Patient guide
Recurring discharge or swelling near the anus or tailbone can be frustrating, and I know it can feel awkward to talk about. Please don't let that stop you. Both conditions are well understood, and I have established laser treatment options for each.
This page is general information from Dr. Jose John Maliakal, not a diagnosis. Your treatment plan is decided together at consultation.
What people usually notice
- A small opening near the anus or at the top of the buttock crease that discharges pus or fluid
- Swelling, tenderness, or a boil-like lump that keeps coming back in the same spot
- A previous abscess in the area that was drained before
- Pain that flares up now and then, often easing once it discharges
- Skin irritation, a small dimple, or an ingrown hair at the site, which is more typical of pilonidal sinus
- A persistent damp patch or staining on your clothing from ongoing discharge
When I would want you seen sooner
- Fever with spreading redness, warmth, or swelling can mean active infection. Please get seen urgently
- Rapidly increasing pain and swelling shouldn't wait
- Feeling generally unwell, with chills or fatigue alongside the local symptoms, needs prompt attention
- Foul-smelling discharge together with fever is a reason to come in straight away
With any of these, go to the nearest emergency department. Don’t wait for an OPD slot.
Your options
Laser treatment for fistula
often day careFiLaC (Fistula-tract Laser Closure)
I pass a laser fibre along the fistula tract to close it from within. It's an alternative to open fistula surgery in suitable cases.
Laser treatment for pilonidal sinus
often day careLaser pilonidoplasty
A laser-based approach to treating the sinus tract, generally leaving a smaller wound than traditional excision.
After the procedure
Everyone is a little different, and I will confirm your own plan when I see you. Broadly, this is what to expect.
Day of procedure
Often done as day care or a short stay, which I'll confirm at your consultation. I'll show you how to care for the wound before you head home.
First week
Regular dressing changes and good hygiene matter here. Some discharge or mild discomfort during this period is common.
2 to 4 weeks
Most people are back to normal daily activity within this window, though desk work is usually easier to return to than physically demanding work.
Longer-term healing
Complete healing of the wound bed can take longer, especially with pilonidal sinus, and it varies from person to person. I'll track your progress at follow-up visits.
Good to know
What's the difference between a fistula and a pilonidal sinus?
A fistula is a small tunnel that usually forms near the anus, often after a previous abscess. A pilonidal sinus is a similar tunnel that forms near the top of the buttock crease, often related to trapped hair. Both can cause recurring discharge and swelling, and I assess and treat each on its own merits.
Why does it keep coming back?
Recurrent discharge or abscesses usually mean the underlying tract hasn't been fully treated. A proper examination, sometimes with imaging, helps me map the tract so treatment addresses the actual cause.
Is surgery always necessary?
Small, uncomplicated sinuses or tracts are sometimes managed conservatively for a while, but persistent or recurring ones are usually best treated surgically. I'll advise you based on what I find on examination.
Will I need regular dressing changes after treatment?
Yes, wound care and dressing changes are a normal part of recovering from either condition, and I'll give you clear instructions before you go home.
How is this diagnosed?
Usually with a clinical examination, and sometimes a scan such as an MRI or ultrasound to map the tract, especially for fistulas. This page is general information, not a diagnosis, so please come in for a proper assessment.
Let us have a chat
If you are worried about a symptom, thinking about treatment, or you just want a clearer answer, send me a WhatsApp message and we will help you arrange a time at Thangam Hospital.
Thangam Hospital of PMRC
West Yakkara, Palakkad, Kerala 678004
OPD 9:00 AM – 4:00 PM
Please confirm the day’s OPD on WhatsApp before travelling.
After you message, we will confirm the day's OPD, help you pick a time, and tell you what to bring: any earlier reports and scans, your current medicines, and your insurance card if you have one. Please avoid sending sensitive medical reports on WhatsApp unless we ask you to.