Fistula On The Tailbone - Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Tailbone fistula

As a result of inflammation of the coccygeal canal, a fistula, or coccygeal cyst, is formed. Mostly young men suffer from this disease. It was first described during the Second World War, when, due to the lack of hygienic conditions, frequent injuries of the sacral spine, fistula on the tailbone began to occur very often.

Currently, coccygeal fistula occurs in men leading a sedentary lifestyle, when normal blood circulation is disrupted in the lower spine.

A coccygeal fistula appears in a narrow tubular canal called the epithelial coccygeal duct. The coccygeal passage is a congenital pathology of the sacral spine, also called the coccyx dermoid cyst or pilonidal sinus.

The epithelial coccygeal passage opens at the top of the intergluteal fold and looks like one or more small holes. It is lined with epithelium, and during puberty, intensive hair growth begins in this channel. The other end of the coccygeal passage opens into the subcutaneous tissue, it is not connected with the coccyx and the sacrum.

If the holes of the coccygeal passage are clogged, the contents stagnate inside it. Pathogenic bacteria multiply intensively, and pus forms inside the coccygeal passage. Under its influence, the walls of the epithelial passage melt, pus enters the subcutaneous fatty tissue. An abscess can open anywhere in the skin of the anal region, then a fistula is formed.

Content:

• Causes of the appearance of a coccygeal fistula
• Coccygeal fistula symptoms
• Diagnostics and differential diagnostics
• Coccygeal fistula treatment
• Disease prognosis

Causes of the appearance of a coccygeal fistula

The epithelial coccygeal passage is formed more often in a male fetus at 5-6 weeks of intrauterine development, when such a rudiment as a small tail, for some reason, has not undergone transformation into the usual form of the sacral spine.

Until puberty, this congenital pathology almost never makes itself felt. During adolescence, increased hair growth begins, an intense secretion of sebum. In combination with violations of hygiene, a decrease in the body's immune reactivity, the contents of the epithelial passage become infected and inflamed.

The lower spine is a rather vulnerable area of the human body, because it is riddled with nerve endings and any injury or pathology of the tailbone causes severe pain and is fraught with complications.

Additional causes of inflammation of the epithelial coccygeal passage:

• Hypothermia;
• Long-term physical overload;
• Sedentary lifestyle;
• Disorders of calcium metabolism (excess or deficiency);
• Entrapment of a nerve;
• Injury.

The coccygeal fistula is a great danger to the body. Its course is difficult to predict, and the risk of eczema, abscess and phlegmon (inflammation of the subcutaneous fatty tissue) increases.

Coccygeal fistula symptoms

The fact that there is such a congenital pathology as the epithelial coccygeal passage, a person may not even guess until the infectious process begins to develop in him.

Sometimes the following symptoms may appear:

• Itching
• Unpleasant sensations when changing posture, when walking and during prolonged sitting;
• Excessive moisturizing of the skin with products of discharge from the epithelial passage.

When the inflammatory process develops and an abscess forms, the pain becomes unbearable. They are not stopped even by strong analgesics, the patient from pain cannot find a place for himself.

After spontaneous opening of an abscess in a patient who did not seek medical help, the intense pain subsides, but the focus of inflammation persists, and the disease becomes chronic. A coccygeal fistula forms, connecting the abscess to the skin. Relapses will not be long in coming, soon suppuration will reappear, occupying an ever larger area. As a result of this, intoxication of the body occurs.

Her symptoms:

• Temperature reaching critical values (+ 40.5 ° C);
• Weakness;
• Headache;
• Increased fatigue;
• Sleep and appetite disorders.

Diagnostics and differential diagnostics

Most often, a visual examination of the patient by a surgeon or dermatologist is sufficient to determine the diagnosis. Inflamed openings in the intergluteal fold are clearly visible, as well as the opening of the coccygeal fistula with purulent discharge. The main task of the doctor is to differentiate the coccygeal fistula from diseases that are similar in symptoms.

For this, diagnostic methods are used:

• Rectal examination with palpation of the tailbone and sacral vertebrae;
• Sigmoidoscopy - exclusion of rectal pathologies;
• Colonoscopy - exclusion of diseases of the lower intestine;
• Fistulography is an X-ray examination of the rectum using a contrast agent.

In most cases, a digital examination of the anus or only a visual examination is sufficient. Additionally, laboratory tests are prescribed - a general blood and urine test, a biochemical blood test, a fecal occult blood test.

Diseases from which a coccygeal fistula should be distinguished:

• rectal fistula - does not go to the coccyx, but to the rectum, has access to the crypt;
• coccyx osteomyelitis - there is pathological mobility of the vertebrae;
• epidermoid cyst - has no primary opening;
• presacral teratoma - palpable like a solid tumor.

Coccygeal fistula treatment

The only treatment for a coccygeal fistula is the removal of the inflamed epithelial coccygeal passage in a hospital setting. No amount of conservative methods will help you achieve recovery. Self-medication with lotions and baths will only worsen the patient's condition, prolong the period of treatment.

During the operation, the surgeon removes the coccygeal fistula along with the affected surrounding tissues. It is better if the operation takes place in a specialized department of proctology, whose specialists have extensive practical experience in treatment without relapses.

Methods for the operation to remove the coccygeal fistula:

• With an open wound - removal of the fistula with the creation of natural drainage, has a high efficiency, a minimum of relapses, despite the long period of rehabilitation;
• With a closed wound - excision of the coccygeal fistula with the creation of artificial drainage, is used during remission, has a risk of relapse;
• Removal of the coccygeal fistula towards the secondary subcutaneous opening through which the wound is drained;
• Method karidakis and Basque - removal of the coccygeal fistula together with the nearby affected tissues, has a minimum of relapses and a short period of rehabilitation.

The incision is made along the intergluteal fold, so the seam will hardly be noticeable. The doctor removes all affected areas of the subcutaneous tissue, sutures the operating wound. The patient is recommended to bed rest in the first 4-5 days after the operation. The stitches are removed only after 2 weeks, sitting on a chair and carrying weights is prohibited for 3-4 weeks after the operation.

During rehabilitation, it is recommended to wear loose cotton underwear, shave off the hair around the wound, and observe thorough hygiene of the anal area.

Disease prognosis

Radical removal of the coccygeal fistula leads to complete recovery. Until the wound heals, the doctor monitors the patient.

If the operation is postponed, purulent inflammation spreads to the tissue, new abscesses, coccygeal fistulas are formed, which exit into the groin and perineum. Pyoderma (purulent skin lesions) and actinomycosis (fungal infection of the skin and internal organs) join the underlying disease. Subsequent treatment takes a long time, and the operation involves a much larger volume of tissue.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.