Pilonidal sinus and hypermobile coccyx
Jonas, Germany
Posted 2021-06-13
Preface - Pilonidal sinus
I began feeling a sharp pain in my coccyx area first in January 2017 which lead to a minimally invasive pit picking surgery in the Munich Hospital, performed by Dr. Imgard Weindl (I don't think she works there anymore as of 06/21).
Unfortunately, I still experienced a feeling of pressure when sitting in the first few weeks. Although the pain overall got better and better and there were days almost without pain, I still had days on which it was difficult to sit. Particularly after long periods of sitting relaxed and leaned back I had a considerable amount of pain. Furthermore, the pain kept increased again in June 2017.
End of June 2017 a second pit picking operation has been performed by Dr. Hofer in Munich, who I can highly recommend for the purpose of treating pilonidal sinus, (see www.darmsprechstunde.de). A distinctive difference in his method is that he examines the area in advance using an ultrasound-device and can thus easily discover the fistula in its whole complexity, which is a big advantage compared to the traditional probing performed by other doctors. The pain got away pretty fast after surgery. Unfortunately, I was experiencing pain again roughly two years later after a long-haul flight to Thailand in November 2019.
Unknown new Coccyx Pain:
My coccyx pain returned after a long-haul flight to Thailand. Even after the flight, I still had lingering pain when sitting and even while sleeping on the hard mattresses in the booked hotels.
However, the pain was still reasonably bearable. This changed during my next vacation around new year's eve 2019/2020. The prolonged sitting times during dinner, followed by even longer sitting times playing board games and drinking at the bar on mostly unpadded chairs for almost the whole vacation time where too much to handle for my coccyx. I only found relieve when we returned to our hotel room at night and I could lay down on my stomach.
At first I assumed that I might have another relapse of pilonidal sinus (see above), so I travelled to Dr. Hofer in Munich again (see homepage above).
(Un?)fortunately, in the ultrasound in January 2020 Dr. Hofer did not discover any abnormalities. So he sent me back home without any treatment. Also, Mr. Hofer recommended that I visit Mr. Pr. med habil. Achim Benditz for treat my coccyx pain.
Dr. Benditz (see Doctors and specialists Germany, I asked Jon to add him there).
After appointments with my family doctor in Stuttgart who sent me to magnetic resonance imaging of my pelvis and then a second time of just my coccyx without any findings, I finally went to see Mr. Benditz in Bad Abbach in December 2020. For the first time dynamic x-rays (standing & sitting) were taken. It was clearly visible that the last 2-3 elements of the coccyx rotate by up to 90 ° inwards when sitting.
As part of the examination, Mr Benditz injected me with a mixture of cortisone and an anaesthetic, the effects of which I observed over the next few weeks. However, since I had been sitting on padded furniture in the home office and otherwise on seating rings during the prior weeks due to corona, the improvement was not as clear and distinguishable as I had hoped because of the already milder pain prior to the injection.
After two interim (and senselessly painful) visits to an osteopath at the request of my wife and family, I went to see Mr. Benditz again in April 2021. This time I had previously tortured (=prepared ?) myself willingly and sat without any seating ring and preferably on hard surfaces the days before and during the three hour car drive to Bad Abbach. This way, I was experiencing almost unbearable pain while sitting in Mr. Benditz waiting room. During the visit I asked him to pat down my coccyx prior to his injection just to verify my coccyx is indeed the problem. He immediately found the spot and I almost jumped. The effect of the cortisone / anaesthetic mixture that was injected immediately afterwards led to a great reduction of pain within seconds and I could sit in his office just minutes later almost painfree. Therefore, I was now confident enough about the cause of my pain and scheduled surgery for June 2021
June 2021 - Coccygectomy
The stay at the hospital and the surgery itself (Mr. Benditz 99th(!) Coccygectomy) were very professional and the motivated team in Bad Abbach took great care of me. A small drawback with the chosen type of anaesthesia (spinal anaesthesia with additional sleep inducing fluids) was that I was initially not really able to urinate the next day. Unfortunately, the pressure on the bladder became so great that a bladder catheter had to be inserted. This was quite uncomfortable (but necessary in my case). I therefore recommend to empty your bladder as much as possible beforehand and not drink too much after surgery until you can urinate again. ? Another alternative would be to choose the general anaesthetic method. The operation took place around 8:30 a.m. Seemingly paraplegic at first, feeling in the legs comes back in the following hours step by step although I wasn't able to move my toes until around 8 hours after surgery. Urinating did not work satisfactory until the following night, almost 20 hours after surgery (I had the catheter removed the evening before because it was too uncomfortable).
The upside about the spinal anaesthesia is that you are basically pain free for up to approx. 24 hours after surgery, due to the morphine injected in your spine in combination with the anaesthetic. A small additional drawback of this method is, that monitoring in the wake-up/monitoring room is required during the day of surgery and the first night. You are not released to your room until the following morning.
The very next day I was already able to walk very slowly without almost any pain. Just sitting down led to (bearable) pain. Lying on my side, on the other hand, was almost pain-free - less than 2 days after the operation! I didn't even need pain killers until the 2nd day after surgery due to the spinal anaesthesia.
Mr Benditz visited me daily and told me that all hypermobile parts of my coccyx have been removed (3 in total). The discharge from the hospital was done after a total of three nights. Regarding after-treatment basically everything is allowed after the threads have been removed, which is scheduled roughly 14 days after surgery. It is advised to also try sitting in various positions and keep mobile to avoid having a very hard and inelastic scar.
Update, 2021-08-15
Healing process at home
Back at home (my wife picked me up and drove me home with my laying on the back row of the car) I tried to keep mobile (small walks etc.). I had to (and was able to) visit my doctor at home for a sick leave letter directly on Monday (five days after surgery). Everything looked fine, no infections. The first days I had to move very slowly but it kept getting better daily. To give you an idea of my surprisingly fast progress, please see the below timeline of my personal "milestones":
- 8 days post surgery: stopped taking pain killers
- 2 weeks post surgery: thread removal, everything looked very good and scar was closed
- 2,5 weeks post surgery: went swimming. The area of surgery felt really stiff, but slow crawling with slow leg kicks really helped loosening everything up. I even started swimming some laps the same day. Like during the prior days, new or "stretchier" movements lead to some "pain-stings" (think 1s of sharp pain). Mr. Benditz later explained me this type of pain is caused by small ruptures, which lead to a softened scar tissue and are very beneficial
- 3 weeks post surgery: started working again (in homeoffice), with breaks on the couch, I couldn't sit for prolonged periods yet.
- 3,5 weeks post surgery: first gym visit after surgery. I did bench press, squats and some dumbbell rows with low weight. Laying back on the bench was pretty unpleasant, especially the process of changing position from sitting to laying back. During the squats there was this stinging pain again, so I took it slow. I did go multiple times during the next weeks and the progress was very good, pain subsided further and further
- 4 weeks post surgery: rode my bicycle again but could only go very slow, because putting pressure on the pedals was still too painful
- 5 weeks after surgery: This was around the time I thought I am already better of pain-wise than prior to surgery (of course the post surgery pain is different, but in terms of overall life quality this was the "break-even" week.)
- 2 months after surgery: I am almost pain free and sold/gave away all my seating rings/pillows. I can comfortably lean back/roll back over the scar (which was painful the weeks before because this compresses the scar tissue)
Images of the scar at 5, 11, 17 and 28 days after surgery.
Final thoughts and tips
- My experiences are not the standard. Mr. Benditz told me during our call after 6 weeks that my healing process went particularly well compared to his other patients
- Mr. Benditz and me think that moving a lot and causing the 'stings of pain/micro-tissue-ruptures' is the best way to soften the scar tissue and reduce pain. Many other patient don't easily reach this point and this could cause the scar tissue to become and remain a 'hard block' for up to a year. So always keep moving and torture yourself a little.
- Swimming (crawling with leg kicks), sitting and squatting really did a lot of loosening the scar tissue. Daily walks were also good
- The type of pain is very different before and after surgery. Before surgery I couldn't sit on hard surfaces for longer periods due to my coccyx, after surgery it was the opposite. Now soft surfaces were problematic because these tended to compress the whole scar tissue more. Sinking into chairs was painful (my benchmark situation was the change from sitting to laying down for bench press in the gym).
- I would definitely recommend Mr. Benditz and wish I had done the surgery sooner.
Update, 2022-10-09
I am still very happy with the results and I am pain free except for standard discomfort when sitting on the hard floor playing with my son for hours.
