PILONIDAL SINUS AND ITS AYURVEDIC TREATMENT

PILONIDAL SINUS AND ITS AYURVEDIC TREATMENT

A pilonidal sinus (PNS) is a small cyst or abscess that occurs in the cleft at the top of the buttocks. It can cause severe pain and often becomes infected. If it becomes infected, it may exude pus and blood and emit a foul smell.

Pilonidal sinus causes

Most doctors think that ingrowing hairs cause pilonidal sinuses. Pilonidal means "nest of hair". It is common to find hair follicles inside the sinus.

Another theory is that pilonidal sinuses appear after an injury to the sacrococcygeal region (the region relating to both the sacrum [the lower vertebrae] and coccyx). During World War II, more than 80,000 soldiers developed pilonidal sinuses that required a hospital stay. People thought the sinuses were due to irritation from riding in bumpy vehicles. For a while, in the US the condition was actually called "Jeep disease".

Pilonidal sinus symptoms

The symptoms experienced by someone with a pilonidal sinus include the following:

•           Pain at the bottom of the spine.

•           Swelling at the bottom of the spine.

•           Redness at the bottom of the spine.

•           Draining pus.

•           Fever.

Who is affected?

Pilonidal sinuses are rare, affecting about 26 in 100,000 people each year.

They affect at least twice as many men as women. The average age for a pilonidal sinus is 21 in men and 19 in women.

They are less common in children and people over the age of 45.

Presentation

A PNS may be asymptomatic for some time prior to presentation. The majority of patients only present with the onset of symptoms, usually pain and discharge. Occasionally a painless lump or swelling may be discovered by the patient while washing, or the characteristic midline pits may be found during a routine physical examination. Symptomatic disease usually presents as an acute pilonidal abscess, a chronic pilonidal abscess or complex/recurrent pilonidal disease.

Acute pilonidal abscess

The patient notices increasing discomfort and swelling over a number of days and the pain may be severe by the time of presentation. On examination there is a localised fluctuant swelling in the midline of the natal cleft with overlying cellulitis. The area is exquisitely painful to touch and often simply the act of separating the buttocks to examine the area is intolerable for the patient.

Chronic pilonidal disease

It is common for patients to present with chronic pain and discharge, often with a history of up to two years[2]. On examination a single, or occasionally, multiple sinuses may be seen. Tufts of hair or other debris, such as clothing fibres, are often visible arising from the sinus. Localised oedema, swelling and inflammation may be present masking the underlying sinus.

Complex or recurrent pilonidal disease

This is due to reinfection in neighbouring hair follicles or chronic infection from entry of hair or debris into a postoperative wound.

How Can I Prevent Pilonidal Sinus Disease?

You can prevent recurrence of pilonidal sinus by washing the area on a daily basis with a mild soap, making sure all soap is removed, keeping the area completely dry, and avoiding sitting for long periods.

Kshar Sutra treatment in pilonidal sinus

Kshar Sutra is a medicated thread (seton) coated with herbal Alkaline drugs like Apamarga (Kshar) (Ash of Achyranthus ascera), Snuhi (Euphorbia nerufolia) latex and Haridra (Curcuma longa) powder in a specific order. This combination of medicines on the thread helps in debridement and lysis of tissues, exerts antifungal, anti bacterial, and anti inflammatory. Another mechanism proposed for the Kshara Sutra is that it destroys the residual glands in the epithelium.

Pathya-Apathya ( Diet and routine activities ) :

From the day of Kshara sutra threading procedure, light diet is advised. Patient is also advised to take plenty of fluids, blend diet, green vegetables, salad and seasonal fruits. Avoid non-vegetarian , spicy and fermented food . Do not strain during defecation. Sitting in warm water is useful for cleaning & pain relief. Take a walk at least 2 kilometers per day.