Cyst on Tailbone


What is Cyst on Tailbone?

A particular type of cyst may occur at the bottom of your coccyx, or tailbone. Cyst on the tailbone is also known as “Pilonidal cyst.” Once the cyst is infected and filled with pus, it is referred to as “pilonidal abscess.”

Cyst on tailbone is like a big pimple at the bottom of your coccyx. The condition is more prone to men than in women. It typically occurs more in younger people. Those who sit a lot, like truck drivers are more susceptible to have this condition. This disease can be treated using various methods. (1,2)

Cyst on Tailbone or Pilonidal Abscess

The clear view of cyst on tailbone. Source – epainassist.com

Symptoms

Some of the common signs of cysts on the tailbone are itchiness and pain. It occurs between the age of 15 and 35. The condition may also occur in areas like the genital region, navel or armpit but are much rarer. Some of the common symptoms of cyst on tailbone include: (3)

cyst on tailbone

  • Discomfort, pain or swelling above the anus or near the coccyx that may be gone for some time and then reappears.
  • Opaque yellow or bloody discharge from the tailbone area.
  • The moisture in the tailbone region.
  • Discomfort when sitting on the tailbone, riding a bike or doing sit-ups.

Some people with a cyst on tailbone will be asymptomatic.

Causes

The origin of cyst on coccyx is not known. Some think that the condition might be congenital from embryologic cells that were in the inappropriate place early in development or because of repeat trauma. Another view on the cause of cyst on tailbone is what most doctors refer to as ingrown hairs. Pilonidal means “nest of hair” in layman’s terms.

Some loose hairs puncture the skin and get stuck there. The pressure during cycling, prolonged sitting, skin gets rubbed and wearing tight clothes pushes the hair deeper into the skin. The body consider this hair as a foreign substance and cyst are formed around the hair. (2, 4)

Around 80,000 soldiers during WW II were hospitalized due to pilonidal cysts. Others thought that it is due to the irritation from riding in bumpy jeeps. The condition was called “Jeep disease” for some time. If you have a small dimple in the skin between your buttocks, there is a possibility that you might get one. (7)

Differential Diagnosis

In confirming the diagnosis for Pilonidal cyst the location of the disease is considered, but you must also to take into account other disease entities: (5,6)

Anal Fistula and Hidradenitis

Anal Fistula

Anal Fistula

Image Source: ibdclinic.ca (8)

There are some surgical cases mentioned the difficulty in differentiating cyst on coccyx from anal fistula and hidradenitis suppurativa. Cyst on tailbone may result in sinuses that stretch in the perianal region and mimic an anal fistula.

One important clinical observation in ascertaining findings of anal fistula is palpation of the tract that extends towards the opening of the anus. If in case there is no primary opening and no tract is palpable, you can consider the possibility of having an extra-anal source of infection.

Hidradenitis suppurativa is also considered. It is a chronic inflammatory disease of the apocrine sweat glands where local friction as well as folliculitis plays a vital role in patients 30 years and above, particularly with comorbidities like obesity and diabetes. It normally affects the axillary, perineal, inflammatory region and perianal. This condition should be referred to a surgeon because it is likely to be a long-term.

Congenital Abnormalities

A continuous tract with the central cord of the spinal cord may be present in some congenital lesions, as well as the discharge of CSF fluid. It is somewhat diagnosis of this variant will take place before an ED presentation.

Perirectal Abscess

The most important factor to differentiate this entity from a cyst on tailbone is the location of the lesion. This condition requires frequent surgical consultation in the ED for formal drainage in the OR.

Pyoderma Gangrenosum

It is an ulcerative lesion usually, occurs in the fourth decade of life with other comorbidities.

Other conditions

Other conditions includes:

  • Inclusion Dermoid/Teratoma
  • Furuncle or Carbuncle
  • Tuberculous granuloma
  • Syphilitic granuloma
  • Sacrococcygeal sinus or Primary presacral

Treatment of Cyst on Tailbone

Antibiotics will not cure a pilonidal cyst. However, doctors have several procedures that they can recommend to you. Here are some of the possible treatments: (7)

Incision and Drainage

For those who have this kind of cyst for the first, this treatment is recommended. Your doctor creates a slit into the cyst and removes it. He will take the hair follicles out and leaves the wound open, putting some gauze on it. This procedure is simple and done under local anesthesia. You need to change the dressing regularly until the cyst heals. The healing takes around three weeks.

Marsupialization

marsupialization of cyst on tailbone

Actual removal of cyst of tailbone thru marsupialization

Image source: medichere.com (9)

This procedure is an outpatient surgery under local anesthesia. Your doctor will make a slit on the area and remove the cyst, hair, and pus inside. Then he will stitch the edges of the cut to create a pouch. Only a small but shallow cut will be done so there is no need for you to change gauze every day. The healing period is around six weeks.

Incision, Drainage, and Closing of Wound

In this procedure, there is no need for you to pack gauze because your surgeon will completely close the wound right after surgery. This procedure is done in an operating room with a surgeon.

Sources:

  1. http://www.webmd.com/skin-problems-and-treatments/guide/pilondial-cyst#1
  2. https://www.epainassist.com/skin/pilonidal-cyst-or-pilonidal-abscess
  3. https://en.wikipedia.org/wiki/Pilonidal_cyst
  4. http://www.medicinenet.com/pilonidal_cyst/page2.htm#what_causes_a_pilonidal_cyst
  5. https://www.mdguidelines.com/easyaccess/pilonidal-cyst/differential-diagnosis
  6. http://emedicine.medscape.com/article/788127-differential
  7. http://www.webmd.com/skin-problems-and-treatments/guide/pilondial-cyst#2
  8. http://www.ibdclinic.ca/media/uploads/.thumbnails/anal_fistula_%26_fissure.jpg/anal_fistula_%26_fissure-460×300.jpg
  9. https://medichere.com/wp-content/uploads/2016/03/Surgery.jpg

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