I have read, with much interest, the various threads regarding the above treatments and thought it would be helpful for me to share my story with you; I understand how helpful these forums are for people who are undergoing or have undergone such a procedure.
In short: eights years ago, I had a fistula which was laid open ("fistulectomy) and it healed fine and I had eight years of no pain or problems.
In September 2011, I noticed that I had an abscess and asked my doctor to refer me to a colorectal surgeon - these are the only surgeons who you should go to. At first, my doctor didn't want to refer me to a specialist but I insisted based upon my own experience and because I had private medical healthcare and the option was there.
My surgeon met with me and said that it looked like I had fistula but that the only way to make sure was to have an MRI scan. I had the scan and it confirmed that I had two fistuals (one branching off from the other).
My surgeon explained that part of the fistula could be laid open and that the other part needed a seton stitch. As others have said on this forum, he explained it to me by way of a hot needle slowly passing through an ice cube. The ice cube freezes over and scar tissue forms where it has healed thus hopefully removing the risk of incontinence that is attached to a scalpal cut.
You should note that a "cutting" seton stitch is there for two reasons: allow the infection that is "feeding" the fistula to drain; cut through the fistula so that it can heal on its own.
I went for the surgery and had a general anaesthetic. When I came round, I was not in much pain because the anaesthetic was still in my system. I was discharged on the same day after I had eaten something and urinated.
On inspection, I had a dressing over where the fistulectomy and a rubber band coming from my anus and just outside of the fistulectomy.
I admit on the first day, I did experience a lot of pain because the fistulectomy was new. It was not unbearable and I lay on my side to ease the pressue. I think my fistulectomy was superficial because it only took about two weeks to heal (packing with Aquacel every day). Aquacel looks like gauze but then turns into a jelly that promotes healing by capturing the excudate (puss) and blood and also trapping microbes within it. Must admit for the first few days, your wound will smell a bit but this does subside.
As I said, the fistulectomy healed ok although I did get some "overgranulation" which was treated by applying 1% hydrocortisone cream once a day and a lyofoam dressing. These were all available on an NHS prescription. The overgranulation healed after a week of it ebing noticed by the District Nurse (for the benefit of US readers, a DN is a dressings nurse here in the UK).
After surgery my seton was slightly painful but I think this was more the fistulectomy. It felt like somebody was pulling down and it was uncomfortable but not like a sharp stinging pain that was associated with the fistulectomy.
I admit it was weird but I could not feel it cutting, I only felt a new pressure on my sphincter.
I took Lactulase twice a day to keep bowel motions soft and also used Fybogel to help me go. Surgery "down there" can shock your body and you may be reluctant to go.
BM are not as painful as you may think if you use the lactulase and fybogel.
My seton has not been tightened regularly and I am going for my first and last tightening a month after the seton was placed. my surgeon explained that he will put me under a GA, tighten it and I can then go home. He said it will be uncomfortable for a day again and should then subside. I told my surgeon that I had read that some people have them tightened regularly and he said that it was not neccessary if you could have one tightening under a GA.
I will, of course, let you know how I get on.
Two-three months after it has been tightened, my surgeon has told me that he will see me again and, under a GA, cut my seton out. He said that although he can just leave it and let it drop, it would be better to remove it once it has done its job. This will involve a small incision (similar to the fistulectomy) and packing for about five days. The other alternative is to leave the band in which I do not want because once this is over I jsut want to forget about it!!
One thing to note, the seton drains as well as cuts. The drainage element, for me, is the worse of the two because the drainage can smell and can cause chafing (nappy rash). I use a gauze to catch it, change said gauze twice a day and use sudocrem on the other cheek to stop the soreness.
NB: If you are in the UK, purchase a pre-payment certificate from the pharmacist so that for a flate fee of £30 c. all of your prescriptions are covered and you can get all of your dressings etc - you will need lots of dressings!!
The experience isn't ideal and I know it's embarrassing but don't give up. Get it sorted by somebody who knows that they are doing and you will be fine.
I do not have chron's and this has been ruled out but I hope this post helps.