Introduction
A coccyx fistula, also known as the pilonidal sinus or pilonidalsinus, is an inflammation that occurs in the gluteal fold (lat. rima ani) between the coccyx and the anus. The development of a coccyx fistula can have various causes.
The therapy is carried out after the doctor has diagnosed the cause of the inflammation and can look very different depending on the trigger of the inflammation. A coccyx fistula often makes itself felt through discomfort, especially when sitting down. If there is pain, stinging or pulling in the region of the coccyx, it is advisable to consult a doctor for clarification of the symptoms.
Cause
There are 2 main causes for coccyx inflammation. One is inflammation of the periosteum (med:periostitis) of the coccyx or inflammation of the tissue (inflamed hair) above the coccyx due to a coccyx fistula. Probably the most common cause of this is the ingrowth of hair in this part of the body.
The ingrown hairs can lead to an inflammation of the skin and the hair follicle, and it is not uncommon for additional bacteria to migrate into the inflamed hair root and increase the inflammation. If this inflammation progresses further and further and the resulting secretion of the inflammation, the pus, cannot drain off, a cavity filled with secretion, a so-called cyst, can form under the skin. If there is an outflow to the outside, this is called a fistula.
A cyst can have several of these fistulas, and a regular duct system can develop under the skin. Because of the increased hair, very hairy men are particularly affected by coccyx fistulas. Depending on the severity of the inflammation, any intermediate stage can develop, from no symptoms at all, through minor complaints, to complete inability to sit or walk.
The inflammation of the periosteum can develop after various injuries to the coccyx. As the name suggests, the periosteum lies as skin around the bone and supplies it with nutrients via blood vessels and contains numerous nerves, which is why it is very sensitive to pain. The bone itself cannot cause pain.
The inflammation of this periosteum is caused by a strong or long-lasting irritation of the periosteum, such as poorly healing fractures, herniated discs in this region, tumors, accidents or even chronic constipation or diseases of the pelvic floor. The latter reasons are due to the muscle attachments of the pelvic floor to the coccyx and thus also to the periosteum. A strong muscular load is therefore also accompanied by a load on the periosteum, which can then become inflamed.
In coccygeal inflammation, a distinction must be made between coccygodynia and pilonidal sinus. The former is an inflammation of the periosteum (the periosteum), which leads to pain in the gluteal region; the latter is a so-called coccygeal fistula, a surrounding tissue inflammation. In both cases, however, the symptoms of coccyx inflammation are very similar.
Depending on how advanced the inflammation already is, burning or stabbing pain in the buttocks area occurs. Sitting on a hard surface (e.g. a chair) for a long time is particularly painful here, as the coccyx is subjected to maximum stress. But turning around in bed or lying on your back can also aggravate the symptoms of coccyx inflammation and lead to pain.
Also noticeable are the strong pains when defecating (defecation) (see also pain during defecation) or urinating (micturition). Permanent constipation in particular can lead to increased symptoms of coccyx inflammation, as the pelvic floor muscles are heavily used. However, these pelvic floor muscles are attached to the coccyx, among other things, and thus exert a pull on the coccyx, which is experienced as very painful in the case of an inflammation.
The reason for this is the irritation of the periosteum, where the muscles and ligaments are attached. The symptoms of a coccyx inflammation can occur, for example, after a lumbago (lumbalgia) or after a herniated disc or after a fall on the buttocks. Especially after fractures, the periosteum can be injured, which then leads to the first symptoms.
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