Painful Swelling Above Anus

A few weeks ago, an online patient from Liverpool sent me a photograph with the following description:

“For about 2 weeks now I have had this swelling above my bum. It seems to be getting bigger. It is not itchy but it is quite painful especially when I sit down”

To me anyway, this case beautifully illustrates just how powerful internet communications and ready access to excellent digital photography can be in helping to make a diagnosis. With her description and excellent photograph I was immediately able to make the diagnosis. Any experienced general medical practitioner would have been able to have done the same thing.

Just look at how much time and effort has been saved for this lady:

• She has not had to make an appointment to see a doctor to be diagnosed.
• She has not had to take a half day out of work and travel to her doctor.
• She has not had to sit in a waiting room and go through all the embarrassment that visiting a doctor can entail.

She will still have to go and see a doctor of course. She will need treatment and possible referral to a surgeon. But now she will do so armed with a diagnosis, knowing what to expect, not fearing anything, and knowing how important it is to have this thing looked after. Here then we have internet technology, digital photography, online consultation and later face to face consultation all coming together to bring about a good result.

None of this was possible 10 years ago. I firmly believe that it is the way forwards. Not that Online Medical Consultation seeks to take over from high street office consultation where that is unavoidable, but it is rather that internet consultation will augment face to face consultation where that is essential and replace it where that is not.

So what is this nasty lesion situated slightly to the left and 1 cm above the anus? It is called a pilonidal sinus or cyst.

What is a Pilonidal Sinus?

A pilonidal sinus is a small hole, tunnel or pit that develops at the top of the buttocks where they meet at the bottom of the coccyx (tailbone). This can cause an abscess called a pilonidal abscess also known as a pilonidal cyst. This can be an acute situation but could become chronic if neglected.

What Causes Pilonidal Sinus?

The cause is obscure. It is commoner in men that women. It is commoner among those who are seated for long periods of time, like, for example, taxi drivers. There are theories about pilonidal sinuses containing contaminants like hairs and of it being commoner among people who cut hair for a living but these are only theories. The truth is that we do not know what causes pilonidal abscess.

What are the treatments for this nasty infection?

This will depend on the severity of the pilonidal cyst. And again there seems to be little agreement among doctors. If only mild it can be controlled by taking periodic courses of antibiotics. If severe, however, radical surgery may be called for. This may involve excising a larger wedge shaped section of tissue to include the sinus and healthy tissue around it and allowing this to heal up over a few weeks while the patient is nursed on his stomach.