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A coccyx fistula is an extremely uncomfortable disease that occurs in the buttock area (buttock fold), which is why no one likes to talk about it. However, those affected should not be ashamed, but should trust a proctologist. Other names for this disease are pilonidal sinus, pilonidal sinus, pilonidal cyst or pilonidal abscess.
What is a fistula?
A fistula is an unnatural duct, a tubular connection that the body forms itself or that has to be placed for medical reasons, e.g. during an operation (e.g. a gastric fistula for artificial nutrition).
If the body itself forms an unnatural tube, this happens in connection with inflammation so that pus and other secretions can be removed.
Causes, formation of the fistula
The cause of the disease is mostly ingrown hair, to which skin germs and also horny skin adhere. As a result, small nodules are formed that can ignite due to invading bacteria. Hair development in the area of the buttock fold may be disturbed: hair that is growing new is not properly pushed out of the hair root and the keratin adheres to the hair roots. Nevertheless, there is a risk of the formation of a coccyx fistula even with normal hair formation. This usually happens when the hair breaks off and spits into the wall of the hair follicle and it fills with the broken hair. In addition, loose hair can be a cause if it gets into the buttock fold due to the movement of the buttocks.
The nodules formed under the skin, also called foreign body granuloma, can become infected, whereupon an abscess can develop. Furthermore, fistula ducts form, which go deep or can spread to the surface of the skin.
Heavy sweating, predominantly sedentary activities, obesity as well as an existing “acne inversa” favor the development of such a fistula. The latter is a chronic skin disease in which painful inflammations with nodules, abscesses and fistulas develop again and again. In general, the disease occurs more frequently in men than in women, who are usually between 20 and 30 years old.
Even if there are no symptoms at all, a pore opening, perhaps a small black dot, can be found in the area of the buttock fold. As a rule, this remains unnoticed for a very long time.
Other symptoms include oozing, swelling, redness, tenderness when sitting and lying down, pus formation, pain, itching, bleeding and possibly even fever.
Acute form - chronic form
A coccyx fistula can occur in an acute or chronic form. The acute form can manifest itself in massive complaints, since those affected suffer from pain when they are sitting or lying on their backs. Swelling is palpable and tender, and the affected area is usually red and overheated. Pus and / or blood may already leak, with fever also possible. At the latest now, a visit to the proctologist is inevitable.
The chronic form differs in that there is an abscess, but there is no pain and swelling. A purulent or blood-purulent secretion emerges from the fistula constantly or repeatedly. From time to time, the patient may feel a feeling of pressure in the area of the coccyx.
If there are no symptoms and there is no secretion, no therapy is required. However, both acute and chronic forms are usually operated on using different procedures.
Pit picking and sinusectomy
Both procedures are minimally invasive and are mainly used for smaller findings. The whole thing takes place under local anesthesia. After the operation, the wound, which has to be showered several times a day, is not sutured. On top of that, hip baths and ointment dressings are included.
Cut out the fistula and then open wound treatment
This is a frequently performed method, which is mainly used for larger findings. The entire fistula system is cut out generously. Of course, the operation takes place under general anesthesia and inpatient. The fistula ducts are often marked with a dye solution during an operation and then completely removed. The wounds are not sutured, but provided with tamponades and pressure bandages and must also be showered several times a day. At the beginning, in particular, an auxiliary person is required. The lengthy wound treatment is a challenge for those affected, which is also due to the uncomfortable area. The entire healing process can take up to three months, whereby the ability to work also suffers for several weeks.
Cut out the fistula system with wound closure
Applied processes are, for example, the Karydakis and Limberg processes. In the operation after karydakis, the skin incision is made on the side of the buttock fold. When the wound is sutured, the surgeon pulls the skin from the opposite half of the buttocks to the wound, which should improve wound healing. Usually the wound heals after about a week. If necessary, the threads are pulled after 14 days. Wound healing disorders are very rare.
The Limberg operation proceeds as follows: the surgeon cuts out the coccyx fistula and exposes a diamond-shaped subcutaneous flap that is located to the side of the wound. The wound is then covered with this. Sitting is a little difficult after this operation. The threads are pulled after about 14 days.
As previously mentioned, stone bite fistulas develop in the buttock fold. This region of the body favors the accumulation of bacteria and the development of infections. This area is insufficiently ventilated and sweat likes to collect there. The opposite skin areas can rub against each other, creating a mechanical stimulus. The proximity of the buttock folds to the anus favors the development of inflammation, which is why hygiene is particularly important. Regular washing and good drying are a matter of course. If there are minor injuries, they must be disinfected and treated.
Since hair is often the cause of the fistula, it should be removed if necessary. If you shave normally, these may grow even easier. Those who are prone to fistulas, abscesses or the like would do well to have their hair removed permanently, for example by laser treatment. An alternative is to use a depilatory cream regularly.
If you sit predominantly, you are more likely to get an inflammation in the area of the coccyx. When you sit, sweat gathers in the fold of the buttocks, which ensures a humid climate. Therefore, it is advisable to get up in between and take a few steps to change the sitting position afterwards.
Another beneficial factor is being overweight. This is due to the permanent mechanical pressure and the close contact of the opposite skin areas with the buttocks. Since obesity is generally not healthy, it is advisable to gradually reduce weight.
Blande fistulas are existing fistulas that do not cause any symptoms. You should watch them, but they don't need to be removed. If there is inflammation and / or pain, you should see a doctor. If it is a bland coccyx fistula, the above-mentioned preventive measures are recommended.
A relapse occurs when a coccyx fistula that has already been operated on recurs. Fortunately, this is rarely the case, but a new operation may be necessary. To prevent this, the preventive measures mentioned above must also be carried out. Unfortunately, there is no 100 percent protection. (sw)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- German Society for Pediatric Surgery (DGKCH): Guideline for anorectal malformations, as of August 2013, detailed view of guidelines
- German Society for Coloproctology (DGK): S3 guideline sinus pilonidalis as of April 2014, detailed guideline view
- McCallum, Iain J D. / King, Peter M. / Bruce, Julie: Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis, TheBMJ, 2008, bmj.com
- Amboss GmbH: Sinus pilonidalis (Pilonidalsinus) (accessed: June 25, 2019), amboss.com
- Iesalnieks, Igors / Ommer, Andreas: Treatment of the pilonidal sinus, Deutsches Ärzteblatt, 2019, aerzteblatt.de
- Lee, Steven L. / Tejirian, Talar / Abbas, Maher A .: Current management of adolescent pilonidal disease, Journal of Pediatric Surgery, 2008, jpedsurg.org
- Altmeyer's encyclopedia: Pilonidal sinus L05.9 (accessed: May 25, 2019), enzyklopaedie-dermatologie.de
- Winkler, Rainer / Otto, Peter / Schiedeck, Thomas: Proctology: A Guide to Practice, Thieme, 2nd Edition, 2011
ICD codes for this disease: L05ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.