Difference Between Pilonidal Sinus and Fistula
By Saksham Bhatia +2 more
Medically reviewed by Dr. Nikita Toshi
Last updated: Dec 19, 2023Click to rate this article!
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By Saksham Bhatia +2 more
Medically reviewed by Dr. Nikita Toshi
Last updated: Dec 19, 2023Table of Contents
A pilonidal sinus is a small tunnel or cavity usually forming at the top of the crease between the buttocks. It contains hair and debris and can become infected, causing pain, swelling and redness in the affected area, as well as drainage of pus or blood.
An anal fistula is a tunnel or passageway forming inside an infected gland of the anus and it extends to the opening around the anus. It can be a result of an injury or surgery and cause pain and inflammation around the anus.
The differentiation is important because pilonidal cyst may mimic Anorectal fistula. Also to know is that pilonidal cyst can evolve into fistula if not treated by a surgeon early.
Dr. M.G. Kartheeka, MBBS, MD
| Different Factors | Pilonidal Sinus | Fistula |
| Causes | Conditions that can cause pilonidal sinus is:Any underlying skin problemPressure or friction between the buttocks Ingrown hair around the buttock area Sitting for long periods | Fistula may develop due to:An infection in the anal glandTraumaRadiation therapy or treatment of anal cancer |
| Symptoms | The signs of pilonidal sinus infection include:Pain while sitting or standingSwelling of the cystRedness in the affected areaDrainage of pus or blood from the abscess, causing a foul odourHair protruding from the lesionFormation of more than one sinus tract or clefts in the skinLow-grade fever | A small opening around the anusRedness and inflammation around the tunnel Blood and pus discharge from the anal openingPain in rectum and anus region while passing stoolsFever |
| Diagnosis | Physical examination. The doctor will check the crease of your buttock area and a cyst is visible to the naked eye.Imaging tests may be rarely required, a CT or MRI scan to look for any sinus cavities forming under the surface of your skin. | Imaging tests likeMRI give detailed images of the sphincter muscle and other structures of the pelvic floor.Endoscopic Ultrasound to identify the fistula, the sphincter muscles and surrounding tissues.Fistulography is an X-ray of the fistula to check the anal fistula tunnel.Other tests include a fistula probe, anoscope, flexible sigmoidoscopy or colonoscopy. |
| Treatment options that can be advised by doctors | Antibiotics to treat skin inflammation Drainage of pus is done by opening and cleaning the abscess, then sterile dressing it to promote healingLaser therapy to remove hair from the areaSurgery may be recommended for a recurring PNS. The surgeon opens the lesions, removes pus and debris and then stitches the wounds closed. | Medicines for local applicationFibrin glue and collagen plug to seal the tunnel after cleaning.Seton placement into the fistula to drain the infection and contents inside the tunnel.Fistulotomy is done by cutting the infected tunnel, cleaning it and stitching it in place.Endorectal advancement flap uses a flap from the rectal wall to cover the fistula.LIFT is a two-stage treatment in which the fistula tunnel is opened, then the infected tissues are removed and the fistula is tied off. |
| Prevalence | Pilonidal sinuses are common in young adults.It develops more commonly in men than women because they have more body hair. | Anal fistulas commonly develop in adults around the age of 40. It affects males more than females. |
| Complications | Chronic pilonidal diseaseRetained hair and infected residue may make it difficult to locate the sinus pits.Systemic infection (when an infection spreads throughout your body) and becomes life-threatening.Cancer (specifically squamous cell carcinoma or SCC). | A recurring fistula or an abscessIncrease in the length and number of tracts Inability to control bowel movements (faecal incontinence).Sepsis or infection that spreads throughout the bodyPeritonitis. An intestinal fistula may cause inflammation and infection of the peritoneum (membrane lining the abdominal cavity).There is a risk of developing cancer in the fistula tract if left untreated for a long period of time. |
Pilonidal sinus are very common and the treatment for the same is usually surgical especially when there is an associated discharge, pain and abscess.
Dr. Ashish Bajaj, M.B.B.S., M.D.
Understanding the difference between pilonidal sinus and fistula will help you seek the best treatment for the conditions. You must look out for the symptoms of both conditions and visit the doctor as soon as you experience pain and discomfort. It is possible for a person to confuse the two conditions as they have a few similar symptoms, which is why you need immediate medical attention. When you leave the conditions untreated for a long time, it may cause various other complications. Never self-medicate, proper diagnosis of your condition is very important, followed by appropriate treatment and surgery if recommended by the doctor.
Also Read: How to Stop Itchy Anus at Night: Effective, Research-Backed Solutions
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