fistual seton

i had an opperation in march 2008 to drain a perianal abcess, which seemed to go ok, i had the abcess packed daily, but unfortunatly it never properly healed, and continued to leak a dicharge for several months. i have recently been back to hospital for a seton placed in my fitual,i have 2 pieces of plastic string coming from the place i had discharge coming from. the hospital have not really explained what a seton is,what it does, how long i will have it.ect. they just said to come back in 3 months.. i find it very painful.especially when i have BM, i have a young family and am self employed, and want to know when i will be ok to go back to work, and what i will be able to safely do, if there is anybody that could give me some advice. i would be very greatful....thanks bob 

Hello Bob!

Oh I feel for you!!! I had a similar situation with an abscess that wasn't treated properly (by a general surgeon who didn't know crohn's). He just drained it. So it didn't heal. I got sooo sick when it abscessed again (it never realy went away). I can only encourage you that it will get better now that you have a seton!! At first I hated the thing but now I realize what it did for me. It allowed the fistula to stay open and drain. Without it, the fistula can become plugged and infection can't drain. Abscess!! With the seton, the infection drains right out. Now the antibiotics and your immune system can work to heal the abscessed area properly. Unfortunately, this can take weeks (in my case months), depending on how bad it was to begin with. Because my abscess wasn't opened and cleaned out properly and a seton placed, the whole area got really infected (cellulitis) and swollen with edema (fluid). It was painful to sit for months. Now I still have two setons and am back to normal activity. Praise God!!

Also, right after the seton was placed, it was a little painful, but that is because the doctor had properly cleaned it out and removed peri-anal skin tags around the anus (another delightful problem in some crohnies). The removal of the skin tags made BMs a ouchie for a while. But a quarter tablet of percoset solved that. The whole area got progressively got better over a week or two. I found a good way to clean the seton after a bowel movement is to use a hand-held sprayer in your tub. I straddle the tub (sitting on the side) and gently spray the whole area clean. Works great and minimizes tugging on the seton with toilet paper. Then I place clean guaze on either side to catch the drainage and cushion the seton. This helps reduce irritation and keeps the skin dry. Also, applying a zinc oxide cream (like Balmex) will help prevent diaper rash (a skin yeast infection that can form from too much icky moisture). At work, I use flushable wet wipes (no alcohol) and carry a small spray bottle.

I'm praying your whole area heals up soon! I found I could start working from home within a couple of weeks (even though I had to recline, I could use the computer). Have you seen your doctor again for a post-op follow up?? I wouldn't wait for 3 months to see your Doc if you see it going in the wrong direction (fever, increased swelling, feeling more un-well, etc.). I decided to be on the safe-side and see the doctor because this was all new to me.

Let us know how it goes for you!

Bob--sorry to hear of your pain!! I've been there too and all the info you've gotten is GREAT. Definately buy the 4x4's from a medical supply store...you'll use a lot of them and they are so much cheaper that way (I just folded one/sometimes two in half and stuck it in place). I had 3 seton's for about 7 years and I have to say that if you can keep the "knot" area on the outside it should feel better. I could actually move them easily (once the swelling went down) and my doc made the suggestion to keep them on the outside.

One thing I will suggest is that IF you start a fever that goes over 100, call you doc (I always called my C/R surgeon directly for faster service:)). It is important to catch any new infections early and your doc can address a course of action.

It will get better as the swelling goes down...I could always go back to work after one week...but I did spend that week laying on my stomach...OUCH!

Well I also came looking for advise. I had my abscess drained and Seton placed the 22 of December. My DR said it was no big deal and I would be up and fine before Christmas. HA! Lier, Lier, pants on fire!!

Just this week I started driving again without too much pain. I just found myself laying in bed going from hip to hip. Sitting straight up was impossible!!

Dr. on follow up visit last Thursday just said, "Sorry. But had to be done." I found sitting in hot water the most comfortable. My Dr. also mention drinking Metamucil and eating high bulk food would be really helpful when it came to BM's. Also sitting on heating pad WORKS WONDERS!! The drainage is a PITA (no pun intended .. LOL) I used those big hospital pads they gave me for a while. But they were so bulky and uncomfortable I switched to gauze pads as well.

But my question is I have never been Dx'd with Crohn's Disease. Are fistula's and Crohn's always related? My Dr. never mentioned it. But it seems all I read they go hand in hand. I also read most people have them for such long periods.

My Dr said this will just stay in 8 weeks and then he will remove it and surgically repair the holes. Now I wonder if he is removing it to soon. (????)

It is amazing how so many ppl and Dr's have such different answers, suggestions, advise.

I am glad though I stubbled into this forum. Wish I had seen this prior.

Baseball Mom,

I'm going to tell you my story, NOT with the intention of scaring the begeezes out of you, but so that you'll understand why my advice is so serious.

I went through 5, yes FIVE abscess/fistula surgeries WITHOUT a diagnosis of crohn's. My abscess and fistula problems were all in the immediate area of my rectum. When the setons were inserted, the general surgeon and colo-rectal surgeons found NO TRACE of crohn's or inflammation in my colon. Because they saw nothing in my colon, they did not even bother to order a scope to see if anything was wrong further up the pipeline. (I was also having 10 BM's a day, but this didn't seem to tip anyone off)

So yes, you can have abscess and fistula problems without having crohn's... they assumed that was the case with me for over a year. But, and it's a big BUT - just because there's no active disease at the source of the fistula/abscess does NOT mean that there is no other problem to be addressed.

If you are having ANY kind of health problems out of the ordinary besides this fistula/abscess problem, please seriously consider getting a colonoscopy and having biopsies of any inflamed tissue they may find.

I truly, truly hope that you don't have crohn's, but I would always seek out second opinions, both on your current abscess and on your potential future exams. I'll be thinking about ya!