Why is the coccygeal tract formed?
The modern point of view associates the disease primarily with hair: under the influence of friction and movement of the buttocks, hair is embedded in the skin of the intergluteal fold, forming the primary openings and passage. The congenital predisposition to a deep fold also plays a role. Hair, sebum and dead cells accumulate inside the passage, bacteria penetrate there, and inflammation develops.
- Male gender, age 15–35 years
- Thick and coarse hair
- Deep intergluteal fold
- Excess weight and excessive sweating
- Prolonged sitting: drivers, office workers
- Sacrococcygeal region injuries
Stages and forms
The course may be different: in some people the course remains calm for a long time, in others it quickly turns into chronic inflammation with repeated abscesses.
- Uncomplicated course - only pinholes without symptoms
- Acute inflammation - infiltrate and abscess
- Chronic inflammation - fistulas with periodic discharge
- Recurrent form - return after treatment
Symptoms
In the calm stage, a person may notice only one or a few small holes in the intergluteal fold, sometimes with protruding hairs. With inflammation, symptoms increase quickly.
- Pinholes in the intergluteal fold
- Pain and tightness above the tailbone, worse when sitting
- Redness and swelling of the skin
- Purulent or bloody discharge with an unpleasant odor
- Increased temperature with an abscess
Diagnostics
The diagnosis is usually made upon examination: the location and type of holes are characteristic. The doctor checks the extent of the tracts and sometimes injects a dye into them during the operation. In complex, recurrent forms, ultrasound of soft tissues or MRI is performed. It is important to distinguish the coccygeal tract from rectal fistula, boil and hidradenitis.
- Examination by a coloproctologist
- Ultrasound of soft tissues of the sacrococcygeal region
- MRI for complex and recurrent forms
- Digital examination of the rectum to exclude perirectal fistula
Treatment
In case of an acute abscess, the abscess is opened and drained - this quickly relieves the pain, but the course remains, and the inflammation usually returns. Radical treatment is excision of the tract with all its branches in a quiet period. There are different techniques for wound closure, including fold retraction, which reduces the risk of recurrence. For small uncomplicated passages, minimally invasive methods are used - endoscopic treatment or laser treatment. The choice of method depends on the form of the disease and the experience of the surgeon. After surgery, wound care and hair removal in the crease area are important.
- Do not postpone elective surgery after inflammation subsides
- Maintain hygiene of the intergluteal fold
- After treatment, regularly remove hair in the tailbone area (laser hair removal reduces the risk of relapse)
- Lose weight if you are overweight
- Take breaks when sitting for long periods of time
