What is a pilonidal sinus? / নিতম্বের ঘা কী?

A pilonidal sinus is a chronic infected sinus tract or tunnel under the skin in the natal cleft, the groove between the buttocks near the tailbone. It is usually caused by ingrown hairs and may cause pain, swelling, pus discharge, blood-stained fluid and bad smell. In Bengali, many patients call it নিতম্বের ঘা or নিতম্বের ফোড়া. It usually does not heal permanently without proper surgical treatment.

Does pilonidal sinus heal on its own? / পাইলোনিডাল সাইনাস কি নিজে নিজে ভালো হয়?

No, a true pilonidal sinus usually does not heal on its own. Pain and swelling may temporarily reduce after pus drains or after antibiotics, but the sinus tract remains under the skin. Because the tract still contains hair and infected tissue, the problem often comes back unless definitive treatment is done.

What is the best operation for pilonidal sinus? / পাইলোনিডাল সাইনাসের সেরা অপারেশন কোনটি?

Modern off-midline flap operations such as the Karydakis flap and Limberg flap are preferred for many patients because they flatten the natal cleft and move the scar away from the midline, reducing recurrence. Simple excision has a higher recurrence rate, especially in deep clefts, complex disease or recurrent cases. Dr. Muhammad Nazrul Islam performs Karydakis and Limberg flap surgery for pilonidal sinus in Dhaka.

What is the pilonidal sinus surgery cost in Bangladesh? / বাংলাদেশে পাইলোনিডাল সাইনাস অপারেশনের খরচ কত?

Pilonidal sinus surgery cost in Bangladesh varies depending on the surgical technique, complexity of the sinus, whether it is first-time or revision surgery, the hospital or clinic, and the type of anaesthesia used. For an accurate and transparent cost estimate, patients should call or WhatsApp Dr. Nazrul Islam's clinic at +88019 7684 2234 after consultation and examination.

Can pilonidal sinus be treated without surgery? / অস্ত্রোপচার ছাড়া নিতম্বের ঘা ভালো হয়?

Conservative measures such as hair removal, good hygiene, keeping the area dry, avoiding prolonged sitting and treating acute infection with antibiotics may reduce symptoms, but they cannot remove the sinus tract. Antibiotics can reduce infection but are not a permanent cure. For chronic pilonidal sinus, surgery is usually the only definitive treatment.

Are antibiotics enough for pilonidal cyst or pilonidal abscess?

Antibiotics may help when there is surrounding infection or cellulitis, but antibiotics alone cannot remove the pilonidal sinus tract. If there is an acute abscess, incision and drainage may be needed to release pus. After the infection settles, definitive surgical treatment is often required to prevent recurrence.

Why does pilonidal sinus keep coming back? / নিতম্বের ঘা বারবার ফিরে আসে কেন?

Pilonidal sinus often comes back when the underlying natal cleft anatomy is not corrected or when hair continues to enter the same area after healing. Simple midline excision may leave the deep cleft unchanged, allowing recurrence. Modern flap techniques such as Karydakis and Limberg flatten and lateralise the cleft, reducing the chance of recurrence.

Is pilonidal sinus dangerous if untreated? / চিকিৎসা না করলে নিতম্বের ঘা কি বিপজ্জনক হয়?

Untreated pilonidal sinus is usually not immediately life-threatening, but it can become more painful, form repeated abscesses, discharge pus or blood, develop multiple tracts and make later surgery more difficult. Long-standing neglected disease can rarely lead to more serious complications. Early assessment and proper treatment give better results.

Pilonidal Sinus (Pilonidal Cyst) in Dhaka: নিতম্বের ঘা — Symptoms, Causes, Surgery & Treatment Without Recurrence

Pilonidal Sinus Treatment in Dhaka — Surgery, Cost & How to Prevent It Coming Back / নিতম্বের ঘা

Dr. Muhammad Nazrul Islam performs modern low-recurrence pilonidal sinus surgery (Karydakis flap, Limberg flap) in Dhaka. These techniques have 3–8% recurrence rates compared to 15–40% with simple excision.

If you have a painful, swollen lump between your buttocks that keeps getting infected and won’t heal — you probably have a pilonidal sinus (নিতম্বের ঘা). It’s a common problem, especially among young men in Bangladesh.

Many patients know this condition as নিতম্বের ঘা, নিতম্বের ফোড়া, or “the wound near the bottom that keeps coming back” — because it does keep coming back if you don’t get the right treatment.

This guide explains what pilonidal sinus is, why it happens, and most importantly — which surgery works best to stop it from coming back. Dr. Nazrul Islam uses modern surgical techniques that have much lower recurrence rates than the simple operations most general surgeons in Bangladesh perform.

✅ Quick Summary / সংক্ষেপে

Pilonidal sinus = a chronic infected tunnel under the skin between the buttocks, caused by ingrown hairs
Most common in young men aged 15–35 — especially rickshaw/CNG/bus drivers in Bangladesh
Does NOT heal on its own — even after the abscess drains, the tunnel remains and will get infected again
Surgery is the only permanent cure — but the RIGHT surgery matters
Simple excision (most common in Bangladesh) has 15–40% recurrence rate
Modern flap techniques (Karydakis, Limberg) have only 3–8% recurrence
Dr. Nazrul performs these modern techniques in Dhaka — call +880 1976-842234 for consultation

What Is Pilonidal Sinus? / পাইলোনিডাল সাইনাস কী?

A pilonidal sinus is a small tunnel or hole that forms under the skin in the groove between your buttocks (the natal cleft), near the tailbone. It contains ingrown hairs, dead skin cells, and bacteria.

When it gets infected, it causes pain, swelling, and discharge of pus or blood. The area becomes red, hot, and very tender. You’ll find it difficult to sit down.

Pilonidal Cyst, Abscess or Sinus — Are They the Same?

Yes — they’re all the same condition at different stages:

Pilonidal Cyst (পাইলোনিডাল সিস্ট)

Early stage: A closed lump containing hair and debris. Often painless at first. May not need immediate treatment, but will eventually get infected.

Pilonidal Abscess (নিতম্বের ফোড়া)

Acute stage: The cyst becomes infected — painful, swollen, red, hot, filled with pus. Severe pain, can’t sit properly. Needs drainage immediately, but drainage alone is NOT the final cure.

Pilonidal Sinus (নিতম্বের ঘা)

Chronic stage (most common in Bangladesh): A tunnel under the skin that keeps discharging pus, blood or fluid. May have one or more openings. This is the stage where proper surgery is essential.

Symptoms — What Does It Look Like? / লক্ষণ

You’ll notice:

Pain and swelling in the groove between your buttocks, above the anus
Discharge of pus or fluid from one or more small openings — stains your underwear
Hair sticking out from the opening — this is the key sign that confirms it’s pilonidal sinus
Difficulty sitting — especially during acute infection
Bad smell from the discharge — causes embarrassment
Fever when it’s acutely infected
Multiple openings if it’s been there for a long time

Why Does It Happen? / কারণ

Pilonidal sinus is caused by loose hairs getting pushed into the skin of the natal cleft. When you sit or move, the groove between your buttocks creates suction that drives the sharp end of the hair into the skin.

Once the hair is inside, your body can’t push it out. It causes irritation and infection, forming a tunnel (sinus) under the skin.

Who Gets It? / কাদের বেশি হয়?

Young men aged 15–35

Men are 3–4 times more likely than women to get pilonidal sinus — because men have coarser, thicker body hair and a deeper groove between the buttocks.

Excessive body hair (অতিরিক্ত শরীরের লোম)

The most important risk factor. Coarse, curly or thick hair on the lower back, buttocks and around the anus greatly increases your risk.

Sitting for long periods (দীর্ঘক্ষণ বসে থাকা)

Very common in Bangladesh among: rickshaw pullers, CNG/bus/truck drivers, office workers, students. Sitting increases friction and drives hairs into the skin.

Other risk factors

Obesity (deepens the groove), poor hygiene, family history, previous pilonidal sinus (most likely to recur).

Can It Be Treated Without Surgery? / অস্ত্রোপচার ছাড়া কি সম্ভব?

This is the question everyone asks. Here’s the honest answer:

If You Have an Acute Abscess (Painful Swelling)

The abscess needs to be drained immediately — a minor procedure called incision & drainage (I&D). Dr. Nazrul can do this under local anaesthesia in the clinic. But this is NOT the final cure. The tunnel under the skin remains, and the infection will come back within weeks or months. You’ll still need proper surgery later.

If You Have a Chronic Sinus (Discharging Wound)

Conservative measures can reduce symptoms but cannot eliminate the tunnel:

Hair removal — shave or laser the area every 2–3 weeks (most effective non-surgical measure)
Keep the area clean — wash daily with soap and water, dry thoroughly
Avoid prolonged sitting — take regular breaks, use a donut cushion
Lose weight if you’re overweight — reduces the depth of the groove
Antibiotics — treat acute infection but don’t eliminate the sinus

What About Homeopathy or Herbal Treatment?

Many patients in Bangladesh ask about this. Here’s the truth: pilonidal sinus is a physical tunnel under your skin containing ingrown hairs. No medicine — homeopathic, Ayurvedic, herbal or otherwise — can physically remove this tunnel or the hairs inside it.

This isn’t a limitation of homeopathy specifically — it’s the nature of the condition. The tunnel must be surgically removed or closed by a trained surgeon. Patients who delay surgery while trying alternative treatments usually end up with a more complex sinus that’s harder to treat.

Surgery — Which Operation Is Best? / কোন অপারেশন সবচেয়ে ভালো?

Surgery is the only permanent cure for pilonidal sinus. But the type of surgery determines whether it comes back or not. This is the most important decision — and where most patients in Bangladesh get poor treatment.

❌ Simple Excision (Most Common in Bangladesh)

What it is: The surgeon cuts out the sinus and leaves the wound open to heal slowly over weeks with daily dressing changes.

Recurrence rate: 15–40% (very high)

Why it fails: Doesn’t change the deep groove between your buttocks — hairs keep getting pushed into the same area after healing.

✅ Karydakis Flap (Dr. Nazrul’s Preferred Method)

What it is: The sinus is removed and the wound is closed off to the side (not in the middle). This flattens the groove and moves the scar away from the problem area.

Recurrence rate: 3–8% (very low)

Why it works: Changes the anatomy — flattens the groove so hairs can’t get pushed in anymore. This is the UK NHS standard of care.

✅ Limberg Flap (For Complex Cases)

What it is: A more advanced technique using a flap of skin from the side to completely flatten the groove. Used for recurrent cases, deep grooves, or obese patients.

Recurrence rate: 1–5% (lowest of all techniques)

When used: Dr. Nazrul uses this for complex or recurrent pilonidal sinus.

Why Does It Keep Coming Back? / বারবার ফিরে আসে কেন?

Pilonidal sinus comes back because simple excision (the most common operation in Bangladesh) doesn’t change the shape of your natal cleft. The deep groove remains, and hairs keep getting pushed into the same spot.

Modern flap techniques (Karydakis, Limberg) physically flatten the groove and move the scar to the side — eliminating the mechanical problem that causes pilonidal sinus. That’s why recurrence rates drop from 40% to 5%.

If you’ve had pilonidal sinus surgery that came back:

You’re not alone. Many patients come to Dr. Nazrul after failed simple excision. Revision surgery using flap techniques is more complex but gives excellent results. The key is choosing the right technique the second time.

Surgery Cost in Bangladesh / অপারেশনের খরচ

The cost varies depending on:

Which surgical technique (simple excision vs flap repair)
How complex the sinus is
First operation or revision surgery
Local or general anaesthesia
Hospital or clinic setting

For accurate cost estimate:

Call or WhatsApp Dr. Nazrul’s clinic: +880 1976-842234

Important: Choosing surgery based on cost alone is the most common reason for recurrence. A cheaper simple excision that fails and needs revision surgery ultimately costs more than a properly done flap repair done once.

Recovery After Surgery / সুস্থ হতে কতদিন লাগে?

Recovery time depends on which operation you have:

Karydakis or Limberg flap: 2–4 weeks before returning to light work; 6–8 weeks for full activity
Simple excision (if done): 6–12 weeks of daily dressing changes
After healing: Continue regular hair removal (shaving or laser) of the area for life to prevent recurrence

Common Questions / সচরাচর জিজ্ঞাসা

Does pilonidal sinus heal on its own? / নিজে নিজে ভালো হয়?

No. Even after an abscess drains, the tunnel under the skin remains and will get infected again. Surgery is the only permanent cure.

Which surgery is best? / সেরা অপারেশন কোনটি?

Karydakis flap or Limberg flap — modern techniques with 3–8% recurrence rates. Simple excision (most common in Bangladesh) has 15–40% recurrence and is no longer recommended internationally.

Can it be treated without surgery? / অস্ত্রোপচার ছাড়া সম্ভব?

Hair removal, hygiene and avoiding sitting can reduce symptoms but cannot eliminate the tunnel. For acute abscess, drainage (I&D) gives temporary relief but isn’t the final cure. Surgery is needed for permanent solution.

Why does it keep coming back? / বারবার ফিরে আসে কেন?

Simple excision doesn’t change the deep groove between your buttocks — hairs keep getting pushed into the same area. Modern flap techniques flatten the groove and move the scar to the side, reducing recurrence from 40% to 5%.

What’s the surgery cost in Bangladesh? / খরচ কত?

Cost varies by technique and complexity. Call Dr. Nazrul’s clinic for accurate estimate: +880 1976-842234. Remember: choosing surgery based on cost alone often leads to recurrence and ultimately costs more.

Have Pilonidal Sinus? / নিতম্বের ঘা আছে?

Pilonidal sinus doesn’t heal on its own. The difference between a 40% recurrence rate and a 5% recurrence rate comes down to the surgical technique used. Dr. Muhammad Nazrul Islam performs modern flap repair techniques in Dhaka — the same low-recurrence operations used in the UK and Australia.

📞 Call or WhatsApp:
+880 1976-842234

Book Your Consultation

About This Page

Written by: Md. Salauddin Biswas

MA Medical Anthropology (Heidelberg University, Germany) | Senior Research Associate, BRAC University | Published researcher in healthcare access and patient behaviour in South Asia.

Medically reviewed by: Dr. Muhammad Nazrul Islam

FCPS (Surgery) · MS (Colorectal Surgery) · FACS
Colorectal & General Surgeon, Dhaka
Assistant Professor, Shaheed Suhrawardy Medical College
20+ years experience · 50,000+ procedures · 300,000+ patients treated

Last medical review: April 2026

NHS: Pilonidal Sinus ↗

Pilonidal Sinus Disease: A Brief Guide for Primary Care ↗

⚠️ Medical Disclaimer: This page is for general patient education only. It does not replace professional medical advice. For personal assessment and pilonidal sinus treatment in Dhaka, please consult Dr. Muhammad Nazrul Islam. Call +880 1976-842234.