Pilonidal.net  The UK’s number 1 resource for the pilonidal sinus

Pilonidal Sinus and Infection (article 2/7) Have you answered this month's poll? This article is for those who feel that, following surgery, their pilonidal sinus wound may be infected. It could also be useful for those who are just interested in the subject of pilonidal infection, despite not having the condition themselves. After leaving hospital and arriving back home, managing your pilonidal sinus wound day-to-day will often be a completely new experience. Since many people who get the condition are relatively young, you may not have ever had to nurse a surgical wound before. Depending on the extent of your surgery, you will likely feel "strange sensations" from the area and it can be difficult sometimes when trying to decide whether these feelings mean there is a problem. Fortunately there are several classic symptoms you can use to help ascertain whether an infection has occurred. It is important to base any decisions on many, if not all of these symptoms and not just one or two, as some of these symptoms may be present due to other, more innocent reasons. Probably the most obvious sign to look out for is the odour coming from the wound. When infected, there will often be an offensive odour originating from the area, which should be easily detectable. Due to the location of the wound, it is best to check this by gently "dabbing" the area with a clean tissue and then simply smelling the point of contact. Another symptom of infection to look out for is increased redness around the wound. This can be slightly more difficult to check than the odour, unless you have a suitably positioned mirror, or the means to take a picture or video recording of the area. You may need to ask your partner, a family member, or a close friend to determine this. It is worth taking into account that the area may be slightly bruised or red if not much time has passed since surgery, which is a good example of why it is important to take into consideration all of the symptoms when trying to make any decisions. In addition to these two symptoms, the area will also likely feel more tender than usual and you may feel restricted in your general movement. Some people also report experiencing headaches and this is because the immune system will be focussing a lot of its attention on the pilonidal disease so the body will be more susceptible to more trivial types of illness. Other symptoms include the wound feeling warmer than usual, a possible discharge of pus, and itching. Now that you should have an idea of whether a pilonidal infection is present, it is really important to have this confirmed by a medical professional. This should be arranged no later than for the day after, but preferably the same day. Often it will be most appropriate to see your GP (General Practitioner) or a nurse, rather than visit A&E (Accident and Emergency). If you feel too unwell to make the trip to see someone, you should be able to arrange for a district nurse to visit you at your home. If you feel that you need to speak to someone immediately about it, you can telephone the ward which you stayed at when you had your operation as they will be able and happy to speak to you 24 hours a day. If you telephone your GP and they say an appointment is not available for several days, explain that it is an "emergency appointment" due to a suspected infection, and then they should be able to see you on the same day. A medical professional will often be able to tell whether there is an infection there and then. However, they may sometimes take what is called a "swab test" to confirm this. Having a swab test done also has the advantage of informing you exactly which types of antibiotics will help combat the infection. The swab test involves a small piece of cotton wool gently making contact with the wound so that the wound's exudate can be collected. It is often a painless process. This will then be sent to your local hospital for testing. The testing process typically takes around 2-3 days but depending on how busy the hospital staff are, and whether it's a weekend or not, it can sometimes take over a week. The results are passed back to your GP who will then contact you if there is in fact a problem. It is possible that antibiotics will be prescribed before any swab results have been received, depending on how obvious the infection is, and whether there are already records of antibiotics working on you. Another reason antibiotics may be prescribed early is because the drugs typically take between 24-48 hours before having any affect, so prescribing them early will generally reduce the amount of time the infection is there for. There is research specifically on pilonidal sinuses which shows that taking two different types of antibiotics carries the best chance of beating an infection. Generally, broad-spectrum antibiotics should be taken such as metronidazole and cefalexin. On the other hand, some medical professionals will prefer to only prescribe antibiotics once infection has been confirmed. One of the reasons for this is because the body can quickly build up immunity to antibiotics, rendering them ineffective, so it is important to only take antibiotics when there is a real need. If immunity does occur, it is usually possible to increase the dosage of the antibiotic, and it can also be an option to take a similar but different type, so it is rare that antibiotics ever become completely futile. Another reason for not taking antibiotics when there is no infection is because the drugs can actually unsettle the wound and end up causing more harm than good. Depending on the extent of the infection and how your body reacts to the drugs, it will typically take several days before any signs of improvement begin to show. Most prescriptions will last for two weeks so this should allow plenty of time for the infection to leave. Once the infection goes, you will want to focus on what caused it so you can avoid the same thing happening again. Due to the location of the pilonidal sinus, a common cause of infection can be bowel movement. This is why it is important to always clean downwards after opening the bowels. The results from the swab test should be able to determine whether bowel movement was the cause. Note that in cases where the pilonidal sinus is very close to the bowels, swab tests can sometimes return false positives. Antibiotics are useful at removing infection but usually only at a superficial level. It is possible that there may still be an infection present deeper down under the skin and there may not be any symptoms of this. Following infection, it is a good idea to arrange an out-patients appointment with your surgeon as they will have a lot of experience in the matter and should be able to advise whether further surgery will be required. If there is infected tissue deeper down, this may be the reason for non-healing, or pain when sitting down for long periods. Comments No comments yet. Add Comment