Obese, very hairy men have a significantly increased risk of coccyx fistula (pilonidal sinus). Inflammation in the deeper layers of the skin is often the starting point for this condition. Heavy sweating also favors the development of inflammation.
A pilonidal sinus - also known colloquially as a coccyx fistula - often forms where "broken" hair grows deeper into the subcutaneous tissue. Rubbing movements of the buttocks and increased sweat production irritate the skin and can lead to inflammation. A foreign body granuloma develops deep down, which is intended to enclose and isolate the ingrown hair. This can eventually become infected and further inflamed, resulting in an abscess. Starting from this inflammation, fistula ducts form, which can spread further into the subcutaneous fatty tissue or even reach the surface of the skin and form a visible fistula opening.
The following factors favor the development of a coccyx fistula:
- heavy body hair,
- high sweat excretion,
- sedentary activities,
- severe overweight(obesity) and
- acne inversa.
A coccyx fistula manifests itself as a reddened and swollen lump on the buttocks @ Pepermpron /AdobeStock
Men between the ages of 20 and 30 are particularly likely to suffer from coccyx fistula. Men are generally affected around twice as often as women. The incidence is given in the literature as 20-30 cases per 100,000 inhabitants.
There are three main types of Pil onidal Sinus:
- asymptomatic,
- acute-abscessing,
- chronic inflammatory.
As the name suggests, asymptomatic Pilonidal Sinus is not symptomatic and therefore does not usually require immediate treatment. Nevertheless, it is not uncommon to see fistula outlets on the surface of the skin, which can become inflamed over time.
In the acute abscessing form, swelling, redness and pain occur. Fever may also occur. The chronic inflammatory coccyx fistula, on the other hand, is characterized by changing symptoms. The chronic form of coccyx fistula is characterized above all by the repeated discharge of pus from the fistula openings.
Moreover, the chronic inflammatory form will not heal spontaneously and therefore requires treatment. If the inflammatory changes in the area of the coccyx fistula persist over a longer period of time, there is also a risk of squamous cell carcinoma, a malignant tumor disease of the skin.
Squamous cell carcinoma is the second most common malignant skin tumor @ Luis /AdobeStock
Pilonidal sinus specialists do not need any major instruments to diagnose pilonidal sinus, as it is a visual diagnosis. A medical history, inspection and, if necessary, palpation of the affected skin areas are often sufficient to diagnose the Pilonidal Sinus with certainty. If the skin in the area of the fistula is slightly depressed, purulent secretions can usually even be pressed out, which further supports the diagnosis.
In terms of differential diagnosis, coccygeal fistula specialists must always rule out a presacral teratoma and spina bifida ("open back") in newborns, especially in atypical cases. In addition, Crohn's disease or psoriasis should always be considered .
Pilonidal cysts are usually treated surgically. In the acute phase, a stab incision can also relieve the abscess and allow the secretion to drain away. Once the inflammation has calmed down somewhat, coccyx fistula specialists will surgically close the fistula openings. It must be decided on a case-by-case basis whether this involves primary stitches or whether the fistula is cleared out and then heals naturally.
The patient's preference is particularly important here, as immediate suturing usually solves the problem of the coccyx fistula more quickly, but recurrences, i.e. a recurrence of the fistula, are more common. Natural wound healing, on the other hand, takes considerably longer, but also has a lower recurrence rate.
As the inflammatory variants of coccyx fistula develop from an asymptomatic variant, asymptomatic coccyx fistula is of particular importance in prevention. Coccyx fistulas can usually be prevented through anal hygiene, shaving and check-ups in the event of repeated inflammation in the anal area.
Coccyx fistula specialists are usually specialists in proctology, coloproctology and surgery. However, specialists in dermatology, visceral surgery or gastroenterology may also be involved.
Above, we have also compiled a list of specialists for coccyx fistula surgery and specialized centers in your area.
