what is coccyx cyst?
A coccyx cyst or hair follicle fistula is a sac-like lesion that develops on the skin, almost always in the coccyx region, just above the intergluteal groove. The cavity may contain hair (hence the term “capillary”) sebaceous secretions, pieces of skin, liquid or semi-solid material, and other cellular elements. The lesion – also known as a sacrococcygeal cyst – develops in the tissues between the muscle fascia and the fatty layer of the skin and appears as a slight swelling in the area.
Coccyx cysts are harmless until they become infected and inflamed. If a coccyx cyst becomes infected, it can develop into an abscess which is often extremely painful. In addition, pus collected in the cavity can become a fistula.
Anyone can develop a coccyx cyst, but the lesion is more common in young men, between the ages of 15 and 24. In particular, people who remain seated for long periods of time, such as truck drivers, are at greater risk of developing a coccyx cyst. The treatment and management of coccyx cysts depends on many factors, including the extent and chronicity of the disease. A complete cure is possible, but the cystic cavity can recur even if surgically removed.
Cyst, abscess and fistula
The terms cyst, abscess and fistula refer to three different stages of the disease:
Coccyx cyst is a small, non-infected sac, similar to a small lump, asymptomatic or mildly painful to palpation. The lesion may remain symptom-free for years or progress to later stages.
An abscess is a collection of pus resulting from bacterial infection of the cystic cavity. This formation is larger than the previous one and includes pain, fever, redness and other characteristic signs of inflammation. A few days after the abscess ruptures, the symptoms immediately improve. However, if not adequately treated, the inflammatory process does not stop and tends to become chronic.
A fistula is a small tunnel (or channel) between the infected cyst and an opening in the skin that provides an outlet to the outside: a serous fluid continues to leak from the open lesion. If the fistula closes, it causes recurrent abscesses to form. After some time, the acute episode may recur, and purulent material continues to exit the tubular canal. As a result, other fistulas can be formed which can branch in different directions, dispersing numerous orifices over a fairly large area of the skin.
Cyst Coccyx: Symptoms
Cyst Coccyx is a lesion that develops centrally in the lower back, at the level of the coccyx, near the buttock cleft, about 4 to 5 centimeters from the anus. Some individuals may remain asymptomatic for some time before the onset of the acute inflammatory condition. Symptomatic disease usually occurs when the cyst degenerates into an abscess: the patient feels more discomfort, local swelling is more prominent, and the area is painful to the touch.
If the cyst becomes infected, the following signs and symptoms may occur:
- Signs of abscess inflammation: pain, swelling, redness and burning in the affected area of the skin.
- Discharge of purulent (or sero-purulent), yellowish and foul-smelling material.
- Fever (uncommon), headache and general malaise.
These symptoms can develop quickly, often within a few days. The pain caused by a coccyx fistula can be severe and is likely to worsen if treatment is not sought.
Cyst Coccyx: Causes
Although there are several theories about the causes of the disease, today most scientists believe that cysts are acquired lesions (and not congenital or congenital as previously believed). Their appearance is related to an infection of the hair follicle, which, once dilated, allows the hair to become encapsulated. In response to these ingrown hairs, a local inflammatory reaction develops that causes a cystic structure to form.
Excessive pressure, friction, or repetitive trauma to the area of the sacrococcygeal ligament may predispose individuals to develop the cyst or cause irritation of an existing coccygeal lesion.
Cyst Coccyx: Causes
Certain factors may predispose to the development of a coccyx cyst. These include:
- Obesity: obese people are more likely to have relapses.
- Sports or professional activities that require prolonged sitting (increases pressure in the coccyx area).
- Poor hygiene and the presence of a lot of unwanted hair.
- Excessive sweating: moisture promotes the growth of anaerobic bacteria, which often infect coccyx cysts.
- Local irritation or trauma, which can cause inflammation of an existing cyst or favor its appearance.
- Tight clothes.
Coccyx Cyst: Diagnosis
The cyst can be diagnosed with a simple clinical examination, based on the characteristic signs in the coccyx: presence of external openings, discharge of liquid or purulent material, etc. The area is extremely painful to palpation, and often the simple act of separating the buttocks to examine the area is unbearable for the patient. Blood tests and a targeted ultrasound may also be helpful in establishing the diagnosis.
The doctor may also detect the presence of the following conditions:
- Fever
- An increase in white blood cells in a blood sample
- Inflammation of the surrounding skin
Possible complications
Complications of a coccyx cyst may include:
- Cystic recurrence
- Abscess formation and chronic suppuration
- Systemic infections
Coccyx cyst surgery
The treatment of coccyx cyst is surgical. Patients without local inflammation generally do not require immediate treatment, but epilation and thorough local hygiene are recommended. If, on the other hand, an infection develops in the cystic cavity, it is necessary to resort to adequate treatment to drain or remove the lesion.
Coccyx cyst surgery: Incision and drainage of the cyst
The first treatment approach involves a surgical procedure that can be performed externally.
After the area is numbed with local anesthetic (local anesthesia), the doctor makes a small incision over the infected area to open the cystic cavity. Purulent material is drained, all hairs and other debris accumulated in the cyst are removed. The wound is cleaned with saline and covered with sterile gauze.
The doctor may prescribe certain antibiotics to treat the inflammation and prevent bacterial reinfection. Often, pain relievers are also prescribed for symptomatic treatment.
A medical check-up should be performed two days after the procedure to assess whether the wound is healing adequately and to monitor for any complications. Once the bandages are removed, the skin wound heals and closes on its own. Most people who have a coccyx cyst incision and drainage do not need any other treatment. Keeping the wound clean and removing all hair from the sacrococcygeal area can help prevent recurrence.
Excision of the coccyx cyst
If you have a cyst that tends to get infected all the time, you may need more invasive surgery to remove all the tissue affected by the cyst (skin, subcutaneous tissues and cystic area up to the sacrum). Excision allows complete treatment of the condition but is a rather more invasive procedure compared to simple incision and drainage.
After the cyst is removed, the doctor may choose to:
a) To leave the surgical wound open (healing by 2nd purpose). In this option, the surgical wound is left open, without suturing, in order to allow the tissue to remodel naturally from the base to the surface. This procedure results in a longer healing time, but is associated with a lower risk of recurrence (recurrent infection of the coccyx cyst). Sometimes a simple, medicated sterile gauze is inserted into the surgical wound. Healing takes place over a variable time between 4 and 6 weeks, during which the gauzes are changed on average once a day.
b) To close the wound with stitches (healing according to 1st purpose). After removing the cyst, some surgeons prefer to immediately close the wound with stitches. Healing time is faster with this option, but it is associated with a higher risk of recurrence. Some surgeons make the incision in the intergluteal groove, an area where healing is especially difficult. The stitches are removed after about 10-12 days.
Possible postoperative complications may include local infection or poor healing of surgical wounds. To avoid these consequences, the doctor will provide the patient with detailed instructions regarding the management of the wound and the progress of a normal healing process. You may also need to shave the area around the surgical site to prevent hair from entering the wound. During the postoperative phase, external treatments and controls are necessary to ensure proper healing of the wound and to quickly deal with possible complications or recurrences of the disease. Although a percentage of patients may relapse, in general, the long-term prognosis is excellent.
Other common operations that can be performed in the case of a coccyx cyst are:
- laser
- excision of the coccyx cyst with advanced energy sources (ultrasound scissors, radio frequencies)
Coccyx cyst prevention
To prevent an acute or recurring coccyx cyst, you can:
- Keep the area clean and dry, paying close attention to local hygiene.
- Wear comfortable clothes, so that the fabrics do not rub against the skin.
- Keep the area free of unwanted hair by regularly using depilatory creams or laser hair removal.
- Avoid prolonged sitting or repeated excessive pressure on the coccyx area.
It is also noted that in obese people, weight loss can help reduce the risk of relapse.
When to seek a doctor’s help
If you present any of the symptoms described above or if you have discomfort that makes you suspect the existence of a coccyx cyst, immediately contact the qualified surgeon Mr. Konstantinos Alexiou who, after examination and receiving the necessary information, will proceed with the appropriate treatment. In any case, do not let diseases such as coccyx develop. Your health and well-being depend on even a small discomfort that you can put an end to immediately and without pain or complications.
