Seton for anal fistula

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TJJJ
New Member


Date Joined Feb 2010
Total Posts : 3
   Posted 2/4/2010 9:35 AM (GMT -6)   
confused Just had my seton replaced and am back in pain! Only through this site and the internet that i have reasonable knowledge of what the seton involves and how it works. However, can anyone tell me what happens when its finished draining i presume the seton will fall out although my first seton didn't i was left and the skin grew over! Do they just leave the scare mess! Not just that all underwear and clothing uncomfortable surely once the fistula had gone they tidy things up!  please reply if you have had same i am female and my perenial area looks a real mess , still painful after first surgery after 9 weeks! I wasn,t given antibiotics and got an infection - well to be honest who wouldn,t even after taking three salt baths a day! Really worried

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3062
   Posted 2/4/2010 10:38 AM (GMT -6)   
My first question is: was your surgery done by a ColoRectal Surgery with Crohn's experience?

There are setons and cutting setons. I have only had 'regular' setons which stay in place until removed and it's job is to keep the track open to avoid closing off the abscess. A cutting seton gets tightened and eventually moves the track outside the body (maybe someone with experience with that could chime in!).

The only time I had mine removed was while on Remicade when the drug was actually closing the tracks. Unfortunately that didn't last and had to have them all put back in:( I had them for more than 10 years...they never closed on their own...so if yours do, I would think your doc should remove the seton.

I have many fistula scars and don't know if they do anything about it...I am sure it's a sensitive area because damaging the muscles down there could be a problem. You should check with your doc if you are still having pain and get something for it. My pain only lasted a week or so but I always had discomfort if I sat for too long.

You should be on meds with your friend(s)...I was on constant maintenance with Cipro/Imuran to help keep things under control. Not perfect but it definitely helps!

good luck!!

HabsHockeyFan
Veteran Member


Date Joined Jan 2006
Total Posts : 2813
   Posted 2/4/2010 11:08 AM (GMT -6)   
I guess mine was a cutting seton then. Mine was tightened over a 6 month period of time. I had to have the seton as I could not take flagyl (oh that stuff was evil on me, but it was healing the fistula drat). Eventually my perianal seton fell out...never actually saw it in the potty, but I knew it was gone.

I was told that if you had to have a fistula, I had the best kind. It did nto involve muscle so I had limted pain and mostly just ache and slight discomfort. I would say if you are having pain, you have muscle involved. I would ask for something for the pain. And DEFINITELY get some antibiotic care.

I will say that I have many issues in the perianal area since my fistula, but I think it is due less to the fistula than to the spread of my disease to that area. I recommend gauze in the area at all times even after the fistula repair and keep using warm baths/showers. I also never use soap on the area and only use kid wipes to clean. The drier you keep the area the better it seems to be for me.

hope things improve...
Dx'd '90 (emergency rupture), symptoms ignored long before that, '03 fistulas and bad flagyl reactions, B12 weekly, Pentasa [until I surrender to the bigger meds]
I'm riding on the escalator of life....


jesflr337
Regular Member


Date Joined Aug 2009
Total Posts : 41
   Posted 2/4/2010 4:21 PM (GMT -6)   

Hey TJJJ,

I've also got a seton- just had it tightened yesterday for the second time, I've posted on here a few times, not too many people have had these it seems, or they're not posting a lot!

My surgeon wasn't sure what he was going to do with the seton in the beginning, I had a large incision on one side that was left open, and the seton which loops around the muscle from the right side of my rectum. It didn't really bother me at first, the incision was what bothered me, it looked horrible and hurt. Once the incision healed up (and I actually may still have a small fistula at the far end of the incision) he started tightening the seton, so I guess at that point it became a cutting seton. It is like a loop of rubber band. The first time he tightened it I was on here in lots of pain, this time either he didn't tighten as much or my body is not freaking out as badly. He said if the tightening bothered me too much, he could just go ahead and cut the muscle under anesthesia, but he said he usually has better success with the seton moving itself slowly outside of the body.

My seton actually seems to collect "stuff" sometimes, and once or twice felt like it was not draining properly, but a hot bath and some pressure usually seems to move whatever is in there out. I still never feel I can keep it clean enough, even with a handheld shower.  He's tightening the seton b/c he says that it may be actually catching some poop and creating more of an infection than it should be, so I'm hoping once it finally works it's way out I'll be healed up... I still have a lot of drainage almost 2 months after the surgery, so I just use those little gauze pads. (I know TMI, but if I can't say it here where can I say it??) :)

I will say he did NOT warn me how much it would hurt the first time around. The nurse kind of chuckled and said it was like having your braces tightened, but I told her I had braces for years and this was a VERY different feeling...

Oh, and I was antibiotics for months before my surgery, but he said I could discontinue after the surgery, and I've felt so much better. That flagyl made me feel horrible and I lost weight, but now I'm starving all the time!


ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 2/4/2010 5:40 PM (GMT -6)   
The first few months are really hard. Remember, that part of the body has gone through infection, inflammation and then surgery: it's bound to hurt. My experience is that the pain will gradually decrease with time, but you will probably always find that it is sore and tender and even painful at times.

I've had a seton in for years. I still wear soft clothing because trousers with hard seams (like jeans) would hurt; I always take a cushion with me if I'm going to be sitting on hard seats; I still always have to wear a pad to catch the drainage.

With time, you may find that this becomes a part of your life, just like managing your diet and timing your social outings in accordance with your gut symptoms.

If you haven't done so, you might like to read the "fistulae" link that you can find in my sig - lots of good seton-related threads in there.

Ivy.
Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


TJJJ
New Member


Date Joined Feb 2010
Total Posts : 3
   Posted 2/5/2010 11:39 PM (GMT -6)   
 Thank you all for your replies- i have another infection - hardly suprising! I dont understand why the NHS dont give you antibiotics when they do the surgery! You have to wait to get the infection first! Mine is in the muscle it came up quite deep on the mri scan. My next appointment is 8 weeks  outpatients not surgery when i suppose he will tighten this thing! At least i now know what im in for! Good luck all

vid53
Regular Member


Date Joined Jan 2006
Total Posts : 117
   Posted 2/6/2010 12:03 AM (GMT -6)   
My seton has been in for 8 years and i have had no problem.

Allison77
Regular Member


Date Joined Feb 2005
Total Posts : 421
   Posted 2/6/2010 12:08 AM (GMT -6)   
Rectal abcess/fistla was the bane of my exsistance for 12 years. My first indication of Crohn's were 2 rectal (on either side of bum cheek) abcess' that required cutting, draining and packing. This left me with 2 continous draining fistula's. I had surgery 4 years later to insert seton's. I ended up with an infection that put me back in the hospital and ended up with 3 strokes. I was 26 at the time. Last November (im now 32) I had my rectum removed and have a permanent colostomy. This was the only way for me to overcome my rectal fistula's, Im so happy that I no longer have to wear a maxi pad to catch drainage. Good luck with yours!!!!!!!

-Allie
-Allison
RX Crohn's 1999, over 30 surgeries, 3 strokes, permanent colostomy and rectum removal.
 
"The most unfortunate thing that happens to a person who fears failure is that he limits himself by becoming afraid to try anything new."


TJJJ
New Member


Date Joined Feb 2010
Total Posts : 3
   Posted 2/9/2010 5:29 AM (GMT -6)   
 Sorry to hear about you Alison -i just hope that i dont end up taking the same route, I am a very young 40 year old who prior to this was very active and sporty. I know there are worse things in life. Good luck

exit 4
Regular Member


Date Joined Apr 2009
Total Posts : 116
   Posted 2/22/2010 1:33 PM (GMT -6)   
wow, i am sorry to hear about your issues, how do you feel now with perm colastomy?
Male, 45; UC 15 years, Lexapro helped with stress and UC.


Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3062
   Posted 2/22/2010 2:21 PM (GMT -6)   
well, I have a permanent ileostomy, for many of the same reasons as Allison (no strokes), and LOVE my ileo:) After losing my quality of life to Crohn's and all it's merry fistula friends, I finally have a life!! I can travel, run/workout, swim, ride horses/bikes and in fact there isn't anything i can't do!!!! btw, I am almost 42, now, and wouldn't trade my 40's for anything:)

Allison77
Regular Member


Date Joined Feb 2005
Total Posts : 421
   Posted 2/22/2010 2:58 PM (GMT -6)   
<-agrees and nods head at what Ohio76 said. I feel FABULOUS, I look FABULOUS and most importantly I can BE fabulous to all my friends and family and especially my husband, who for many years have watched me cope with Crohn's and all the things that have come with it. Do you know what I did yesterday?? I went out and helped my friends flyer cars in a mall parking lot. I could have NEVER done that without Oscar (my colostomy, he has a name). I can do and eat things that I haven't been able to do/eat since I was 18.
I am still on Imuran, but have NO sign's or symptoms of Crohn's. NONE. I want to shout for joy and tell everyone that Oscar is the BEST thing I have ever done. I haven't struggled with the body image issue as most do when they receive an ostomy, Im not sure why, but think it's because I don't view Oscar as an impediment to life but rather a life giver. I love him and I feel amazing. Im 32 and life is just beginning for me. WOOHOO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

-Allie
-Allison
RX Crohn's 1999, over 30 surgeries, 3 strokes, permanent colostomy and rectum removal.
 
"The most unfortunate thing that happens to a person who fears failure is that he limits himself by becoming afraid to try anything new."


Crohnalicious
New Member


Date Joined Feb 2010
Total Posts : 2
   Posted 2/22/2010 9:50 PM (GMT -6)   
I have had 3 different fistulas with setons over the past 5 years, the last one had to be tightened and that was so extremely painful for the first 12 hours, I cannot describe. If you are having pain that is lasting more than 24 hours since your procedure or tightening, call your doctor. I was almost going to cut the thing out myself, it was so bad. I think it was worth it in the long run as the fistula closed shortly thereafter. I never felt discomfort wearing clothes or sitting unless it wasn't positioned correctly.

I found the only thing that helped keep it draining and clean was bathing in very hot water. I am lucky to work from home when I need to so I was in my tub 5-6 times per day in water deep enough to cover my bum and soaking as much as possible for 15-20 minutes or longer at a time, especially after a bowl movement and especially in the beginning/after surgery. I carried a small baggie of baby wipes (with no alcohol that causes burning) in my purse for times when I wasn't home or in a public place to make sure the area was clean. I limited my food to liquids or close to liquid as possible to reduce the amount of action in the bowels to lessen the irritation. I always where a pantyliner, even now. My bum is not the same and has leakage issues from the scars and surgeries. I think one of the setons I had in almost a year and it fell out on its own.

SOAK SOAK SOAK.....see if that helps you. And I was always on an antibiotic from the get-go as well. Good luck to you. I know it sucks. I'm sorry you are going through this and it breaks my heart to read these posts of how much people suffer with this disease. I'm managing with mine right now, so I can't complain but I always wonder what is to come. I'm 42 and I'm liking the wisdom/experience part of it all, but not the wrinkles on my face, blah! haha

iran
New Member


Date Joined Mar 2010
Total Posts : 1
   Posted 3/15/2010 2:07 AM (GMT -6)   
Hi everybody, I have had a fistula for 2 years and had a seton surgery on November 2009. I have to make it tighter that is so painful for me. On top of it I am 4.5 month pregnant, so I cannot take too much medication. My Dr wants to tight the seton on another surgery (because I cannot handle the pain), but I am worry because of my pregnancy. It is so uncomfortable situation for me; I have a 2.5 years old baby boy that makes it harder. I am so hopeless. Sorry to say this. God bless you all.

Fenway111
New Member


Date Joined Apr 2010
Total Posts : 1
   Posted 4/26/2010 10:24 PM (GMT -6)   
Hi,, I am new to this site.. I was just looking for some people who went through having a seton placed.. I was diagnosed with Chrohns two years ago around Christmas time,,  I am a 34 year old women,,  and I have been having problems ever since..  I had two surgeries this past December, the first surgery was to place two cutting setons in.. and the second surgery was an absess that my doctor drilled.. both very painful, I have to keep going back till this day to have the setons tighten, actually tomorrow I have to go..  I am in tears just thinking about going. I hate it! It is so painful and my doctor told me when I had them placed that they should only be in for a couple of months now here is May and they are still in full force.. I hate wearing tight jeans and sitting for a long time kills too... I am just wondering if this was the best way to go about having the fistulas corrrected, because too me it just seems like torture!! I am also wondering if people actually work when they are going through this because I ( never thought I would say this) am so happy that I am collecting unemployment because I don't think I could handle being at a job all day with this crap! Not only does it kill when you get them tighten, I have to plan my week around being sore and not have any plans when making the 3 week appts..... uggh!

rectally fedup
New Member


Date Joined Jul 2010
Total Posts : 11
   Posted 7/11/2010 10:19 PM (GMT -6)   
Crohnalicious said...
I have had 3 different fistulas with setons over the past 5 years, the last one had to be tightened and that was so extremely painful for the first 12 hours, I cannot describe. If you are having pain that is lasting more than 24 hours since your procedure or tightening, call your doctor. I was almost going to cut the thing out myself, it was so bad. I think it was worth it in the long run as the fistula closed shortly thereafter. I never felt discomfort wearing clothes or sitting unless it wasn't positioned correctly.

I found the only thing that helped keep it draining and clean was bathing in very hot water. I am lucky to work from home when I need to so I was in my tub 5-6 times per day in water deep enough to cover my bum and soaking as much as possible for 15-20 minutes or longer at a time, especially after a bowl movement and especially in the beginning/after surgery. I carried a small baggie of baby wipes (with no alcohol that causes burning) in my purse for times when I wasn't home or in a public place to make sure the area was clean. I limited my food to liquids or close to liquid as possible to reduce the amount of action in the bowels to lessen the irritation. I always where a pantyliner, even now. My bum is not the same and has leakage issues from the scars and surgeries. I think one of the setons I had in almost a year and it fell out on its own.

SOAK SOAK SOAK.....see if that helps you. And I was always on an antibiotic from the get-go as well. Good luck to you. I know it sucks. I'm sorry you are going through this and it breaks my heart to read these posts of how much people suffer with this disease. I'm managing with mine right now, so I can't complain but I always wonder what is to come. I'm 42 and I'm liking the wisdom/experience part of it all, but not the wrinkles on my face, blah! haha
 this is my first time on this site.  For the last 3 years I have had 8 Abcesses drained finally they sent me to a specialist who put in a seton string.  That was may and now it is july I know thats not a long time but after 9 surgeries I have almost given up  hope.
After you seton came out did the drainage stop or continue?
 
 
 
 
 
 
 
 
 
 

rectally fedup
New Member


Date Joined Jul 2010
Total Posts : 11
   Posted 7/11/2010 11:01 PM (GMT -6)   
Dear TJJJ, I had a seton placed in May I only wish I knew for how long this will continue I had 9 abcess surgeries prior to this one and was finally sent to a specialist I am still draining I only wish I knew how to get the drainage to stop I take sitz baths on a regularly basis.  It is very uncomfortable at times and it is very hard to hold down a job for the last 3 years because of all that is happened.  Most of my pain is gone from the seton placement I just wished it could be taken out and a fistula plug put in and this could all be behing me.
TJJJ said...
confused  Just had my seton replaced and am back in pain! Only through this site and the internet that i have reasonable knowledge of what the seton involves and how it works. However, can anyone tell me what happens when its finished draining i presume the seton will fall out although my first seton didn't i was left and the skin grew over! Do they just leave the scare mess! Not just that all underwear and clothing uncomfortable surely once the fistula had gone they tidy things up!  please reply if you have had same i am female and my perenial area looks a real mess , still painful after first surgery after 9 weeks! I wasn,t given antibiotics and got an infection - well to be honest who wouldn,t even after taking three salt baths a day! Really worried

This my first time on this site and I am looking for ways to cope with whats goin on.  I have had 8 surgeries to open abcesses rectally.  In May I was finally sent to a Specialist who Placed a Seton string in.  I was hoping this would not be a long term thing but I have read otherwise.
I was also told the seton string would eventually be removed and fistula plugs would be used.
 
Has anyone heard of these fistula plugs and does the drainage have to totally stop before the can be put into place?


ABF
New Member


Date Joined Apr 2012
Total Posts : 1
   Posted 4/9/2012 8:31 AM (GMT -6)   
Hi
I have had my fistula for over a year now. From your post I have learnt a lot and the pain I was experiencing was normal. I had surgery a week ago and they never said anything about the pain. However my seton had fallen out less then a week after the surgery. I looked after it washed as match i could ( being a primsry school teacher doesnt help). I was just wondering if this has happened to anyone else and what the next step might be. Thanks

jensen62
New Member


Date Joined Aug 2012
Total Posts : 1
   Posted 8/20/2012 7:31 AM (GMT -6)   
I had foot surgery 12/19/11, having been prescribed Oxycodone for pain (which I definitely needed), I didn't realize that I'd need a stool softener to go along with it, and I wasn't given any instructions stating this. Subsequently, I developed an external hemorrhoid a month later (very painful), because I was constipated from the Oxycodone. Toward the beginning of Feb, I noticed a squishy lump in my perineum. I guessed it was a cyst, so I went to my doctor. She prescribed me some meds for the hemorrhoid, and referred me to general surgery to get all checked out. In mid-March, I was seen by (2) surgeons, who determined that the hemorrhoid was going away on its own, but the cyst could be removed, since it wasn't going away.

Fast forward to May, when I finally got the cyst (non- malignant) removed under general anesthia. I was happy for a few moments, until I got home and noticed that the surgeon did NOT close the wound completely. I notified him of this and he said 'it's better to heal this way, drainage is better if left partially open'. I wasn't convinced, yet I followed the after care instructions to a T and was hopeful this was over. Well, it never fully healed. Several tiny holes in the scar (which would leave tiny blood droplets, periodically) did not close. (3) trip back to the doctors office, to include: a urologist (It looks like it's healing ok), the Chief of Surgery who was going to do a sigmoidoscopy on me, (well i cannot see anything wrong down there), to finally going to my surgeon with a baggy of tissue that had blood on them as proof that my scar hadn't healed correctly.

He stated that initally while he was taking out the cyst, he had not seen a fistula, but now he suspected there was one present. Anyway, I had surgery again (8/13) to clean out any remaining cyst remnants and scar tissue. I woke up from the anesthesia feeling much different then I had from my surgery in May. The nurses couldn't tell me what had been performed because apparently my surgeon had to do another surgery immediately after mine, and didn't log it (my info) into the computer. They discharged me w/o telling me what had happened. I didn't know that I had a fistulotomy/seton drain until I got home, pulled this heavy bleeding pad out from between my ass and saw these yellow bands hanging down. To say 'I freaked out' would be an understatement.

It's been (7) days, my scar from the cyst clean up busted wide open. Went to the emergency room, they decided that leaving it WIDE open would be best for drainage/infection control (???). It is quite painful to have that sitting there open. I didn't take the pain meds (Norco) initially, because I thought my procedure was the same I had (3) months ago, in which I skipped the meds. I am behind on the pain, have major bowel movement problems, not to mention that when I try to go, that scar opens up wide, so I'm sure there's more infection going in/then coming out. Don't even want to go into the seton/drain issue. Don't even know how I'm going to manage another day much less a few weeks/months with this contraption installed inside me.

My apologies for my early morning tirade. I cannot sleep. I've been investigating (abcesses, fistulas, fistulotomies, setons, etc) for a week now. I guess I should try to accept this and relax. I feel like I should have had a full explanation to what I might expect before I had this done. I had no other medical issues, active, healthy, just turned 50. To all you others out there; I know it could be much better/worse. As I said before, I apologize if I offend anyone who is going through something far more difficult then what I am presently. I'm just frustrated.

God speed to ALL with a healthy recovery.

Frustrated

MedievalHamster
New Member


Date Joined Aug 2012
Total Posts : 2
   Posted 8/30/2012 7:03 PM (GMT -6)   
My seton is looped through the fistula and the anus.. and it isnt a cutting seton. So it is supposed to cut through the muscle of the anus and then fall out, since it isnt a cutting seton the muscle should have time to heal back.. Even though this sounds extremely painful it is somewhat fine until i go to the bathroom. In which it burns so badly the only word I would think to describe it would be a terrible burning sensation in the anus.. I know there are far worse things to happen, and to be honest I'd take this over the tube down my nose when they needed to scope me. and possibly since the seton didnt work last time maybe it's a cutting seton like Equest said
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