Tailbone abscess


A coccyx abscess usually forms on the basis of a so-called coccyx fistula.
This is a chronic inflammation of the gluteal folds, in which fistulas develop due to hair growing inwards. Constant pressure, e.g. Long car journeys and the invasion of germs can cause bacterial inflammation in this area. Tissue melts and an accumulation of pus can become encapsulated.

Causes of a tailbone abscess

The tailbone abscess is characterized by an accumulation of pus in the subcutaneous fatty tissue. This is often due to an ingrown hair in the skin. The localization is mostly in the sacral region. Most often, the tailbone abscess occurs in obese, very hairy men between the ages of 20 and 30.
The collection of pus is located in an encapsulated space under the skin, which leads to an inflammatory reaction in the surrounding tissue. An abscess is usually caused by immigration by bacteria. This can be relieved if there is a connection to the outside through the ingrown hair (fistula duct). In the case of the tailbone abscess, it is usually an infection with Staphylococcus aureus, a skin germ that is part of the normal skin flora.

Read more on this topic at: Abscess - cause, symptoms and therapy


Signs of a tailbone abscess

The chronic tailbone abscess goes with one Redness and swelling the region concerned. It can too Oozing of the abscess, but often resolves on its own. In contrast to the acute tailbone abscess, the chronic tailbone abscess is often not painful. The acute tailbone abscess also presents with redness and swelling in the tailbone region. Here, however, there is severe pain that requires rapid treatment.

The abscess can too dangerous become. When bacteria migrate into the blood or when there is a large inflammation in the coccyx region, in addition to general symptoms such as fever and Exhaustion come. The reason for this may be that the abscess has no connection to the outside and therefore empties inward. If a fever occurs during an abscess formation, a doctor should be consulted immediately. About 5% of the bacteria responsible for tailbone abscesses are toxin-forming. This means that these bacteria form a substance that can be very dangerous to humans. These bacteria can get into the blood from this sepsis (Blood poisoning) arise.

Symptoms of a tailbone abscess

The symptoms of a tailbone abscess depend on the stage and location of the disease.

At the beginning of the disease, the abscess can be relatively symptom-free and symptom-free, as the abscess is relatively small, encapsulated and does not have to affect any nerve structures.
However, it is possible that nerve tracts are in the area of ​​the abscess and are irritated, so that pain can occur in very different parts of the body. It may well happen that pain in the abdomen or the side of the trunk is caused by the abscess. If the sciatic nerve is irritated by the abscess, symptoms can also occur in the course of this nerve.

However, the most common is pain that occurs in the lower back and the tailbone itself. The affected area is called the rima ani or gluteal fold and is the crease that divides the buttocks in half. Especially with inflammation of the tailbone abscess, redness and swelling, as well as pronounced pressure sensitivity, occur in this area. It is often no longer possible, or only possible to a limited extent, for those affected to sit in a normal chair, as too much pressure is exerted on the affected area. Walking can also cause severe pain for patients with this condition. It can even go so far that affected persons can only lie on their stomach without pain.

If there is a small fistula in addition to the abscess, clear, yellow, or bloody fluid may appear from the affected area.

For more information on the topic of tailbone abscess, see the main article abscess.

Duration of a tailbone abscess

The tailbone abscess can be divided into a chronic and an acute form.
The chronic form should be treated surgically, but is not an urgent indication for surgery. Here, the surgery date can be freely selected if there are no acute symptoms. Most often, the chronic form of the tailbone abscess is not accompanied by severe pain.
The acute form of the tailbone abscess, on the other hand, is usually accompanied by strong jokes. A fever can lead to fatigue. If symptoms occur, immediate surgery should be carried out here. The pus should be removed by splitting the abscess so that the inflammatory response is reduced. In addition to local antiseptics, an oral antibiotic can also be given to ensure that it is absolutely sterile. However, this will be dependent on the spread and severity of the infection.


The diagnosis is mostly from the doctor posed by the clinical appearance. The abscess presents itself through Pain when sitting and on pressure, the surrounding Skin is reddened and swollen. Ingrown hairs can often be seen. A hardening can be felt when pressure is applied to the abscess. Sometimes a fistula exit to the skin can be seen. In the chronic form of the abscess, it can ooze from the fistula outlet.

Which doctor should I see?

A family doctor can be consulted for diagnosis. He can make the diagnosis and write a referral. Surgical therapy should be performed by a general surgeon. The procedure can be carried out on an outpatient basis, so that an operation in an outpatient operation center or in a hospital is possible. The operation is usually carried out under general anesthesia, which is why a discussion with an anesthetist is necessary before the procedure. The procedure usually does not take long and the patient is ready to go home a few hours after the operation.

Treatment of a tailbone abscess

Operative therapy

A tailbone abscess can be treated using different surgical methods. It is important to distinguish at which stage the disease is present. A tailbone abscess in an asymptomatic state, i.e. in a symptom-free stage, does not necessarily have to be treated. However, the acute or chronic form of the disease should be addressed with surgical removal.
From today's perspective, conservative treatment methods cannot lead to a cure for the disease, which is why these methods cannot be recommended.

There are different surgical methods for a coccyx abscess, which are almost identical to the methods of treating a coccyx fistula. Since the only difference between the two diseases is that there is no outward inflammatory pathway in the case of a tailbone abscess, similar surgical techniques lead to a cure for the disease.

It is important to treat the inflammation in the surrounding area before starting the actual surgery.

The operations are usually performed under anesthesia, with smaller abscesses also under local anesthesia. An inpatient hospital stay of 3 to 4 days is usually recommended, during which the correct healing process can be checked after the operation.

The classic operation of a tailbone abscess is the excision of the entire affected area. This means that the entire tissue, depending on the size of the abscess, is removed down to the tailbone. If part of the coccyx itself is affected, the bone may need to be scraped off. There are different methods of such an excision. In general, one has to differentiate between an operation with secondary wound healing and an operation with primary wound healing.

Both operations have in common that the abscess is first opened with a scalpel so that the fluid contained in it (usually pus) can drain off. Afterwards, the entire tissue that belongs to the abscess is excised in a large area, so that it can be ensured that recurring abscesses are unlikely. Since the abscesses can sometimes reach a considerable depth, it is not uncommon for a relatively large wound to remain.

Read more on this topic at: Treatment of an abscess

In addition to a surgical procedure, there are other alternatives.

The difference between the surgical method with secondary and primary wound healing lies in the care of the wound.
With the method with primary wound healing will the Wound sewn up after the operation. This leads to a faster wound healing, but also to one greater likelihood of recurrences and complications. For this reason, in Germany, a secondary wound healing preferred in which the wound is not sutured, but through Tamponades is kept open. The This slows down healingso that complete healing of the wound can take up to 3.5 months However, the number of complications after the operation is severely limited.

As with the treatment of the coccyx fistula, there are also alternative methods of surgical treatment for a coccyx abscess. These methods can be referred to as minimally invasive treatment methods of the tailbone abscess.
For example, there are methods in which a so-called Drainage into the wound is placed so that the secretion can drain away and the likelihood of complications is low.
Surgical techniques such as the so-called "Pit picking“, A method that is used for an operation on a coccyx fistula, are not suitable for the treatment of a coccyx abscess. These methods are intended to close the inflammatory ducts, the fistulous ducts and thus lead to healing. Since these ducts do not exist in an abscess, these surgical techniques are not an alternative to the treatment of a tailbone abscess.

There are also so-called plastic proceduresin which instead of leaving the wound open or suturing it, skin flaps are sewn over the wound to close it. However, due to the risk of numerous complications and little experience, these methods are used very rare these days applied.

At smaller abscesses can also be a simple one Incision, So a Open up the abscess with a scalpel and conveying out the contained fluid lead to a healing with a low recurrence rate. Depending on the size of the abscess, such a gentle method with a relatively short wound healing time can be recommended.

By and large, it must be decided on an individual basis which therapy option is best for the affected person. Depending on the size of the abscess, a complete excision of the tissue up to the scraping of the coccyx may be necessary, or a skin incision with opening of the abscess cavity may be sufficient for healing.

Treatment without surgery

The conservative therapy (i.e. therapy without surgery) of a tailbone abscess not promising.
Operations that are nowadays performed either in a minimally invasive procedure, a plastic operation method or the classic operation, depending on the type of disease, are the only therapeutic options that can be recommended for a tailbone abscess.

A cure of the tailbone abscess through Anoint, cooling, special baths and of course with one antibacterial therapy with antibiotics can the disease not heal. Also a therapy with homeopathic remedies and naturopathic therapy options can possibly use the Improve wound healing after surgeryHowever, these drugs cannot cure the disease itself.

Conservative therapy can first of all help fight inflammation in the area around the fistulato perform an operation afterwards. Here the Treats inflammatory responseHowever, the cause of the abscess formation cannot be resolved.

In any case, it makes sense to use the to discuss individual therapy with the attending physician, and not trying to self-treat the tailbone abscess.
Should the abscess are carried out exclusively in self-treatment with conservative treatment methods and pain medication, there is a possibility that the abscess will open inward and possibly cause blood poisoning!
Such a complication requires strict intensive medical care and should be prevented in any case.

In a conversation with the attending physician, worries and fears of an upcoming operation can possibly be resolved so that the procedure can be more relaxed.

Overall you should get one if possible timely surgery of the tailbone abscess aim, as complications and the likelihood of recurrence, which can be associated with this disease and surgery, otherwise become more likely.

Treatment with pull ointment

The pull ointment has an antibacterial and anti-inflammatory effect. It is used for various inflammations or abscesses under the skin. Here it can have a germicidal effect in the abscess and anti-inflammatory in the surrounding tissue. Furthermore, the pull ointment has a blood circulation-promoting effect. Thus, the pull ointment can ensure that the abscess drains outwards.

Home remedies for a tailbone abscess

A doctor should always be consulted if the tailbone abscess is symptomatic. Here an abscess split must be made with subsequent rinsing of the wound. Depending on the general symptoms, antibiotics may also have to be used. A chronic tailbone abscess can be treated with local antiseptics. In addition, chamomile baths or zinc ointment can be used to try to reduce the number of germs.

Tea tree oil for a tailbone abscess

Tea tree oil is said to have an antiseptic effect. Tea tree oil penetrates the skin and can eliminate the accumulation of pus under the skin. Tea tree oil is a natural product and is therefore kind to the skin and well tolerated.

Treatment of tailbone abscess with laser

Laser therapy is possible. Here, the pus is eliminated from the abscess using laser beams. This system should be gentle and should replace the conventional operation. At the moment there are various testimonials about the success of laser therapy. The gold standard in abscess therapy is currently still the conventional surgical procedure. Here, the pus can be completely cleared out and a suture can be made to securely close the fistula.

Read more on this topic at: Treat coccyx fistula with laser

Treatment during pregnancy

To prevent the bacteria from spreading during pregnancy and to prevent blood poisoning (sepsis), a Cleavage of the abscess be made. This can also be done under local anesthesia without the woman having to be put under general anesthesia. The division can usually lead to a bypassed antibiotic therapy become. If splitting under local anesthesia is not possible, a non-teratogenic antibiotic should be administered.

Coccyx abscess healing

A coccyx abscess can be said to have healed if the abscess has been removed and there is no recurrence (i.e. a recurrence of the abscess). Depending on the surgical method, the recurrence rate from study to study and the healing time of the wound vary considerably.

The most common surgical technique used in Germany to treat tailbone abscesses is classic excision with secondary wound healing. Wound healing can take weeks to months with this method, but the recurrence rate is between 2% and 6%, depending on the study, and is therefore relatively good. In high-risk patients, however, the recurrence rate can be up to 35%. People who have already had an operation to remove a coccyx abscess or a coccyx fistula are particularly at risk of recurrence.

The reason why the surgical method with primary wound healing is not preferred to the method with secondary wound healing despite faster wound healing is the greater likelihood of recurrences after such an operation. The recurrence rate is 2-13%.

Postoperative care is particularly important for the correct healing of the wound. Individual care by relatives or nurses is necessary and helpful in most cases due to the location of the wound. At the same time, adequate pain therapy is necessary for a certain time after the operation. Depending on the surgical procedure, the wound must be treated differently.In the case of an open wound after an operation with secondary wound healing, the wound should be rinsed regularly and under medical observation.

After the wound has completely healed, it is important that the likelihood of recurrence is kept low.

Previously it was thought that shaving the hair in this area could prevent recurrence to some extent, but it has been found that such shaving can actually cause a recurrence of abscess or fistula. The removal of hair using laser therapy cannot be recommended at the moment due to a lack of data.

Overall, when treating a tailbone abscess, there is a good chance that the disease can be cured with an operation. It should be noted, however, that wound healing after the operation can sometimes take up to 3.5 months, with an incapacity for work after an operation with secondary wound healing averaging around one month.

Difference from the coccyx fistula

The term Coccyx fistula is a somewhat misleading term. A fistula formation is characterized by duct formation under the skin. This is the case with the coccyx fistula, for example through an ingrown hair. The coccyx fistula is the basis on which the coccyx abscess develops. The correct name for an ingrown hair in the coccyx region is, however, "Pilonidal sinus". Pilon stands for hair in Latin, nidus for nest in Latin. The ingrown hair leads to an accumulation of pus, which can lead to abscess formation.