Diagnosis

The diagnosis is usually made by the doctor through the clinical appearance. The abscess presents with pain when sitting and under pressure, the surrounding skin is reddened and swollen. Often ingrown hairs are visible.

When pressure is applied to the abscess, a hardening can be felt. Sometimes a fistula exit to the skin is visible. In the chronic form of the abscess, it can wet from the fistula outlet.

A general practitioner can be consulted for diagnosis. This doctor can make the diagnosis and write a referral. The surgical therapy should be performed by a general surgeon.

The procedure can be performed on an outpatient basis, so that surgery is possible in an outpatient surgery center or in a hospital. The surgery is usually performed under general anesthesia, so a consultation with an anesthesiologist is necessary before the procedure. The procedure usually does not take long and the patient is able to be discharged home a few hours after the surgery.

The treatment of a coccyx abscess can be done by different surgical methods. It is important to distinguish in which stage the disease is present. For example, a coccyx abscess in an asymptomatic state, i.e. in a stage without symptoms, does not necessarily need to be treated.

However, the acute or chronic form of the disease should be treated by surgical removal. From today’s perspective, conservative treatment methods cannot lead to a cure of the disease, which is why these methods cannot be recommended. There are different surgical methods of treating a coccyx abscess, which are almost identical to the methods of treating a coccyx fistula.

Since the only difference between the two diseases is that a coccyx abscess does not have an inflammatory duct to the outside, similar surgical techniques lead to a cure of the disease. It is important to treat the inflammation in the surrounding area before starting the actual surgery. The operations are usually performed under general anesthesia, in case of smaller abscesses also under local anesthesia.

Usually an inpatient hospital stay of 3 to 4 days is recommended, during which the correct healing process can be monitored after the operation. The classical surgery of a coccyx abscess is the excision of the entire affected area. This means that all tissue is removed up to the coccyx, depending on the size of the abscess.

If a part of the coccyx itself is affected, a scraping of the bone may be necessary. There are different methods of how such an excision is performed. In general, a distinction must be made between surgery with secondary wound healing and surgery with primary wound healing.

Both operations have in common that the abscess is first opened with a scalpel so that the fluid (usually pus) contained in it can drain away. Afterwards, all the tissue that belongs to the abscess is cut out extensively to ensure that recurring abscesses are unlikely. Since the abscesses can sometimes reach a considerable depth, it is not uncommon for a relatively large wound to remain.

The difference between the surgical method with secondary and primary wound healing lies in the treatment of the wound. In the method with primary wound healing, the wound is sutured after the operation. This leads to faster wound healing, but also to a higher probability of recurrence and complications.

For this reason, secondary wound healing is preferred in most cases in Germany, in which the wound is not sutured but kept open by tamponades. Although this slows down the healing process, so that the complete healing of the wound can take up to 3.5 months, the number of complications after the operation is greatly reduced. As with the treatment of coccyx fistula, there are alternative methods of surgical treatment for a coccyx abscess.

These methods can be classified under the term minimally invasive treatment methods for coccyx abscesses. For example, there are methods in which a so-called drainage is placed in the wound so that the secretion it contains can drain away and the probability of complications occurring is low.Surgical techniques such as “pit picking”, a method used for surgery on a coccyx fistula, are not suitable for the treatment of a coccyx abscess. These methods are intended to close the inflammatory ducts, the fistula ducts, and thus lead to healing.

Since these ducts do not exist in an abscess, these surgical techniques are not an alternative for the treatment of a coccyx abscess. There are also so-called plastic procedures in which instead of leaving the wound open or suturing it, skin flaps are sutured over the wound to close it. However, due to the risk of numerous complications and little experience, these methods are rarely used nowadays.

For smaller abscesses, a simple incision, i.e. opening the abscess with a scalpel and draining the fluid contained in the abscess, can also lead to healing with a low recurrence rate. Depending on the size of the abscess, such a gentle method with relatively short wound healing time can be recommended. In general, it must be decided individually which treatment option is best for the respective affected person.

Depending on the size of the abscess, a complete excision of the tissue up to the scraping of the coccyx may be necessary, or a skin incision with opening of the abscess cavity may be sufficient for healing. The conservative therapy (i.e. a therapy without surgery) of a coccyx abscess is not promising. Surgery, which, depending on the type of disease, is nowadays performed either in a minimally invasive procedure, a plastic surgery method or the classical surgery, are the only therapeutic options that can be recommended for a coccyx abscess.

Healing the coccyx abscess with ointments, cooling, special baths and of course with an antibacterial therapy with antibiotics cannot cure the disease. Also a therapy with homeopathic remedies and naturopathic therapy options can possibly improve the wound healing after an operation, but the healing of the disease itself cannot be achieved by these remedies. A conservative therapy can first of all help to fight the inflammation of the surrounding area of the fistula and then perform an operation.

This can treat the inflammatory reaction, but the cause of the abscess cannot be eliminated. In any case, it makes sense to discuss the individual therapy with the treating physician and not to try to treat the coccyx abscess in self-treatment. If the abscess should be treated exclusively in self-treatment with conservative treatment methods and pain medication, there is a possibility that the abscess opens inwards and possibly causes blood poisoning!

Such a complication requires strict intensive medical care and should be prevented in any case. In a conversation with the attending physician, the worries and fears of an upcoming operation can possibly be eliminated, so that the operation can be faced more calmly. Altogether, one should strive for an operation of the coccyx abscess as soon as possible, since complications and the probability of a relapse, which can be associated with this disease as well as with an operation, otherwise become more probable.

The pulling ointment has an antibacterial and anti-inflammatory effect. It is used for various inflammations or abscesses under the skin. Here it can have a germicidal effect in the abscess and an anti-inflammatory effect in the surrounding tissue.

Furthermore, the ointment has a blood circulation-promoting effect. Thus the pulling ointment can ensure that the abscess is drained to the outside. In case of a symptomatic coccyx abscess a physician should always be consulted.

In this case an abscess must be split and the wound rinsed. Depending on the general symptoms, additional antibiotic therapy may be necessary. In case of a chronic coccyx abscess, local antiseptics can be used.

In addition, camomile baths or zinc ointment can be used to reduce the bacterial count. Tea tree oil is said to have an antiseptic effect. Tea tree oil penetrates the skin and can eliminate the accumulation of pus under the skin.

Tea tree oil is a natural product and therefore gentle to the skin and well tolerated. The therapy with laser is possible. Here, the pus is eliminated from the abscess with the help of laser beams.

This system should be gentle and should replace the conventional operation. At the moment there are various reports about the success of laser therapy. The gold standard in the treatment of abscesses is currently still the conventional surgical procedure.In this case, the pus can be completely removed under visual control and a suture can be made to securely close the fistula tract.