Stevo, so sorry to hear about
all the pain.
I currently have three setons for an RVF (rectovaginal fistula, not being sexist but you’re a bloke so might not know ;)) and two abscesses. I look like a badly made sieve.
With regards to the knots and bearing in mind I am a first hand newbie (highly educated through Dr Google though), to me it sounds somewhat unusual. Two of my knots (one on each seton) are showing and I know how much pain they are when they get into the wound. I periodically rotate the circle so the knots are away from any wound entrance. One of the setons doesn’t have the knots showing so they must be lodged inside the wound, away from any nerve endings because I can’t feel that one.
I wonder if your CSR tried to use the multiple knots to secure the seton and stop it from moving? It clearly failed but I can’t imagine any other reason why the CSR would do it. Apart from intentional patient torture! Can you speak to your CSR to question it?