Diagnostics
The most important step in the diagnosis of a coccyx fistula is a detailed doctor-patient consultation (anamnesis). Based on the detailed description of symptoms, a suspected diagnosis of coccyx fistula can be made. In addition, a physical examination of the affected patient is mandatory.
During the inspection (observation) of the anal region, local redness and swelling may be noticed. In addition, in many cases small openings of the fistula ducts are found in the area of the gluteal fold. If you notice something that deviates from the normal state, be it a simple symptom such as headache or a physical change such as a noticeable pimple or “bump”, it is never wrong to consult your family doctor.
The family doctor is responsible for classifying in whose area of responsibility an illness falls and referring the patient to a specialist who can help if the problem is more specific. So if you are unsure which specialist is responsible, it is best to consult the family doctor first. Coccyx fistulas are a dermatological problem because they are changes that affect the skin and surrounding tissues.
Of course, if there is any suspicion, you can also immediately consult a dermatologist, who will immediately make this diagnosis. Since coccyx fistulas must be operated on in any case, the next step is the referral to a surgeon. The operation can be performed on an outpatient basis or in hospital.
This also varies from case to case. In each case, however, specialists in surgery will of course act. Dermatologists often have this additional specialist training as well.
Therapy
Unlike many other diseases, there is no promising conservative treatment for coccyx fistula. The only possibility to control a pilonidal sinus is surgical opening (excision). Without surgery, coccyx fistulas cannot be treated adequately or at all.
Surgical removal of the cyst can be performed in various ways that have become established in everyday clinical practice. In the course of classical surgery, the coccyx fistula is first stained with a dye (methylene blue). The staining enables the complete and extensive removal of all affected tissue.
In order to prevent the recurrence of a coccyx fistula in the same location (so-called recurrence), the surgeon cuts down to the periosteum of the coccyx during the operation. After successful removal of the fistula, the surface of the bony coccyx should be additionally scraped. The treatment of the fistula by means of surgery is usually performed under general anesthesia.
In mild cases where there is a small fistula system not yet affected by inflammatory processes, the surgical procedure can be performed under local anesthesia if necessary. Although the treatment of coccyx fistulas is now increasingly performed on an outpatient basis, a hospital stay of approximately three to four days should be considered due to the possible postoperative complications. After the treatment, the surgical site can be closed immediately in some cases.
However, in some patients it is necessary to choose a so-called secondary wound healing. This means that the incisions are not sutured but left open. The choice of secondary wound healing results in a long period of illness for the patient.
Depending on the size and extent of the coccyx fistula, healing can take several months. To accelerate wound healing after coccyx fistula surgery with open wound treatment, a vacuum pump can be used. During the healing phase in secondary wound healing, however, care must be taken to ensure that the surgical site is kept moist and that the wound edges do not dry out.Pit picking for the surgical treatment of a coccyx fistula was first described in the 1980s by the American James Bascom (synonym: Pit Picking Operation according to Bascom).
This method represents the smallest surgical procedure for the treatment of a coccyx fistula and thus reduces the wound healing time enormously. In contrast to classical surgery, coccyx fistula surgery with pit picking is always performed on an outpatient basis without a major hospital stay. Furthermore, this procedure does not have to be performed under general anesthesia.
A simple and low-risk local anesthesia of the buttock region is completely sufficient. In addition, the surgical procedure can be approached with pit picking immediately after the diagnosis has been made and a detailed explanatory talk. The actual surgery usually takes only a few minutes and the treated patients can be discharged home after a short recovery period.
Before the actual coccyx fistula surgery with pit picking, a local anesthetic is applied in the buttock region. In order to ensure the full effectiveness of the anesthetic, there should be a break of about ten minutes between anesthesia and the beginning of the procedure. The surgery with pit picking is performed in prone position.
In this way, the surgeon gains a good overview of the surgical area and can proceed as gently as possible. In the next step, the surgeon gains an overview of the extent of the coccyx fistula. Every visible fistula passage (so-called pit) in the gluteal fold is then cut out as closely as possible.
The loss of tissue during coccyx fistula surgery with pit picking is many times less than in classical surgery. Nevertheless, even with this principle, no treatment is possible without surgery. With pit picking, incisions of only a few millimeters in size usually occur, which can heal quickly and easily.
In addition, a so-called relief incision is made on the side of the gluteal fold. This usually covers a length of about 2 cm and serves to drain inflammatory substances from the original fistula duct. In this way, the fistula ducts can heal much better.
In order to avoid secondary bleeding, a simple wound dressing is applied after the coccyx fistula surgery with pit picking. In addition, the small wounds are treated with tamponades. After leaving the clinic, patients are advised to watch out for heavy bleeding and to consult a doctor if necessary.
The success of coccyx fistula surgery with pit picking can be assessed approximately four weeks after the surgical procedure. Within this period, the wound must be completely dry. Moist or even weeping wounds indicate that pit picking has not brought the desired success.
The success rate of pit picking is relatively high, but in some cases, a new coccyx fistula may develop months after surgery. In this case, the surgery can be repeated with pit picking or the classic procedure can be considered.
- Procedure:
- Evaluation of the success of the treatment:
Laser fistula lobliteration is a modified form of pit picking.
In this procedure the coccyx fistula surgery is performed with pit picking using a laser. With the help of a thin glass fiber probe, the energy produced by the laser is used to sclerotize the inflammatory modified fistula tissue. Laser fistula lobliteration is an extremely gentle and precise procedure, which not only sclerotizes the fistula tissue but also enables the removal of ingrown hair.
Originally, laser fistula obliteration was used for the treatment of anal fistulas for the first time, but this principle has now also become well established in the treatment of coccyx fistulas. The great advantage of laser treatment is that it is gentle on the tissue and the comparatively fast healing of wounds. Nevertheless, even with this method, the coccyx fistula cannot be completely removed without surgery.
The patient himself can also make a major contribution to successful wound healing after the operation. In general, however, this should always be discussed with the doctor and adapted to the wound. Primarily, however, meticulous hygiene of the operated area is very important.
In addition, the avoidance of tobacco, alcohol and other stimulants is essential for good wound healing. A healthy diet can also help. Furthermore, regular rinsing of the wound is very important.
Irrigation is done several times a day, especially after bowel movements. The treating doctor will explain to you exactly what you have to pay attention to.In general, in the case of open wound healing, the wound should be allowed to dry for a few minutes after rinsing before it is closed again with the tamponade. In general, liquids that are sterile, hypoallergenic, heatable, non-absorbable, odorless and atraumatic are suitable for irrigation.
These include saline solution, Ringer’s solution (saline solution with additional electrolytes such as potassium and calcium) and wound irrigation solutions containing polyhexanide. Due to their antibacterial effect, the latter is particularly suitable for rinsing chronic and purulent wounds. In addition to rinsing the wound, sitz baths can also be very helpful.
Sitting baths can be prescribed by the doctor, such as potassium permanganate baths. They can also be simple sea salt baths. They serve to clean the wound antibacterially.
In general, however, such measures should be discussed with the doctor. It is better to refrain from using wound healing ointments, unless a doctor explicitly prescribes this. This is where the opinions differ as to whether such ointments are good for wound healing in the case of coccyx fistula.
One should also be very careful with homeopathic remedies and home remedies. Especially in the case of an open wound, the wrong handling of the wound can delay the healing massively. Therefore: Before taking any measures, consult your doctor!
The change of bandages can be made more bearable with the help of a sitz bath. This softens the tamponage and prevents it from sticking to the wound. Lukewarm water is sufficient to moisten the wound.
However, camomile extract in the water can provide additional relief due to the anti-inflammatory effect of camomile. Coccyx fistulas are always a case for the surgeon. If an untreated coccyx fistula is left untreated, there is a great danger of sepsis if purulent secretions enter the bloodstream.
A purely conservative treatment is not possible, let alone a homeopathic one. Since this is a disease that can lead to major complications if left untreated, it is better to refrain from homeopathic self-medication. This endangers your own health and the therapeutic success of conventional medicine.
However, if you would like to ease your symptoms a bit with calming homeopathic remedies, you can do so with a clear conscience. In order to relieve pain and irritation, one should ask a homeopath or doctor which remedies are best suited to the individual. The use of ointments for coccyx fistulas cannot bring about a cure, they can only serve to alleviate the current suffering somewhat, e.g. by having a disinfectant effect.
