Understanding Fistulas on the Tailbone: Causes, Symptoms, and Treatments

Understanding Fistulas on the Tailbone

Fistulas are abnormal connections between two organs or structures in the body. When they occur around the tailbone area, known medically as the coccyx, they can cause significant pain and discomfort. Tailbone fistulas often arise due to infection, injury, or as a complication of certain medical conditions like Crohn's disease.

In this detailed guide, we will cover the causes, symptoms, diagnosis, and treatments for fistulas on the tailbone. Understanding the basics about these abnormal connections can help those affected get the proper care and find relief from uncomfortable symptoms.

What Causes Fistulas on the Tailbone?

There are several potential causes of fistulas developing around the tailbone area:

• Infection - Abscesses or infections near the tailbone can cause fistulas. Bacteria may spread from a skin infection, boil, or infected hair follicle into deeper tissues, creating an abnormal passageway for drainage called a fistula.
• Injury - Prior trauma to the tailbone area, like a fracture, dislocation, or deep wound, can damage soft tissues over time and lead to a fistula.
• Crohn's disease - People with Crohn's disease often develop fistulas as a complication. Areas near the anus and tailbone are especially prone to this.
• Radiation treatment - Radiation to treat cancers like rectal, cervical, or anal cancer can damage healthy tissue and cause fistulas months or years later.
• Childbirth - Difficult vaginal deliveries or obstetric injuries can sometimes result in a fistula forming from the vagina to the tailbone.
• Surgery - Rarely, a fistula can form after surgical procedures near the tailbone, like pilonidal cyst removal, hemorrhoid surgery, or coccygectomy.

There are also some rare congenital conditions, like dermal sinus tracts, that can leave an infant prone to developing tailbone fistulas later in life after infection or repeat trauma to the area.

Symptoms of Tailbone Fistulas

The most common signs and symptoms of fistulas on or near the tailbone include:

• Pain around the tailbone, especially when sitting
• Sensation of rectal fullness and needing to pass stool, even with an empty bowel
• Discomfort or itching around the anus and tailbone area
• Irritation of the skin near the tailbone
• Presence of an opening or hole near the tailbone with possible drainage
• Recurrent episodes of boils, abscesses, or infections around the tailbone
• Difficulty controlling bowel movements or gas (fecal or urinary incontinence)
• Passage of stool, gas, or purulent drainage through the opening of the fistula

Symptoms can range from mild to severe depending on the size and location of the fistula. Multiple fistula openings may be present in some cases. Seeking prompt medical treatment is important to alleviate discomfort and prevent dangerous complications.

Getting a Diagnosis

If you suspect you may have a fistula near your tailbone, the first step is getting an accurate diagnosis from a doctor. Your physician will ask about your symptoms, medical history, and perform a physical exam of the affected area.

Several tests can help confirm the presence and details of a tailbone fistula:

• MRI or CT scan - Cross-sectional imaging provides in-depth views of the fistula tract.
• Anoscopy - The doctor uses a small scope to examine the inside of the anal canal and rectum.
• Fistula probe - A thin instrument gently inserted into the tract to determine if an opening is present and its route.
• Anal ultrasound - Soundwave echoes create images of soft tissues around the anus and tailbone.
• Exam under anesthesia - The provider thoroughly examines the area with you sedated for comfort.
• Fistulogram - Contrast dye is injected to highlight the fistula tract on x-ray imaging.

Blood tests, sigmoidoscopy, colonoscopy, and biopsy of the fistula may sometimes be performed to rule out underlying conditions like Crohns disease or cancer.

Tailbone Fistula Treatment Options

Treatment of fistulas on the tailbone focuses on stopping drainage, managing infection, and promoting healing of the abnormal pathway. Specific approaches may include:

• Medications - Antibiotics to control infection and anti-inflammatory drugs help reduce swelling and discomfort.
• Sitz baths - Warm water soaks promote hygiene and soothe irritation around the anus and tailbone.
• Seton placement - A thin rubber band threaded through the fistula tract guides drainage externally until it heals.
• Fistulotomy - Surgically opening and trimming the fistula heals it by exposing it to air and promoting drainage.
• Advancement flap - Healthy tissue is pulled over the internal fistula opening and sutured closed.
• Fibrin glue or bioprosthetic plug - Sealants injected into the fistula can close it off and stimulate healing.
• LIFT procedure - Ligation of the tract and lining collapse it from the inside to allow healing.
• Fibrin sealant patch - A patch with fibrin glue is placed over the tract opening to close it.
• Diversion colostomy - Part of the colon is diverted to a stoma, allowing fistula healing.

The specific fistula procedure recommended will depend on factors like the severity, location, causes, and number of tracts present. Treating any underlying Crohns disease, infection, or radiation damage is also important.

Recovering from Tailbone Fistula Surgery

Recovery time from fistula procedures depends on the approach used and complexity of your individual case. Most people can get back to light daily activities within 1-2 weeks but should avoid strenuous exercise and heavy lifting for 4-6 weeks after surgery.

Your surgeon will provide postoperative care instructions for wound care, pain management, and activity restrictions. You may need to:

• Clean the surgical area daily
• Apply antibiotic cream and change dressings
• Avoid prolonged sitting
• Take over-the-counter pain medication
• Do sitz baths or soak the area in warm water
• Stay well-hydrated and take fiber supplements to ease bowel movements
• Take antibiotics to prevent infection
• Follow up with your surgeon for examination and potential stool diversion closure

Full healing of the fistula can take two to three months. Call your doctor if you have signs of infection like fever, increased swelling, foul-smelling drainage, or debilitating pain. Prompt treatment helps prevent complications like abscess recurrence.

Preventing Tailbone Fistulas

While not all fistulas can be prevented, the following tips may reduce your risks:

• Maintain proper hygiene around the anus and tailbone.
• Gently clean and dry the area after bowel movements.
• Avoid constipation and straining during bowel movements.
• Treat infections, abscesses, and boils around the tailbone promptly.
• Practice safe sex and get regular STI screenings if at risk.
• Seek care for suspicious wounds, growths, or pains near the tailbone.
• Avoid unnecessary radiation exposure.
• Manage chronic conditions like Crohns disease or diabetes.
• Don't smoke, as this impairs wound healing.

Report any persistent drainage, pain, or swelling around your tailbone to your doctor to determine if a fistula or abscess is developing. Proactive care can help avoid complications.

Outlook for People with Tailbone Fistulas

With proper treatment, most cases of fistulas on or near the tailbone can be successfully cured, especially when caught early. Even more complex or recurrent fistulas can often be managed with the advanced surgical techniques available today.

Aggressively controlling underlying conditions like Crohns disease or pursuing surgery to definitively close obstetric fistulas helps prevent recurrences. Seeking care from a specialist experienced in treating coccygeal or anorectal fistulas can improve outcomes.

Left untreated, tailbone fistulas may lead to disabling symptoms impacting quality of life. Potential long-term complications if a fistula is not properly treated include:

• Chronic or worsening pain
• Difficulty sitting, walking, or moving
• Bowel leakage or incontinence
• Infection spreading to the pelvis or spine
• Abscesses or cellulitis
• Bone and tissue damage around the tailbone
• Narrowing of the rectal passage (anal stenosis)

Coping with the discomfort and impact of a fistula can also take an emotional toll over time. Seeking counseling or a support group may help.

Key Points About Tailbone Fistulas

• Fistulas around the tailbone or coccyx are abnormal tracts that often arise from infection, injury, or inflammatory conditions.
• Symptoms include pain, discomfort, drainage, and difficulty controlling bowel movements.
• Exams, imaging, endoscopy, ultrasound, and other tests help diagnose tailbone fistulas.
• Treatments range from antibiotics to various surgical approaches based on the fistula specifics.
• Controlling underlying conditions and proper postoperative care support fistula healing.
• With early expert treatment, most cases can be successfully cured or managed for improved quality of life.

Fistulas on the tailbone can be incredibly uncomfortable and concerning. Understanding the basics about these abnormal connections helps you seek appropriate care to alleviate symptoms and promote healing. Working closely with your doctor and following their treatment recommendations provides the best chance for a positive outcome.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.