Fistulotomy with Seton

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New Member

Date Joined Sep 2011
Total Posts : 10
   Posted 9/13/2011 12:50 PM (GMT -7)   
I have read a lot of postings on the Fistulotomy procedure and recovery, and I am truly grateful for all of the information. While some of the information did not pertain to me, most of it did, and was VERY helpful. So I really wanted to say thank you to everyone who has posted on this topic.
I hope that by posting my experience, more people will gain knowledge and maybe some of you can post with current updates about your recovery. :-)
In January of 2008 I was diagnosed with a fissure. It was extremely painful and took about 3 months of sitz baths, witch hazel wipes, and anti itch creams to clear it up. I never thought anymore of this pain, once it had healed.
Then in February of 2010 I felt a lump on the bottom right buttock, close to where your bum curls under. It wasn't painful, or squishy. Just a golfball sized, hard lump. When I finally got the nerve to see my Family Doctor about the lump it was August of 2010. He did not know what it was, and refered me to a specialist/surgeon. When I went to see him in September, he thought it was a cyst, and did not want to do surgery back there, unless absolutely necessary. So we left it at that.
In November of 2010 I had a LOT of pain back there. Then one evening it burst. A smelly brownish discharge oozed from this tiny little hole. I thought great! No more pain, and no more lump bothering me any more. I thought it would ooze for about a week, (like a boil) but that was not the case. I didn't worry to much about it because it only oozed on occasion, and really never gave me any upset.
Then it May of 2011, the hole sealed up; the absess tried to start again, and I was in extreme pain, I couldn't wear pants, sit, or stand for long periods. So I called the specialist/surgeon again. This is when he told me it was a Fistula, and that it required surgery. When he explained what would happen I almost fainted. How can you leave a gaping wound open in that area?
Within 2 weeks they called for me to have surgery, however we were heading into a busy season at work, and I was covering for a co worker, I could not get the original time off of work. They wanted to operate at the end of July, but my son was going into Lacrosse provincials and I did not want to miss that. So I postponed it again. And really started research the procedure. 
Friday September 2, 2011 I had a fistulotomy with Seton, (no more excuses) Preformed as a day surgery at our local hospital. I guess I am one of the lucky ones. The surgery went off without a hitch. I came out of the Anaesthetic and was a little uncomfortable. Was able to get up and go to the bathroom, and was home in about 5hrs. I slept most of the remainder of that day.
Day 1 post op. I was a little uncomfortable getting around (on a scale of 1-10 - maybe 4 or 5) light meals, lots of water, and pain medicine. Sitz baths x2 daily, and after a bowel movement. The wound is open and oozing pinkish-white, panty liners placed in underwear was catching all of the ooze.
Day 2 post op. Pain was worse (5-6 on scale) but it felt more like muscle pain than sharp pain. Was able to pass wind with no pain. Same diet (light meals, lots of water, pain meds) and I had my first BM. I had been dreading it. But surprisingly it wasnt bad. Cleaned up with flushable wipes, had a sitz bath. Felt better after that.
Day 3-5 post op. Walking around without much pain - more sore than anything. Back on a regular diet, bowels moved very easily... feeling better each day...
Day 5 post op - All is going well, until I went to for my 1st post op appointment. I guess with him looking at the incision site,and seton, it stirred it up a bit, more oozing and a bit more pain.
Day 7 post op - felt great! Diet back on track, 1-2 regular BM a day, pain at about a 1-2, down to 1 panty liner for the little bit of ooze. I thought I could go to work (I have a sit down office job) I made it from 9-3, then I had to go home. Pain medicine and sleep. But happy that I was able to make it as long as I did.
Day 8-9 - feeling good, almost back to normal. incision still open and oozing (but not nearly as much as when it was a draining fistula) still doing sitz baths 2-3 times a day. Able to sit long periods of time. Sometimes Seton Stitch gets in the way but all in all feeling good about the whole thing.
Day 10-11 - back to work now. Not a lot of pain or ache, ooze is almost down to nothing. Took a percacet last night for some pain after sitting all day, BM 1-2 day semi solid, no pain passing them. Looking forward to getting the stitch out and being completely healed again.
Day 12-13 - for some reason I am in a lot more pain. I looked at the incision and it looks good, not red, not hot, so I dont think there is infection. The stitch looks a little longer - maybe I sat on it, or its working its way out now?
I go back to the specialist/surgeon on Sept 27th, he wants to see how I am healing and talk about removing the stitch!

Post Edited (PITA1972) : 9/22/2011 10:53:43 AM (GMT-6)

New Member

Date Joined Sep 2011
Total Posts : 10
   Posted 9/22/2011 12:34 PM (GMT -7)   
Almost 3 weeks post op now. Hardly any pain, fistulotomy incision is healing nicely. Starting to get anxious about the stitch removal, and have a few questions I hope that someone can help with.

My seton does not come out the anus. It is located about 1/2way between where the fistula open was and my anus. Is this normal? Will the seton come out on its own? Will it be another surgery to remove it? If so is it under general anaesthetic? How long is the recovery after that?

Any help would be apprciated

New Member

Date Joined Sep 2011
Total Posts : 10
   Posted 9/28/2011 1:34 PM (GMT -7)   
So, yesterday was my 2nd post op appointment.
The Bad news - seton stitch has to stay in for 8 more weeks confused
The Good news - no further surgery, is needed, as it stands right now. The fistulotmy incision is almost healed (3 1/2 weeks after surgery). I was in a good place yesterday so was able to take in everything the surgeon said.
My fistula was up quite high up and crossed thru the involuntary sphinter muscle up. The seton is a cutting seton and will continue to work its way thru this muscle so that I will not become incontinent.  
There is no surgery to remove the stitch, he will do it right in the office, and it is only a tingling feeling as it is being pulled out.
I will update after November 25,2011 - unless something happens before the stitch is scheduled to come out.
I hope that my experience helps others new to the fistula world... And a BIG SHOUT OUT to all those that posted and gave me the information that I needed during these last few months - THANK YOU!!!!!! smilewinkgrin

Jonny Five
Regular Member

Date Joined Sep 2009
Total Posts : 107
   Posted 9/28/2011 8:33 PM (GMT -7)   
I'm happy to hear things are proceeding well and you are happy with the results from your seton.  I hope everything continues to go well for you.

New Member

Date Joined Sep 2011
Total Posts : 10
   Posted 12/7/2011 8:42 AM (GMT -7)   
I am scheduled to have my seton out at 10:15 today, (14 weeks post op) but it is still leakling a little. What are my chances that he will take the stitch out today? The way it has healed around the seton is now making it a bit uncomfortable to sit directly on my bum.
I would like it out today, but if its not ready I dont want another absess and fistula.... really stressing.

New Member

Date Joined Sep 2011
Total Posts : 10
   Posted 12/7/2011 1:12 PM (GMT -7)   
So it went well, a little discomfort when he was taking the stitch out. I will be back to sitz baths 2 to 3 x daily until it heals (about 3 weeks). It is a bit uncomfortable now, but I think that is because of the location(plus I am at a sit down job). It will be nice to go home tonight and have a soak. There is a little blood oozing, but he said that was to be expected. Provided there is no other issues, I am in the clear.

Thanks to everyone who posted about this procedure. You all have been very helpful

New Member

Date Joined Apr 2012
Total Posts : 1
   Posted 6/2/2012 12:40 PM (GMT -7)   
PITA1972, how are you doing?

New Member

Date Joined Jan 2012
Total Posts : 19
   Posted 6/2/2012 9:35 PM (GMT -7)   
I have to say you are LUCKY.. I had my surgery Feb 12th and I am still wearing gauze between the cheeks and a panty liner.. this Friday May 25th I started running a high fever 104.8 and called my GI.. on cipro and flagel and have a huge new abscess.. so I get to have another surgery and have another seton put in.. he wanted to do it May 31st but I do not want to miss my sons high school graduation.. after the surgery my doctor leaves in a penrose drain ( HORRID PAINFULL) for a week and I am unable to sit at all.. lay down take pain meds.. after its out I still have a hard time for weeks afterwards.. by far the worst thing to happen to me is these perianal abscess's ...

New Member

Date Joined Mar 2015
Total Posts : 4
   Posted 3/6/2015 10:51 AM (GMT -7)   
Hello everyone,

I have read a lot of postings about Anal fistula, fistulotomy, procedure and recovery, and I am truly grateful for all of the information I was able to find online. Thank you!

I also want to share my experience to help others.

It was very helpful to read forums because I didn't know that much about the surgery. However, we also need to be careful because reading too much information or about bad experiences can also become confusing and even scary... balance is the Key!
I hope you can find below a good summary and maybe the answers to some of the questions you may have about this surgery or about the recovery.

For me and at first, I thought it would be a simple intervention and that I would be all good after a week or so but when I came back in the room after the surgery, the doctor told me that I had also a Seton in place (I didn't know what it was!)  ...the medication was probably very strong because I didn't realize that much on that day what was a seton ;)

The next day I realized that this surgery was only the start of a recovery and it was better for me to learn more about it and go through it with the best attitude I could. 

I had my fistulotomy with a cutting Seton placement almost 3 months ago and I can finally say today that it is now all OKAY. I SURVIVED :)

Now I feel very good and the recovery is 99% completed but the first 8 weeks were totally different (see more details below).

TRY TO STAY POSITIVE. You will feel so good and proud once everything is finished.

I also find that there are more people posting about their negative experiences about anal fistula than people sharing good and positive experiences.

On this post, I would like to share with you a summary of the experience I had with my anal fistula surgery in order to help others that might be facing the same situation.

I think it is also important to remember and to always keep in mind that keeping a positive attitude in the most difficult times we may face in life, will help us going through it better and faster.

I think our Mental power/attitude can be our best tool and be very helpful in any surgery/recovery and keeping positive vibes will not only help us going through the recovery but will also help us to keep a happy life during the healing process.


My suggestion & tips:

- Keep the area clean (Sitz baths (5 minutes)  3 Times a day + after bowl)

- Keep the area Dry after shower and sitz baths (Hair dryer if needed)

- Drink alot of water  (6-8 glass of water)

- Take your prescribed pain killers only if you feel severe pain.

- Drink food that a rich in Fiber

- After few days, try to go the bathroom at the same time everyday and try to keep that routine....  You will be able to keep regular bowel movement.

- For the discharge, you can wear pads or 4x4 (non sterile gauze) that you place between your butt cheek. (I had to change mine many times per day).

- Don't worry, discharge is normal for the first few weeks. It can be yellowish to brownish color and it can have some smell and especially if the seton is other material than Rubber.

My Experience:

- Small bump near the anal area (No pain).
- Bump was sometimes becoming bigger and then start leaking liquid (not smelly).
- Doctor said it is an Anal Fistula and the solution is a Fistulotomy
- I went for the surgery in the morning and it took about 30 minutes.
- They offered me to do it under general anasthesia or with Spinal anesthesia. I chose the second option with a feel good cocktail of medication during the surgery.
- The doctor came to see me after the surgery and told me that the fistulotomy went well but that he also had to place a Seton.

A new episode in my life was starting...

Day 1 to Day 5 after the surgery: 
Pain, lot of discharge, not feeling good at all.
Need to accept the situation, the seton, the discharge, etc.
I drove my car after 24 hours and I tried to go for a few minutes walk everyday. Drinking a lot of water and trying to eat healthy.

Week 2 after surgery:
Feeling much better than first week, still some pain and discharge.
Still drinking alot of water and trying to eat healthy

Week 3 after fistulotomy:
Feeling better than week 2, less/light pain and still some discharge.
I Went to the doctor for a follow up and he tightened the Seton (Pain!). The rest wound was healing well and I still have to do sitz bath or clean with shower head 2 times a day.

Week 4 after fistulotomy:
Feeling pretty normal and I feel that the worst part is now behind.

Week 5:
The seton was tightened again (The pain may last for up to 24 hours after the Seton is tightened by the doctor).

The doctor told me that we need to keep a cutting seton usually up to 8 weeks after the surgery and until it falls by itself. If it doesn't fall by itself, the doctor will simply remove it in his office.

My seton felt on week 7 during bowl and few days after I had no more discharge.
I was so happy and that is the point were I totally starting to feel Free again! :)

I saw my doctor few days ago and he said that everything is OKAY but the wound can take up to 1 year to completely heal into a nice scar. I still have to see him again in 2-3 months for a simple follow up.

Good luck to All and remember to stay positive.
There are so many beautiful things we can learn and see when we face difficult times.

On the first 2 weeks after the Fistulotomy, you may find it hard to believe that you will be feeling 100% normal again, but YES YOU WILL! :)

Take care,
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