Diagnosis of coccyx inflammation

The diagnosis of periostitis can often be made by examination with a finger through the rectum. If a finger is inserted carefully, the lower side of the coccyx can be palpated through the wall of the intestine, which is extremely sensitive to pain if the periosteum of the coccyx is inflamed.If the cause of the inflammation is unclear, an x-ray, CT or MRI of the pelvis can provide indications of the inflammation as well as previous fractures or other causes such as tumors or herniated discs in the lumbar spine. The diagnosis of a coccyx fistula is usually already made on the basis of physical examination by palpation or the visible external signs of inflammation such as extreme sensitivity to touch and pain, as well as swelling and redness, the classic signs of inflammation.

Therapy

The therapy of coccyx inflammation is not very easy. Especially after a fracture a therapy is difficult, because the coccyx cannot be splinted like for example the arm bone. If the fracture does not heal properly, this can lead to permanent inflammation, which is associated with chronic pain.

In order to keep this inflammation as minimal as possible, it is therefore important to protect the coccyx after a fracture. This means: Sitting a little, not riding a bicycle and sleeping on the side with pillows if possible. If coccyx inflammation is already present, an anti-inflammatory ointment is first used as therapy.

If this does not help, the painkillers can also be administered orally (via the mouth) or injected into the area where it is particularly painful. Furthermore, physiotherapeutic treatment is recommended or the patient should consult an osteopath as a further therapeutic measure. Acupuncture is also another possibility for the treatment of coccyx inflammation.

Here, certain nerve endings are stimulated with the insertion of the needle. This leads to an increased release of pain-relieving substances (such as endocannabinoids). These can promote healing and above all painlessness (analgesia).

Reflex zone massage can also be considered as a therapy. This is especially helpful when the muscles of the pelvic floor are very tense. This cramping can be caused by increased stress or psychological trauma (e.g. sexual assaults).

Reflex zone massage can help to loosen the muscles and thus relieve the periosteum of the coccyx, thus preventing inflammation. If the cramping is of psychological origin, additional therapy by a psychologist is indispensable. In addition, laser treatment can be performed, for example, if a coccyx fistula is present.

A further therapeutic option for coccyx inflammation is the administration of homeopathic remedies. Especially Hypericum and Staphisagria are suitable remedies. Since a coccyx fistula (sinus pilonidalis) develops due to ingrown hair, therapy with painkillers is not sufficient here.

Here, the ingrown hair must first be surgically removed in order to prevent the inflammation in the surrounding tissue from becoming even worse. The hair is perceived by the tissue as a foreign body, and the surrounding tissue reacts accordingly with a painful inflammation. After the surgical removal of the hair, the permanent removal of the hair in the anal area is a suitable therapy, since a relapse rate of over 20% is otherwise quite likely.

The removal can be done by laser. Special personal hygiene is also very important after the operation or hair removal. A coccyx inflammation due to irritation or injury of the bony skin, such as after a fracture (med: fracture) of the coccyx, cannot be treated surgically.

However, in the case of a coccyx fistula, the so-called pilonidal sinus or pilonidal sinus, surgery is often the only possibility to remove the fistula permanently. Several surgical procedures can be used to stop the coccyx fistula. In most cases, a conventional total surgery, such as the Karydakis procedure, or the Bascom procedure, also called pit-picking, is used.

In the traditional Karydakis operation, the patient lies on his stomach under general anesthesia and all parts of the fistula are surgically removed. This type of complete removal by cutting out the affected tissue is also called excision (ex=out, caesare=cut) in medical terminology. Only in the case of smaller fistulas can the operation be performed under local anesthesia.

In order not to leave any parts of the duct system and the cyst behind, the dye methylene blue is often used after the incision of the cyst to stain all parts and to show them in the operation field. In order to reduce the risk of recurrence (=relapse), it is not uncommon for the entire tissue up to the coccyx to be removed in depth and even a “hole” to appear in the gluteal fold.The removal of the tissue means that simple suturing is not possible and also carries a high risk of wound healing disorders and the recurrence of another coccyx fistula. Therefore, the wound in these cases is left open and not sutured.

In this open procedure, the wound is covered with special dressing materials or wound sponges and heals from the depths over several months. The wound is then covered airtightly with wound sponges or other materials, often as part of so-called negative pressure wound therapy (NPWT), and a small suction pump is connected to the drainage system (drains are the tubes that drain wound fluid to the outside). Another method, the so-called pit-picking, the method according to Boscom, is at the moment the procedure with the smallest necessary incisions and can always be performed on an outpatient basis under local anesthesia.

In pit-picking, the fistula ducts are cut out with small incisions, even in the prone position, and an approximately two-centimeter incision is made at the side, from which the wound secretion should drain away. The entire pit-picking procedure takes only a few minutes. Only a few home remedies can help against coccyx inflammation.

The most important thing is not to put unnecessary strain on the coccyx. This means more walks, during which the pelvic floor muscles can relax more and the coccyx is not exposed to any additional pressure or pull. It is important not to ride a bicycle as this only promotes inflammation!

A seat cushion or a seat ring helps when sitting. This can be made of rubber or foam depending on your needs. Many patients can be helped by heat treatment, for example, you can find so-called sitting baths in pharmacies.

The heat relaxes the muscles and allows the coccyx to take a break. Often a cold compress or a so-called quark wrap is also used as a household remedy. The latter is a cloth filled with quark, which you can lay on your coccyx for a few hours at night or in the evening.

This should help to relieve the pain and help the patient to relax. Wraps with Retterspitz® can also provide relief. In addition, you can use a pillow to fall asleep with which you sleep on the side. This also relieves the coccyx. However, the most important home remedy against coccyx inflammation is rest!