Coccyx abscess | Pilonidal abscess | Pilonidal Sinus acute form

coccygeal abscess

How a 15 - second - surgery eliminates your pain on an outpatient basis
Ultrasound-guided puncture instead of radical surgery

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".

Ultrasound image coccyx abscess
Coccyx abscess. Only minor swelling. Pain since 2 days.
Family doctor, specialist or hospital?

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.

Need immediate help?

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.

Coccyx abscess-fuer-How-To.jpg
Time required: 20 minutes

Required Instruments:

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


Sterile disposable perforated cloth
Sterile ES Compresses 10 x 10
Sterile gloves
Local anaesthetic, e.g. Prilocaine 0.5% solution for injection
2 ml disposable syringe, e.g. B|Braun Injekt® Luer Solo
Dermatological biopsy punch, e.g. Stiefel™ Biopsy Punch 5 mm
Fine, short injection cannula e.g. BD Microlance™ 30G x ½ (0.3 x 13 mm)

Treatment Steps:

1. education and reassurance of the patient
Inform the patient about the benign nature of his disease and the good treatment options by means of a two-stage procedure with abscess drainage and minimally invasive surgery of the Pilonidal Sinus in the second stage. Fears regarding blood poisoning, bone infestation or connection to the intestine must be dispelled.
2. identification of the optimal puncture site
Locate the apex of the abscess cavity, palpate and measure the thickness of the skin over the abscess. For the use of the biopsy punch, this should be a maximum of 5 mm. Often the best place for the puncture can be palpated as a "soft dent". If the abscess is deep, one should offer cleavage under general anesthesia.
Coccyx abscess-ultrasound-for-how-to.jpg
3. injection of local anesthesia
Infiltration of a 1.5 cm diameter skin area at the puncture site by intradermal injection. Wait. Verify efficacy. The use of cold spray as analgesia is insufficient and environmentally harmful and should therefore be rejected.
Treatment coccyx abscess outpatient with local anesthesia
4. opening the abscess cavity
Creation of a 5 mm opening by biopsy punch. The skin cylinder is removed with the forceps, if necessary the abscess capsule is opened with the fine scissors. If the procedure is performed correctly, copious amounts of pus will now drain out. The round opening is large enough so that it does not immediately stick again, and small enough for the patient to cope well with it.
Biopsy punch for puncture of coccyx abscess
Five. Stop!
This ends the acute treatment. The remaining secretion will empty passively. Application of a thick absorbent dressing. If necessary, prescribe an antibiotic if the surrounding area of the abscess is markedly phlegmonous. No tamponade. Do not use a sharp spoon!
Opening of coccyx abscess with 5 mm biopsy punch
Informing the patient that the risk of recurrence of further abscesses is very high if the second step of the treatment is not carried out. Offer of a follow-up appointment on the following day in case of insufficient regression of the inflammation. If one waits too long, the abscess may recur; if one operates too quickly, the procedure is technically cumbersome. We prefer a time interval of at least 1 week and at most 3 weeks.
Don't forget to make an appointment for pit picking surgery