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There is a basic set of factors that
underlie a person's susceptibility to the disease, this is certainly
not an inclusive list, these are only KNOWN risk factors:
- Family history of Pilonidal Disease
- Fetal development
problems (Spina Bifida Occulta)
- Shape, size and scaliness of the person's hair
- Amount of hair in the natal cleft & buttocks
- Size of the pores in the skin over the tailbone
- High degree of friction and pressure on the tailbone (such
as sitting improperly)
- Traumatic injury to the tailbone (such as a fall)
- Participation in high tailbone-impact activities (such as
horseback riding)
- Depth of the natal
cleft (impacted by weight and genetics)
- Shape of the natal
cleft (overhanging areas, dips)
- Tendency towards blocked hair follicles (acne, boils,
sebaceous cysts)
- Tendency towards other skin problems (eczema, etc...)
This organization has chosen to follow the philosophies of Dr.
John Bascom, who is largely considered the foremost expert in the
world in the treatment of Pilonidal. Now retired, Bascom has
done over 600 Pilonidal surgeries throughout his career.
Understanding Follicular Occlusion:
Follicular Occlusion is medical terminology for "blocked pores."
Which is to say that pores in the midline of the natal cleft (more
pretty language, this time meaning butt crack) becoming stretched
and blocked with debris. On most other body parts this process
results in a common pimple; the natal cleft, however, is a special
place where lack of oxygen allows anaerobic bacteria to frolic and
thrive. But we will come back to bacteria in a moment.
How the pores got stretched and infected - when the body
rises from a sitting position, gravity naturally exerts force
pulling the tissues in the midline down at the same time as the body
is being propelled upward. The pull of gravity stretches the
pores in the midline and so does another culprit - slouch sitting.
Mother nature endowed us with "sit bones" at the junction of our
legs and buttocks, but many of us are a little lazy when we sit and
we slouch forward in our chairs (raise your hand if you are doing
this RIGHT NOW!) So, there you are with some pores in your
midline that have become stretched out wider than they should be.
They might look like this:
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Once the follicles have been stretched out, they provide a very
convenient place for stuff to collect: dead skin cells,
sweat, clothing lint and hair. As the crud fills in the stretched
pores, they become blocked and the oils (sebum) that are naturally
secreted can no longer flow and they back up inside the follicle. As
the crud builds up, the follicle becomes inflamed and eventually
ruptures. Once the follicle has ruptured, it now provides a
handy opening for the anaerobic bacteria (we told you we would meet
Mr. Bacteria again) to enter the fatty tissues below the skin.
Here in Pilonidal world, we now call this a pit.
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The pit is the start of a Pilonidal abscess. One thing that
continues to raise questions are those people who develop a
Pilonidal after a traumatic tailbone injury. What we don't
know - and never will - is if those people already had a pit in the
midline at the time of the injury and the inflammation resulting
from the injury triggered an abscess to form more quickly than
normal. We speculate that this is what happens, but there is
no way to ever really know.
(My personal experience as a person prone to Pilonidals is that
this process of follicle stretching & blocking is constant in the
midline and can be stopped at the early stages if you know what to
look for. I've had easily 8 instances since my surgery in 2000
where a pimple formed in the midline and I was able to treat it with
No Bump to keep it from turning into a new abscess.)
With the natural barrier of skin breached, the anaerobic bacteria
that normally live in the body locations where there is no oxygen,
can go off exploring in the fatty tissues of your behind.
Infections caused by anaerobic bacteria are characterized by abscess
formation, foul-smelling pus, and tissue destruction. For those of
you reading this right now with an ache at the top of your natal
cleft, this should be starting to sound very familiar....
Even though Pilonidal technically means Nest of Hair, only 50% of
abscesses have hair in them. It has been noted that because of
the scales on a hair shaft, hair does travel into a pit or sinus
when the base of the hair is pressed into the opening - as through
normal friction of the buttocks. Surgeons have found hairs
from the heads of patients and hairs from patient's bedmates in
Pilonidal abscesses.
It's a family affair - it is common
for Pilonidal Disease to run in families and it has been
suggested in medical literature that this is due to an inherited
weakness of the skin over the tailbone and in the shape/depth of the
natal cleft which makes family members
more prone to the condition. Just one more genetic gift from
Mom and Dad!
Friends & neighbors - Pilonidal is linked with 3 other
conditions in what is known as the Follicular Occlusion Tetrad (Acne
Conglobata, Perifolliculitis Capitis, Hidradenitis Supperativa,
Pilonidal.) All 4 diseases share common cytokeratin expression
that is unique to the group.
Congenital (born
with) Pilonidal - it is not at all uncommon for
babies to be born with a Sacral Dimple and it is important to note
that this is not the same as a Pilonidal abscess as it is discussed
on this site even though your
pediatrician might refer to it (wrongly) as a Pilonidal Dimple. A condition known as Spina
Bifida Occulta (spine failing to close fully during gestation) can
leave a hole over the tailbone that resembles a Pilonidal sinus
opening and there is often hair at the site of the defect, this
occasionally develops into Pilonidal Disease later in life. Other
problems during fetal development can leave a "hollow" area at the
base of the spine, which can lead to Pilonidal Disease later in
life. Many years ago it was believed that all Pilonidal Cysts were
congenital - the majority of surgeons now believe that most cases
are acquired. If you are seeing a doctor who is telling you that all
Pilonidals
are congenital, then it is highly recommended that you find another
doctor. Sadly, there are a lot of family doctors, general
practitioners and general surgeons out there that have not kept up
on new developments for treatment of this disease, they read about
it in a text book during medical school 20 years ago, but they've
not learned anything new since.
On the
Abstracts Page
are several summaries of research into the congenital theory and
various other topics.
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