Questions re: surgery to place Seton

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firecracker1
Regular Member


Date Joined Apr 2007
Total Posts : 208
   Posted 12/14/2009 7:07 PM (GMT -7)   
I just spoke to my colorectal surgeon. He would like to place a seton for a fistula that I have. I also have narrowing of the anal canal and a benign tumor. All of these are causing issues with me passing stool. It is very painful. I cannot afford more than two weeks off of work. He said I would be off of work for 3 to 4 days. He also said he would not do a balloon dilation because the narrowing is not that bad. I love it when they say it is not that bad. They're not the ones trying to pass stool through a narrow passageway. My questions are:
 
1.) How painful is a seton placement?
 
2.) How long would I need to take off of work?
 
He said I would have an open, draining incision. I cannot believe that I would be back to work in 3 to 4 days after such a  procedure. It sounds awful painful to me.
 
Any advice would be greatly appreciated.
 
Thank You,
Valery 

Curly9878
Regular Member


Date Joined Apr 2007
Total Posts : 165
   Posted 12/15/2009 5:48 PM (GMT -7)   
Nobody responded? That sucks... Come on people, I am curious tooooo
30 years old.
Single, probably always will be...  In fact, I bet I become "the cat lady" of the neighborhood...  Only thing is, I am not a fan of cats.    
Oh and as an added bonus, I am a FAT girl with Crohns...  
I am getting ready for my first resection....   My mom always said my beauty was on the inside...   sooo what does it mean when my insides are a mess???   Thanks mom!  I bet I inhereted Crohns from your side of the family.  
NO GUTS-NO GLORY!!!    So, once I get my guts removed...   My "Glory" days are over....
 
That about sums me up!
 


sr5599
Veteran Member


Date Joined Aug 2007
Total Posts : 1202
   Posted 12/15/2009 7:50 PM (GMT -7)   
I don't read the forum everyday, so I just read this today. For me it really depended upon whether I'd been cut before. I had seton placement three times, the first time I had a seton placed in the perianal area I was not comfortable to drive for a week or so. A few years later I had that seton replaced (it had been out for over a year) and I was fine in a couple of days.

I don't know what a seton ring is, though. I had a plasticy string type of seton.

What type of work do you do? Is there any way that you can work from home?
1 fistula, crohn's colitis, limited to large intestine
Compounded budesonide 3mg/daily, Started Cimzia first dose 2/10/09. Dx Osteoporosis 10/08 started Forteo 1/27/09


firecracker1
Regular Member


Date Joined Apr 2007
Total Posts : 208
   Posted 12/16/2009 6:10 PM (GMT -7)   
Thank you for the responses. I sit at a desk all day. Mine is in the perianal area too. A seton ring is a rubber ring instead of the thread. I guess it depends on how deep they have to cut and how much infection there is.

sr5599
Veteran Member


Date Joined Aug 2007
Total Posts : 1202
   Posted 12/16/2009 8:15 PM (GMT -7)   
Mine starts a couple inches (at most) into the rectum and drains out to the perianal area.

They say not to use a donut to sit on... I never wanted to anyway because I didn't want to have to explain it! but I found if I sat to the side, say on a foot or something, it was enough to take the pressure off the incision and I could be fine. If you sit most of the day, you can go back sooner. i'd say if a person had a more physical job it would take more time to recover. I also found that if I leaned way back, it put more pressure on the tail bone and less on the incision.

Good luck... They will also give you pain meds, so that will help!
1 fistula, crohn's colitis, limited to large intestine
Compounded budesonide 3mg/daily, Started Cimzia first dose 2/10/09. Dx Osteoporosis 10/08 started Forteo 1/27/09


patientspiders
Veteran Member


Date Joined Jul 2005
Total Posts : 733
   Posted 12/16/2009 9:13 PM (GMT -7)   
I've had a rubber-band type of seton before, which I think is what it sounds like you're getting...

After several perianal abscess and fistula surgeries, the number one thing is -

Make sure your surgeon knows what he is doing. Mine first surgeon placed the seton in such a manner that it rubbed a nerve or something, so it was particularly miserable. I sat on my left butt-cheek for months. Ask your surgeon how many he has put in before. Be confident in your surgeon.

Other than that - use 4x4" gauze pads (in bulk at med supply stores, saves $$)- those will soak up the ick.
I would give yourself at least one full week off of work, just to get used to the stupid thing.
I can't say you'll "forget about it" exactly, but you get used to it after a couple of weeks.
27f, dx'd CD July '05 after 6 fistula/abscess surgeries
Remicade '05 through '08, with no other maintenance meds (ah, those were the days, eh?)
Tried Humira. Failed. Tried Gluten Free. After 11 months, failed that too. Cimzia - failed.
Currently on:
Helminthic Therapy, Prednisone


jesflr337
Regular Member


Date Joined Aug 2009
Total Posts : 41
   Posted 12/17/2009 9:54 AM (GMT -7)   
I have a rubber band seton, was placed on Thursday.
I was just going to post some questions...
 
As for the surgery itself, I felt really good when I woke up. They gave me a patch behind my ear for any nausea, so I didn't need any of the nausea drugs that make you so sleepy.
I am taking vicodin when I need it and ibuprofin through the day so I can drive and work :)

Surgery was thursday morning, I took Friday off, but was able to get out and go Christmas shopping for a bit.
My bum has been killing me for years, so the fact that it was finally an incision pain, was different... it wasn't too bad. I just took the excuse to sit in bed and watch movies all weekend, but felt pretty good!!
 
I was back to work on Monday and find that even sitting too long hurts, so I try to get up and move around.
 
I was going through 12 4x4s in the beginning, but now am only changing ever 4 hours or so... My question I'm posting is about the drainage- I don't really know what is normal. Follow up on Monday.

FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 12/17/2009 5:02 PM (GMT -7)   
I wonder why you need an incision to get a seton. A seton just is threaded through a fistula. I had one installed after my first abscess wound had healed (long story) and really didn't notice it all. It was weird, but no pain. If he has to make and incision, he must be draining something or what ???? Everyone and every surgery is different so it is hard ot tell if you will need more that 3-4 days. My doctors say you can do as much as you feel like doing. The wound will heal when it does. The only things they all strongly advised that makes it hard to go to work is they want you to take 3 -4 sitz baths a day (meaning butt in a tub of hot water rather than toilet-top sitz bowls -- they really do help), and cleaning out the wound after you go potty (I love my hand-held shower sprayer!). Search out previous posts for wound care suggestions.

Today is Thursday, so I hope it went well!! Let us know how you feel!
Diagnosed with Crohn's in early 2007.  Several peri-rectal abscesses and two fistulae with setons.  Allergic to Remicade and Humira.  Currently on 6MP, and vitamins D and B-12.


firecracker1
Regular Member


Date Joined Apr 2007
Total Posts : 208
   Posted 12/17/2009 5:18 PM (GMT -7)   
this info is so helpful. I am thinking now I'll probably need about a week off of work. I have several abscesss and now a bartholin cyst. I'll also have to have a stricture dilation, but that's not much worse than a colonoscopy. Thank you all for the information. The surgeon explained that they have to do an incision to drain and clean the infected areas. I guess the pain of an incision isn't much worse than the fistula and abscess pain. I feel much more calm about the procedure now.

firecracker1
Regular Member


Date Joined Apr 2007
Total Posts : 208
   Posted 12/17/2009 5:23 PM (GMT -7)   
Also, I have a very detail oriented job and get monthly audits. So, pain killers are out of the question. I also have a new colorectal surgeon who is addressing my stricture/narrowing issues. I fired the other one after he refused to let me ask questions. He kept cutting me off mid sentence and would get annoyed. Told me I was overreacting. No way I was letting him perform any procedures on me.

jesflr337
Regular Member


Date Joined Aug 2009
Total Posts : 41
   Posted 12/18/2009 6:55 AM (GMT -7)   
Fallcolors, I also have an incision and a seton. The incision is just to the right of the seton, and is about 2 inches long, and teardrop shaped. I haven't actually seen my surgeon since Thursday so I'm not sure why he did this too... perhaps he had to clean out some tissue or something. It is an open wound about the size of a nickel I guess... That has been a bit painful, more than the seton itself...

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3110
   Posted 12/18/2009 3:30 PM (GMT -7)   
jesflr337~it is an individual thing as to 'normal' drainage...there were times when I only used 1 or 2 4x4's and then there were days that I used 20:(

I am surprised that you take Ibuprofen...it can cause more harm than help...did you doc say to use it?

good luck firecracker1...take a week to recover, there is no use pushing yourself to go back right away, and delay your healing!
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