Short and painless
With pain at the coccyx always think of coccyx abscess: On the ranking list of the painful inflammations the coccyx abscess stands completely far above. The symptoms often arise within a short time without warning. Sometimes valuable time passes until the diagnosis is made, because one initially thinks of a sports injury or overuse pain.
In the early stages or mild irritation, the inflammation sometimes calms down without surgery. Cooling, anti-inflammatory drugs (e.g. ibuprofen) and traction ointments (questionable) can support the healing process.
If there is a more diffuse spread of inflammation in the tissue, rather than an encapsulated collection of pus, antibiotics may help.
Spontaneous healing: Once the coccyx abscess has burst, the pain subsides. This may be scary for the patient as blood and foul-smelling pus drain out. However, a ruptured coccyx abscess is not dangerous. An abscess cannot burst "inwards".
Which doctor helps in an emergency?
Opening the abscess, despite all the understandable fears, is the best treatment for acute inflammation. Which doctor is best to go to?
In principle, general practitioner, specialist or even the emergency room in the local hospital are equally suitable. Especially among surgeons, the opinion is still widespread that one should immediately cut out the entire inflammatory process.
Since the swelling always affects the surrounding tissue and not only the fistula itself, one would always cut away too much with the result of a much too large wound with this concept.
In accordance with the Guideline 2020 I therefore recommend relieving the abscess and operating on the fistula after the inflammation has subsided. Minimally invasive procedures such as pit picking and / or sinusectomy are then almost always possible. Consequently, two small interventions are clearly better than one large one.
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How to: Coccyx abscess surgery - emergency treatment
"Ubi pus, ibi evacua." - This Latin saying "Where there is pus, there empty it" is familiar to every physician and describes a therapeutic principle that is as simple as it is effective. The practical implementation, however, especially in the case of coccygeal abscess, often causes difficulties for the physician and unnecessary pain for the patient. We describe our technique here.
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.