Painful lump near your tailbone? Fortis surgeon Dr Pankaj Sharma explains why you should not ignore it

Are you dealing with a painful lump in your tailbone region which makes it difficult to sit? Dr Sharma warns it could be a pilonidal sinus.

A painful lump near the tailbone, discomfort while sitting or a small opening that occasionally causes discharge may not seem like symptoms worth discussing with a doctor. However, these can be signs of a pilonidal sinus, a condition that is often overlooked until it becomes infected and develops into a painful abscess. It typically occurs on the skin near the tailbone and can interfere with everyday activities, particularly sitting and walking.

HT Lifestyle reached out to Dr Pankaj Sharma – the director of the department of robotics, bariatric, laparoscopic and general surgery at Fortis Hospital, Shalimar Bagh, and the founder of Shalya Clinic in Rohini, New Delhi – who explains, “Pilonidal sinus is often misunderstood as a simple skin problem. In reality, once a sinus becomes repeatedly infected or starts forming an abscess, it can become a persistent problem. Recognising the symptoms early can help prevent unnecessary pain and recurrent infections.”

What is a pilonidal sinus?

Hair, friction and prolonged pressure can play a role. While the exact cause is not completely understood, the current reasoning is that loose hair can become trapped in the buttock cleft and penetrate the skin. Friction, pressure, prolonged sitting, excess body weight and a hairier cleft can increase the likelihood of developing the condition.

“This is not simply a problem caused by poor hygiene, as many people assume. Factors such as prolonged sitting, friction, body hair and individual skin characteristics can contribute. People who spend long hours sitting at work should pay attention to persistent discomfort or swelling in this area,” explains Dr Sharma.

People who spend long hours sitting at work should pay attention to persistent discomfort or swelling in the tailbone area.

Symptoms to watch out for

Painful swelling

A pilonidal sinus may initially appear as a tiny pit or opening and may cause no symptoms. When infection develops, however, the area can become red, swollen and tender. The surgeon stresses, “A painful abscess may form, sometimes making it difficult to sit comfortably. Painful swelling is one of the biggest warning signs. Blood or foul-smelling pus may also drain from the opening. Fever can occur when there is significant infection. ”

Recurring discharge

Some people experience repeated episodes of fluid, blood or pus leaking from the same spot. Dr Sharma highlights that this can indicate chronic or recurrent pilonidal disease and warrants assessment rather than repeatedly treating the symptoms at home.

How is pilonidal sinus diagnosed?

“Usually, a physical examination is enough,” says Dr Sharma. Doctors generally diagnose pilonidal disease by examining the affected area and taking a detailed history. Additional scans are not routinely required in straightforward cases, although investigations may be considered when another condition needs to be ruled out.

Does pilonidal sinus require surgery?

“Not necessarily. Treatment depends on whether it is infected and whether it keeps coming back,” the surgeon points out. An asymptomatic pilonidal sinus may simply be monitored, with attention to keeping the area clean and dry. If there is an acute abscess, the priority is usually to drain the collection of pus. Antibiotics may be used in selected situations, particularly when there is surrounding infection, but they do not by themselves eliminate an established sinus tract.

For chronic or repeatedly recurring disease, a surgeon may consider procedures to remove or treat the sinus. Dr Sharma explains, “Depending on the individual case, options can include excision, procedures that allow the wound to heal openly, flap-based surgery for more complex disease, or minimally invasive techniques such as endoscopic ablation.”

Can it be prevented?

According to the surgeon, reducing hair and friction may help lower the risk of recurrence. Keeping the cleft clean and dry is important. For people with recurrent disease, a surgeon may recommend appropriate hair-removal measures. Avoiding prolonged sitting where possible, maintaining a healthy weight and changing out of sweaty or damp clothing can also be sensible preventive measures.

“Patients should not wait for a pilonidal sinus to become extremely painful before seeking help. When there is recurrent swelling, discharge or infection, the underlying sinus needs to be properly assessed. With the right treatment, most patients can return to normal daily life, but ignoring recurrent disease can make management more complicated,” concludes Dr Sharma.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

Dr Pankaj Sharma is Director of Robotics, Bariatric, Laparoscopic and General Surgery at Fortis Hospital, Shalimar Bagh, and founder of Shalya Clinic, Rohini. With over 27 years of experience, he specialises in minimally invasive, robotic, bariatric and advanced anorectal and venous procedures.