Why is my tailbone bleeding

Coccyx fistula: causes, symptoms, prevention

When ingrown hairs cause pain

A coccyx fistula - also called pilonidal sinus - is an inflammation of the gluteal fold. This is mostly caused by hair roots that are filled with ingrown hairs. If hair grows inwards instead of outwards, broken hair and keratin flakes are brought under the surface of the skin. In this way, small nodules (medicinally granulomas) form, which can become inflamed by bacteria.

Coccyx fistula: causes

One reason for the development of a coccyx fistula can be impaired hair development. Newly growing hair is not pushed out of the hair root properly. The building material of the hair, keratin, accumulates in the form of clods in the hair roots (follicles).

Even if the hair is formed normally, a pilonidal sinus can occur. Namely when hair breaks and spikes into the wall of the hair follicle. The follicle fills with broken hair. Loose hair from the back or head can also be massaged into the buttock folds due to the constant movements of the buttocks. The surface structure of the hair, similar to an arrow with a barbed hook, means that once impaled hair remains stuck in the tissue and cannot be removed again by washing.

A third cause can be a phenomenon that is sometimes seen in fistulas that have already been removed: It appears as if hair has grown directly “underground”, probably as a result of a developmental disorder. Here, too, a coccyx fistula is the result.

In any case, the enlarged hair follicle can always be seen as a small black point or as an opening the size of a millimeter. If one sees such a pit, the diagnosis of a coccyx sinus is confirmed.

In addition to ingrown hairs, congenital deformities of the tailbone or bruises after a fall can also be responsible. Men are affected by coccyx fistulas around twice as often as women and usually develop the disease between the ages of 20 and 30 years. In addition, there are other factors that can favor coccyx fistulas:

  • Strong hair growth
  • Persistent sitting
  • Profuse sweating and tight underwear
  • Inadequate hygiene
  • Obesity
  • Weakened immune system

Make sure you get up more often if you have to sit for long periods and prefer well-padded chairs. If you are prone to excessive hair growth, preventive hair removal with laser in the coccyx area can be useful.

Coccyx fistula: symptoms

But how do you recognize a coccyx fistula exactly? There are basically three stages of inflammation that are associated with different symptoms:

  • Blande form: You don't notice the development of a coccyx fistula at first or the symptoms are minor and unspecific (pain when sitting on hard chairs, feeling like a “pimple” or a bruise). Sometimes there is no discomfort apart from a visible opening in the area of ​​the gluteal fold.
  • Acute form: A pilonidal abscess can develop within a few days, the underlying coccyx fistula already existed unnoticed. The typical expression with a reddened, painful bump on the buttocks or in the coccyx region can be seen at a glance. The externally visible symptoms can be minor. The patient is in severe pain, although there is not much to see. On closer inspection, a hardening can be felt and the skin looks conspicuous. The pits are often invisible due to the swelling. Sometimes patients report a previous fall on the tailbone. A causal relationship cannot be explained. It is not uncommon for complaints to occur after long periods of sitting, such as with students and office workers or after long flights.
  • Chronic form: Some patients experience only mild pain and only notice the presence of the fistula by chance or because of the discharge of blood or pus. The colonization of the pilonidal fistula by the bacteria that are always present in this region can cause a very unpleasant odor. The capsule often contains a lot of collagen fibers and feels hard like cartilage, so that irritation occurs when sitting for a long time without actual pain. Sometimes the patients themselves discover small openings in the area of ​​the gluteal folds.

No matter what symptoms you notice: see a doctor! The earlier a coccyx fistula is detected, the better it can be treated.

Pilonidal sinus: prevention

There are tips that you can follow to avoid an unpleasant coccyx fistula in the first place. Since pilonidal sinus is usually caused by ingrown hairs, permanent removal of the hair in the coccyx area is the best way to prevent the disease. With a diode laser, the hair can be lasered away painlessly, quickly and for a long time. If you sweat profusely and wear tight underwear, the risk of coccyx fistula also increases. It is also important to avoid long periods of sitting on hard surfaces and being overweight.

In our proctological practice in Munich, we are there for you if you have any questions about coccyx fistula.