft of buttocks clean, shaving of hairs from cleft and nearby areas so that they don’t get messed up to each other, avoiding prolong sittings especially on hard surface. You should also avoid wearing low-waist jeans.
Once you get a pilonidal sinus you can only get its complete cure with surgery. It can be delayed by keep many cares but final cure without operation is not possible.
Surgical and Post Surgical care of Pilonidal Sinus: Based on my experience.
I was admitted to hospital on 15th Sept 2013. My parents were informed by me and they left hometown to visit me before the operation. Meanwhile I was diagnosed for various things which were compulsory before the operation. I was also asked if I was having anything to share related to my body. :: Take care, Share all your allergy and previous medical history with doctor before any treatment. :: In my case I was having no allergy to any medicine or towards any treatment. “I was operated for appendix operation laparoscopically some 6 years ago”, I said and they noted (it was no issue). I was having many small cyst or round structures below my skin all over the body which I also shared with them (it was also no issue). At noon hairs from my complete body (below face) were removed with help of a lotion. In evening I was given some light food and a tablet. On 16th, Morning at 6am a nurse knocked me up and asked me to get fresh and instructed to take bath throughly. ::You should get fresh and empty your intestine thoroughly before a operation. :: I did that all by 7:30Am and was taken to bed again after that. Now they introduced a I-V drip in my vein on my left hand. A bottle with some 300ml solution was inserted in my blood stream. Later at 9:30am I was on the stretcher on the way to Operation theater. I was asked several more question related to me and they also asked which anesthesia they should use, local or complete. :: If you are not brave enough to see operation consciously with your senses choose Complete anesthesia. :: I opted local anesthesia which was given in my spinal cord to disconnect the sense of my lower body (Reason why I opted local anesthesia was one both I and doctor thought it is a minor operation and second I was brave enough to sense the way I was operated.)
Many machines introduced to me and was used over me somehow, a few on face, some on hands, some on chest and shoulder etc. Sharp at 11:45am operation was started and Dr. Uma did that. It was expected to go maximum for 30 minutes. Some after 15 Minutes doctor asked me how long you think the nest of hair would be? I said “May be 3-5cm”. Well I was not asked anything else. It was 12:30pm in the round clock I was able to see in OT. Time passed, Finally at 12:40 Dr. Uma left OT saying me that my sinus was long and now been removed successfully. At 1:10 pm I was stitched (Yes, stitched as my operated area was more than 10cm in lenght. Most of the cases doctor prefer open surgery if wound is small.) I was immediately shifted to recovery room on my request as I was shivering badly and lost few hundred mls’ of blood in surgery. After chilling some 15 minutes in Recovery room I was stretchered out of OT. My mom was standing out with wet eyes which was about to flow. I suddenly raised my hand to tell them how comfortable I was. She accompanied the group of 4 nurse and a ward boy whom took me to my bed. I was shifted to my bed slowly and asked to rest (My body below chest was still under anesthesia and to remain like that for next 3 hours.) I was getting blessing and well wishing call laying straight on the bed and continuously running I-V in my veins. Around 5:00pm I felt a little pain around my both kidneys. I kept silence but started moving my hand around. I realized there was something kept between my legs. I asked my friend who was sitting beside me to check what is there. He pulled out a Urine catheter and a more equipment which was collecting blood discharge. I suddenly realize that i have to lay by either of my side to let urine flow out. I asked nurse to permit me to turn right, She agreed. As soon as I turned right, urine catheter was filled with some 300 ml of urine. My kidney pain was lost in some 60-70 sec after it. It was urine which created that all problem.
Well everything was fine for next 4 days I asked my doctor to remove Urine catheter on next day of operation and she did it on next morning. Now I started moving outside that room. I was also doing daily morning habits easily. The other equipment was introduced to my operated area itself. It was there for pumping out blood (if any) from wound. On 5th day after my operation I asked for leave to doctors and nurses and they agreed but asked me to go home with the blood pulling equipment (Sorry, I don’t know Its name.)
I was discharged and asked to return after 8 days. I went to home and first thing I did was washed my body somehow without affecting wound. I was on regular Diet now. Next day in morning I decided to take bath which was complete no from doctor as there was risk of getting dressing wet. But I was not ready to continue without bathing (I can’t leave without bathing a day easily and was, 6th without.) Finally I tied a plastic sheet over the dressing and managed to bath.
On 30th September I visited doctor and asked her to remove the blood tube (I said na, I don’t know the name.) She agreed and removed my dressing too and thoroughly cleaned the operated area. A cleaning method she taught to my father which was to be done every next day. I was permitted to bath with the same way I discovered. My stitches was still supposed to be there for next 10-15 days.
On some 15th October I was again carried to doctor and got my stitches off. Dr. Uma appreciated my recovery and asked me to rest more for minimum 1 Month. She also said that it would not be that worst if I would have taken it seriously.
I took long bath that day with Luke warm water and felt like heaven. I continued my rest for 30 more days and did final visit to doctor before continuing to University. :: I was asked to clean shave my operated area for rest of my life :: She also asked me not to sit on bike for next 30 days. I was not allowed to work out at GYM for same 30 days and was asked to eat power capsules too (which I haven’t done).
Today more than 100 days passed and I am having no problem in my day to day habit. I am very very Thankful to Dr. Uma for the great job. My father and mother were the next who deserve all the thanks. It was though not a painful experience but I made it worst by delaying it for 3 years. I ask my friends not to do same if you feel the same sinus.
A Paragraph for Girls
The day I was operated for Pilonidal Sinus a girl was also operated for the same. I got chance to interact a little with that girl and came to know a strange thing. She said,”I kept my sinus hidden from my friends as it is a men’s disease”. Men’s Disease!!?!? I exclaimed.
Later I researched and found that girl was speaking of some 16th century. Pilonidal sinus is not a men’s disease. I a generation where women have equal right as per as a man this kind thinking should be changed. Today women are found more in office doing prolong sitting work then why can’t they get this. I agree that some 30% girls only have hairs on their various body parts but that’s not abnormal. It you feel that it can’t come to a girl you are completely wrong.
Disclaimer:- Post is based on personal experience. Above given precautions and treatment may not be correct one. Please consult with your doctor before taking any step.
Guest post by Indian medical doc Gagan