coccygeal abscess
Short and painless
If you experience pain in the coccyx area, always think of a coccyx abscess, colloquially known as a boil or carbuncle. If an Pilonidal Sinus is inflamed, the symptoms often occur suddenly and without warning. Avoid misdiagnoses such as coccyx contusion, periostitis or overuse pain by contacting a specialist directly.
In the early stages or with mild irritation, the inflammation can sometimes calm down without surgery. Supportive treatment with cooling, anti-inflammatory drugs such as ibuprofen and traction ointments can promote the healing process.
If the inflammation is more diffuse in the tissue rather than an encapsulated collection of pus, antibiotics can be used. antibiotics can be helpful.
If the abscess opens up on its own, the pain will subside within 1 - 2 days. Although the discharge of blood and pus worries the patient, smells unpleasant and looks unattractive, it is not dangerous. If a coccyx abscess has burst, this defuses the acute situation. There is no such thing as an abscess that has burst inwards.
Which doctor helps in an emergency?
Despite understandable fears, opening the abscess is the quickest way to freedom from pain. Which doctor should you see? (If you don't live too far away, you can also simply fill in the form below and come directly to us).
Otherwise, your family doctor, a specialist surgeon or the emergency room at the local hospital can help you. But be careful - it is often recommended to remove the entire inflammatory process in a major operation.
We and the current guideline Sinus pilonidalis (AWMF 2020) see it differently - they only recommend relieving the abscess with a small (!) incision and operating on the fistula once the inflammation has subsided. Our minimally invasive techniques such as pit picking, laser treatment and/or sinusectomy are then almost always possible.
Two small interventions are therefore better than one large one to solve the problem effectively and gently.
Need immediate help?
Coccyx abscess surgery - emergency treatment
"Ubi pus, ibi evacua." - This Latin saying "Where there is pus, drain it" is familiar to every doctor and describes a simple and effective therapeutic principle. The practical implementation, however, especially in the case of coccyx abscesses, often causes difficulties for the doctor and unnecessary pain for the patient. We describe our technique here.
Can I open the abscess myself?
We strongly advise against trying to do this yourself. The instructions are intended for appropriately equipped doctors in practice or hospital outpatient departments.
Attempts to squeeze the coccyx abscess are also not promising and sometimes worsen the pain and inflammation.
Required Instruments:
- Experience
- Diagnostic ultrasound unit Linear transducer 7.5 or 10 MHz
- Fine, surgical forceps, e.g. Adson
- Fine, pointed dissecting scissors, e.g. Supercut Iris scissors 11.5 cm
Consumables:
1. education and reassurance of the patient
We inform the patient in detail about the benign nature of their condition and the successful treatment method using a two-stage procedure. This initially involves abscess drainage followed by minimally invasive surgery on the Pilonidal Sinus in the second stage. We discuss any fears openly and comprehensively.
You do not normally need to worry about blood poisoning, bone involvement or a connection to the intestines.
2. identification of the optimal puncture site
When locating the apex of the abscess cavity, the first step is to palpate and measure the thickness of the skin over the abscess. It is important that the skin thickness for using the biopsy punch is a maximum of 5 mm. The optimal puncture site can often be localized by means of a "soft dent". In the case of a deep abscess, it is recommended to perform the cleavage under general anesthesia.
3. injection of local anesthesia
After the intradermal infiltration of a 1.5 cm area of skin at the puncture site, we take a brief moment to check the effectiveness. We do not recommend the use of cold spray for pain relief as it is not particularly effective and the CFCs it contains are harmful to the environment.
4. opening the abscess cavity
We make a 5 mm opening with a biopsy punch and remove the skin cylinder with tweezers. If necessary, we open the abscess capsule with fine scissors. If done correctly, plenty of pus will now drain out. The round opening is large enough to prevent re-adhesion, but at the same time small enough for the patient to cope well.
Five. Stop!
The acute treatment is now complete. The remaining secretions will empty themselves. We apply a thick absorbent dressing. If there is a pronounced phlegmonous reaction in the area surrounding the abscess, an antibiotic may be prescribed. No tamponade is used and no sharp spoons are used.
We inform the patient that the risk of further abscesses recurring is very high if the second treatment step is not carried out. We offer a follow-up appointment on the following day if the inflammation has not subsided sufficiently. If you wait too long, there is a risk that the abscess will return. On the other hand, the procedure is technically demanding if it is performed too early. We therefore prefer a time interval of at least one week and a maximum of three weeks.
