Coccyx cyst

People have such congenital anomalies with which they live for a long period and do not suspect anything at all. This includes such a defect as a coccygeal cyst, which occurs due to the fact that the soft tissues in the sacrococcygeal region did not develop correctly.

Pilonidal cysts appear mainly in young people aged 15-30 years, often in males.

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Causes of Pilonidal Cyst

A pilonidal cyst is a congenital phenomenon, but there are factors that provoke its manifestation:

• mechanical injuries;
• infectious diseases;
• hypothermia;
• decreased immunity.

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Coccygeal cyst in men

It is widely believed that a coccygeal cyst occurs only in males. But in fact, this is fundamentally wrong. The whole point is that the epithelial coccygeal passages of men have a higher probability of inflammation. According to rough estimates, men suffer from a coccygeal cyst 3-4 times more often than women. But the probability of a woman developing an epithelial coccygeal passage in the intergluteal fold is exactly the same as in the stronger half of humanity. Only it becomes inflamed more often in the stronger sex.

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Symptoms of a Pilonidal Cyst

When a pilonidal cyst forms:

• a small painless infiltrate appears;
• a foreign object is felt in the area of the intergluteal fold, discomfort occurs when moving;
• my tailbone hurts when I sit;
• body temperature rises;
• the skin in the tailbone area swells and there is redness.

To diagnose a coccygeal cyst, it usually does not take much time, special methods are not used here. But to determine the exact diagnosis, a doctor is absolutely necessary: only he will be able to understand where the coccygeal cyst is, and where other diseases are. The place where the inflammation is localized is evidence of the diagnosis. In addition, a person suffers from aching and jerking pain, the intensity of which increases when sitting or lying on the back, as well as when touched.

The main signs of a pilonidal cyst:

• a swelling or lump between the buttocks, slightly above the coccyx, above the anus. The inflamed area may be of different sizes and shapes, and may also cross the line of the intergluteal fold to the left or right.
• There is an opening on the line between the buttocks from which pus or a colorless infiltrate may be released.
• There may also be a secondary opening or several secondary openings. The epithelial coccygeal passage may have many exits to the outside, this is especially aggravated during inflammation. Discharge may ooze from the exit, i.e. it is active, or it may be passive, scarred. Such an opening is most often located near the first one, a few centimeters away from it.

If an infection penetrates through the opening of the epithelial coccygeal passage, there is a high probability that acute inflammation of the coccygeal cyst will develop. The temperature may rise, the skin near the opening swells, and hyperemia is observed.

Dermoid cyst of the coccyx

In medical theory, the epithelial coccygeal tract and the dermoid cyst are completely different phenomena, but general practitioners regard them as one diagnosis. The epithelial coccygeal tract differs from the dermoid cyst of the coccyx in that when it develops, a person develops an opening in the intergluteal fold. Although, due to extensive suppuration, in very rare cases, the opening can be veiled. When a person has a dermoid cyst, the tumor necessarily contains a clearly defined capsule. Sometimes the capsule breaks through, in which case the only difference between the epithelial coccygeal tract and the dermoid cyst is the presence or absence of an opening.

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Consequences of a pilonidal cyst

If the pilonidal cyst has not been completely cured, the following consequences are possible:

• secondary fistula, often not even one, but multiple;
• recurrent abscess;
• phlegmon (purulent inflammation).

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Complications of a pilonidal cyst

Complications of the pilonidal cyst are observed in two stages: acute (chronic) inflammation (fistula), and remission. If there is a delay in the release of waste products of the epithelium from the epithelial pilonidal tract, a small painless infiltrate appears, which has clear contours and often interferes with movement. When an infection gets through the opening, acute inflammation develops, accompanied by pain, the temperature rises, the skin near the opening swells, and its hyperemia is observed.

Diagnoses-complications of pilonidal cyst:

• purulent abscess;
• skin eczema;
• fistula.

When inflammation of the epithelial coccygeal passage is chronic, it does not particularly affect the general condition of the patient, the discharge is rather scanty, swelling and hyperemia of the skin are not observed. Some of the secondary openings may even become scarred, while others continue to function.

If the inflammatory process is in remission for several (or even many) months, then the secondary opening (or several) are scarred; when pressure is applied to the epithelial coccygeal passage, no discharge is observed, and there is no possibility of inserting a probe.

The patient, and especially the doctor, must be very careful not to confuse the coccygeal cyst with cystic formations, rectal fistula, pyoderma with fistula, osteomyelitis of the sacrum and coccyx bones. To establish an accurate and correct diagnosis, a rectoscopy is recommended, as well as an examination of the epithelial coccygeal passage using a probe. If probing has shown that the passage lies in the direction of the sacrum or coccyx, then as an addition, an X-ray of the sacrum and coccyx is prescribed to exclude osteomyelitis of the bones.

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Pilonidal cyst and cancer

Domestic medical practice has not encountered cases of cancer developing from a coccyx cyst, but it would not hurt to study the removed tissues, since foreign literature describes cases where a coccyx cyst turned into cancer. If the disease is not treated for a long time (more than twenty years) and abscesses and fistulas often recur, then the development of squamous cell carcinoma may well take place.

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Suppuration of the pilonidal cyst

The epithelial tract (coccygeal cyst, dermoid coccygeal cyst, pilonidal coccygeal cyst) is a narrow tube that is located in the middle of the intergluteal fold. It opens on the skin as one or more openings. They do not manifest themselves for a long time. However, as a result of injuries, inflammation of the coccygeal cyst develops, which contributes to the appearance of purulent discharge, due to which the tract expands and collapses. Inflammation also manifests itself in the surrounding tissues, which affects the formation of an abscess that breaks out. Thus, this leads to the appearance of another opening.

Treatment of pilonidal cyst

The most important point when a doctor prescribes one or another antibiotic for the treatment of a coccyx cyst is to determine the type and kind of microorganism that caused the inflammation of the coccyx cyst. This requires a long and often expensive laboratory test. Therefore, many doctors simply prescribe one of the broad-spectrum antibiotics. The disadvantages of such drugs are strong side effects and low efficiency. And if the antibiotic was able to eliminate the discomfort, then it is still only a temporary measure, providing only a small delay in surgery and relief of painful sensations caused by the coccyx cyst.

The use of anti-inflammatory drugs makes it possible to eliminate pain and resist inflammation of the pilonidal cyst. But they only relieve symptoms, so their use is even more unreliable and temporary than even antibiotics. In any case, surgery is necessary.

There are a number of specialists who recommend using hair removal creams to get rid of hair in the sacrococcygeal region. In their opinion, this can have a positive effect on the course of the disease.

Inflammation and related processes lead to the formation of an abscess (an abscess with purulent contents) in the coccyx area. There are two possible scenarios: when it is opened by a doctor and when it opens naturally. In either case, the pain and inflammation go away outwardly, the wounds close, and there are even situations when a fistula does not form. However, this is only an apparent blessing. The fact is that under such circumstances, the coccyx cyst is not completely cured - the lesion is preserved and after a while it will worsen again.

Surgical treatment of coccygeal cyst

In order to completely get rid of the coccyx cyst, a radical surgical operation to remove the coccyx cyst is necessary. The surgeon removes the source that caused the inflammation - the epithelial canal and its primary and secondary openings. The effect today is only brought by surgical treatment of the coccyx cyst.

Doctors who treat coccygeal cysts

To begin with, you should contact a general practitioner in your area, who will be able to assess which surgeon you should contact and refer you for diagnostics in a specialized proctology department. Treatment should be carried out under the supervision of an experienced proctologist, although at first glance it may seem that this specialist has nothing to do with the coccyx cyst, because the disease is not associated with the anus. But the peculiarity of the structure of the sacro-gluteal region and the likelihood of relapses of the coccygeal cyst after surgery classifies this disease as the area of the proctologist.

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Preparing for surgery to remove a pilonidal cyst

Surgery to remove a coccygeal cyst is usually not sudden and urgent – it is most often a planned event. Therefore, after the diagnosis is established, the patient has several days or even weeks to prepare for the operation.

It is a good idea to clarify the following points with the surgeon who will perform the operation:

• How long will you have to stay in the hospital after the operation? The thing is that depending on the method of the operation and your specific circumstances, the recovery time and need for hospitalization will be different. Sometimes the patient is sent home on the same day, then you just need to come for dressings and consultations. If the situation is very complicated or complications arise, sometimes you even need to spend several weeks in the hospital.
• How long will you not be able to sit after surgery? This is one of the most important questions that you need to clarify with your doctor. Naturally, everything again depends on your specific circumstances. Often this period is extended to two weeks, but in general it can be both longer and shorter in time.
• When will you be able to return to work? Depending on your occupation, your surgeon will be able to estimate how soon you can return to work.
• How likely is it that coccygeal cysts will recur? As a rule, no one can guarantee that a coccygeal cyst will not recur. The possibility of recurrence is affected by the method of surgery, the qualifications of the surgeon, and the correctness of the postoperative recovery.

Surgery to remove a pilonidal cyst

The operation to remove the pilonidal cyst is performed when remission occurs, although sometimes during an exacerbation. Local or general anesthesia is used, the operation takes 20-60 minutes.

In order to cure a pilonidal cyst completely, surgical intervention is necessary. Moreover, for everyone without exception with an uncomplicated disease and at any stage of inflammation of the epithelial pilonidal tract. The sooner the doctor excises the pilonidal cyst, the less time it will take for the body to fully recover, and the less likely it will be that relapses and complications will occur. As practice shows, the experience of the surgeon also plays an important role: in non-specialized surgical departments that performed operations to remove the pilonidal cyst, relapses occur much more often than after excision of the pilonidal cyst by an experienced proctologist surgeon. In addition to this, surgical specialists know modern methods of removing the pilonidal cyst, which favor a quick recovery. General surgeons, in turn, may not be familiar with these methods.

In addition, there are modern methods of surgical intervention for coccygeal cysts that can significantly reduce recovery time. A surgeon who does not specialize in coccygeal cyst surgery may not have mastered them.

The operation to excise a pilonidal cyst is performed under both local anesthesia and general anesthesia. Local anesthesia is usually sufficient. However, at the patient's request or in the case of complex epithelial tracts, general anesthesia can be administered. The operation lasts, depending on the stage of the disease and the method of operation: from 20 minutes to an hour. The purpose of the operation is to remove the epithelial canal with outlet openings. Usually, the operation to remove a pilonidal cyst is tolerated by patients quite easily. After a planned operation during the remission period, the wound heals within a month, and the ability to work is restored within 1-3 weeks.

After the operation, the patient remains in hospital from several hours to several days until the condition is completely stabilized.

On the first day, the patient is prescribed bed rest, on the second day he can already get up. Walking is recommended on the 4-5th day. On the 10-14th day, the stitches are removed. In no case should you sit or lift weights for 3 weeks after the operation.

Postoperative therapy includes antibiotics and painkillers. Dressings are applied daily under periodic control and observation of the surgeon for a long time - until the postoperative wound condition is completely stabilized.

The inflamed epithelial coccygeal passage will sooner or later become inflamed again. Constant infection of the subcutaneous passages of the coccyx requires surgical intervention. Other methods of treating the coccyx cyst can only give a temporary effect, or can lead to complications due to a long-term refusal of surgery. According to experts, the operation to excise the coccyx cyst is the only method to completely get rid of this disease. This disease is not fatal, you can live with it even for some period, eliminating the symptoms, but there will still come a time when you will have to come to a solution to the problem with the help of surgery. The fact is that each time the coccyx cyst becomes inflamed again, the situation will become more and more complicated, restoring the ability to work will be more and more difficult and take a longer period of time. The operation completely eliminates the problem, tolerating the discomfort from inflammation is a much more difficult test.

Methods of excision of the coccygeal cyst

The method of removing a coccygeal cyst depends on how complex the epithelial coccygeal passage is, where it is localized. Taking into account all this and much more, the surgeon determines which method to use to remove the coccygeal cyst. Until now, none of the existing methods has been the main one and is not universally recognized.

Existing methods of surgery for removal of pilonidal cyst:

• when the wound is open. Relapses in this case are the least likely, the body takes about two months to recover. This method is used when there is a complicated form of the coccygeal cyst. The doctor removes the coccygeal cyst completely, sutures the wound to the bottom, creating natural drainage. After the operation, the patient must be under the supervision of a doctor.
• when the wound is closed. With this method, relapse is more likely, but the operation causes less discomfort and recovery takes much less time. This method is especially effective when the disease is in remission - then relapse is least likely. The surgeon completely excises the coccyx cyst, sutures the wound and leaves an opening for drainage. After eight days to two weeks, the stitches are removed. Until the wound is completely healed, it is bandaged daily.
• Bascom method. In this operation, the wound is also closed. The essence of this method is that the coccygeal cyst is excised under the skin in the direction from the primary opening to the secondary ones. During the operation, the primary opening is completely sutured, and drainage is left in the secondary ones in order to remove the infiltrate.
• Karydakis method. It is not quite correct to call this method by the name of this specialist only, since Dr. Bascom is also directly related to it. In some medical reference books, this method is also called the Bascom method. But the operation here is completely different. The skin flap and the coccygeal cyst are completely removed, the entire affected area is slightly displaced, and the entire wound goes to the line between the buttocks. It is widely believed that in this way the patient recovers faster after the operation, in addition, relapses and complications occur less often.

Prices for coccygeal cyst removal surgery

The cost of a coccygeal cyst removal surgery varies depending on many related factors: the city, the specific clinic and surgeon, the method by which the coccygeal cyst will be excised. However, in general, this is not the most complicated and relatively affordable surgical procedure. The average cost range is 200-1000 USD. The amount may increase depending on complications, the complexity of the epithelial tract, if preoperative sanitization is required, etc. In addition, the sooner the patient seeks medical help, the less money will most likely be required for the surgery.

However, only the surgeon who will be directly involved in your case will be able to determine exactly how much money you will need for the surgery to remove the coccygeal cyst.

Postoperative period for coccygeal cyst

The wound heals within four weeks, after two days the patient is already standing, after four to five days he is walking, sitting position is contraindicated for another three weeks. After the operation to remove the pilonidal cyst, treatment is carried out with medications (antibiotics, painkillers), the wound is bandaged, possibly the use of physiotherapy procedures so that the wound heals faster.

The operation removes the pilonidal cyst, after which relapses usually do not occur.

Postoperative difficulties

Many people have a question: how to get home after surgery if you can’t sit after the removal of the coccygeal cyst? You won’t be able to drive a car on your own. Public transport is a possible option if you can stand. Although it’s worth considering how comfortable you will be on public transport after the surgery. But the ideal option is if someone close to you picks you up by car or uses a taxi. This way, you can lie down on the back seat, and in a “lying down” position, so that there is no pressure on the coccyx, you will be taken home.

If this option is not possible for you, you should stay in the hospital as an inpatient, since putting pressure on the coccyx in the first period after surgery is contraindicated.

It is recommended to do an enema before the operation. Many argue that it is possible to do without it. Yes, the anus is located quite far from the coccygeal cyst, so discharge and pathogenic flora do not affect the course of the operation. But after the surgical intervention, it is quite problematic to go to the toilet "for a big one". With the help of an enema, you can clean the intestines and not worry about this need for the first time after the operation. Modern drugs allow this operation to be performed painlessly, quite comfortably and quickly.

Treatment of pilonidal cysts with folk remedies

As in most other cases, folk medicine makes it possible to alleviate the manifestations of a pilonidal cyst, but they do not relieve inflammation or deal with the lesion. Therefore, they can be used as an additional treatment, temporarily, and also to reduce discomfort before surgery.

Traditional medicine uses compresses to treat pilonidal cysts. There are the following recipes:

• two tablespoons of butter + one tablespoon of tar.
• propolis tincture. A compress from it is kept on the sore spot for two to three hours, daily for a week.
• A piece of canvas from the beehive is applied to the tailbone at night for a week.