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Cutting seton and pain

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Posted 4/10/2011 6:20 AM (GMT 0)
Hi, i'm new to the board, but have been reading it since i got my fistula done almost 10 weeks ago. I am a 39 year old male who first had a flare up of perianal abscess around 15 years ago, it was drained, but over the last few years ,it has come back once ever 3-5 years. After the most recent outbreak, i approached a specialist who recommended that i have a cutting seton put in and have it heal once and for all - as i was sick of the infections, and it taking me out for 2-3 weeks whenever i got this, i went for it.

10 weeks later, i'm still not sure if i did the right thing. While the abscess area is healing fine with very little pain, the cutting seton experience has been excruciating. Everytime the doctor tightens the seton, he also scrapes the area, resulting in bleeding, and pain - though it usually lasts 2-3 days. The most recent tightening, however, has been the worse, i'm in day 4 of pain, and not being able to walk around much, drainage was small before, suddently with the last tightening, drainage with pink stuff is much more.

my question to folks who have gone through this before, it is common for the cutting seton to become so painful after so many weeks? my doctor kinda chuckled and said, it's nearing a nerve without much evaluation (he is the kind that is super confident, but doesn't really tell you much... sigh). What nerve is it hitting, why only after so many weeks, as others have said, tylanol and ibu don't help - the only thing seems to be vicoden, but i can't keep taking that, it gums up my tract and makes me constipated! i do at least 2 sits bath a day, and keep the area packed with gauze all the time - any other advice on managing the pain? i need to continue to work, and this is really hurting that.

thanks!
Posted 4/10/2011 2:45 PM (GMT 0)
Hi Jericho and welcome to Healingwell. So so sorry you are in so much pain, sounds horrible. I do not have any experience with setons, but I am sure someone who does will be along soon. The weekends are a little slower, so it might be a bit.

I did want to address the constipation that the Vicodin is causing though. I would suggest stool softners. I use them daily as I tend towards constipation not diarrhea with my Crohns. I take stool softners nightly in order to keep things softer and easier to pass. I hate to see you suffering so with pain, so maybe get yourself some stool softners so you can use your pain meds as needed. Big Hugs!
Posted 4/10/2011 10:36 PM (GMT 0)
Thanks Nanners, i have been popping Senna-S stool softener alongside the Vicodem, it doesn't really help :( that said, thanks for the suggestion!
Posted 4/10/2011 10:40 PM (GMT 0)
Been there and done that.. I am so sorry that you are having to go thru so many weeks of pain. A Cutting Seton moves thru the tissue at the rate of 1/2 to 1 a mm a week. It is designed to let the area heal as it is cutting thru. My fistula involved too much sphinkter muscle and he had to use a Seton. I found that the hydrocoden family did nothing for the pain.. So after taking 10 in an 8 hour period of time I called the surgeon on call and he got me some percoset, that worked.
Everytime they tighten it it is back to square one. Putting the same pressure on the darn rubber band that you had befor. Honest I feel for you.. mine fell out in 2 weeks. As far as the drainage.. I drained all manner of colors green ,pink ,yellow and it freeked me out. A call to the surgeon and he basically said that was normal and Id have to live with it.
I worked for 2 weeks with that rubber tail...I think thats why it cut thru so quickly. My motto was I was miserable at home.. so I might as well go to work and get paid to be miserable!
When my second fistula poped up I was so fearful of the surgery because he said if it involved the muscle again I was destin to have another Cutting Seton! Thank God it was superficial and he did a Fistulectomy. Id do that 10 times befor another Seton.
I feel your pain and I am so sorry that you have to suffer for so long. Just hope it finishes doing its job soon.
Heather
Posted 4/11/2011 3:54 AM (GMT 0)
Thanks Heather, i assume that the nerve it's hitting is the sphincter muscle, otherwise i have no idea why it's so painful. The doctor is on vacation in the next week, so i hope my supply of Vicodin is enough to last the week, it's day 6 now, and it hasn't let up, i can't really sit or lie on my bottom, only relief is to lie on my stomach. Standing and walking is also become challenging... it's almost like a blast to the 1st week of recovery after the surgery.

i'm speculating that the other times, the tightening was cutting through non-muscle, else i can't imagine why i was able to stand those other sessions. i should have just asked him for more pain killers immediately after my last visit, now i know better. :(

if anyone has any other advice, it would be greatly appreciated.

suffering...
Posted 4/11/2011 10:09 AM (GMT 0)
The Vicodin did NOT work for me! Call his office and get someone to write you a script for percoset. There is no reason for anyone to be in pain and these Dr who are stingy with oxycoden should have to have a rubber band tied thru their sphincter! Dont suffer get someone to help you.
Kisses
H
Honest if they hadnt given me the percoset my husband would have been taking me to the ER! I feel your pain
Posted 4/12/2011 5:23 AM (GMT 0)
Thanks heather, Vicodin has been working for me, and i've managed to go through one day without having it put me to sleep. The first hour is the toughest though, i get so sleepy after vicodin. It also has constipated me... senna-s is not helping much :( i called the doctor's office and they told me to go to the ER if i was bleeding excessively - nope, i'm not going to have some random ER doctor poking around there! looks like i will have to wait it out until the doctor gets back. sigh.
Posted 4/15/2011 11:19 AM (GMT 0)
OH i am going in for my first tightening today actually in an hour. I don't think anyone can understand the pain associated with this procedure overall. I had a whole year of draining the abscessed area until a month ago when my doctor sent me again to a surgeon whom immediately sent me to surgery. I found out there were two tennis ball sized areas in my perennial area one that I had known and reared its ugly head so to speak just under the skin and a much more sinister one up higher embedded in the muscle area. I had the seton placed a month ago and now to my dismay i must begin what from the posts here appear to be a horrific journey in misery. I am 36 a full time mom and wife who has been finishing my two majors and minor in college due to being laid off work. I just started this problem with these after i had a cyst removed about a year ago.....and now more. surprisingly i manage to get myself up and back at classes (in a lot of pain) in a matter of days as this is my second to last term and i must push through....it is nice to have others to commiserate with however since this is so painful. My family keeps talking about so and so who had hemorrhoid surgery and I just cannot tell them how very different this is.....I HAVE A FREAKING TUBE AND WIREY STRING HANGING about FIVE INCHES OUT OF MY BUTT......i feel like a transvestite learning to tuck every day as i dress.....can anyone offer ways this can be made more comfortable for daily management.....it just feels like a nightmare really...how in gods name does someone actually get this did i do something wrong at some point. cry
Posted 4/15/2011 11:22 AM (GMT 0)
also i have not been diagnosed or anything for crohns however i do have a hypothyroid issue which has always been a problem with my bowel movements but even as a kid i can remember everything constipated me is this some type of predictor for the problem i have now????
Posted 4/17/2011 1:59 PM (GMT 0)
Trish, so sorry to hear about your situation. I've not much good advise to give, as I've been making do most of the time. Just trying to pack the area with gauze and being very careful how i sit, and constantly being worried about the softness of my stools, and the degrees of discomfort i am in. This has been a very tough recovery, and i don't wish it on anyone else. That said, i think i could be an exception, and not the norm (i hope). just an update, it's been more than a week since the last tightening that led to all this pain, I've been managing it with Vicodin everyday except for this weekend, it seems like if you start depending on the pain drugs, you really want it everyday (not good), so I've been forcing myself off it... surprisingly, it's been manageable in the last 24 hours, i look forward to sitz baths all the time, and i've also realized that a clean gauze in the area helps. my doctor was on vacation, and is back Monday, I'm looking forward to yelling at him, and asking him to explain and fix the situation :P though i know the options aren't that great :P

so hang in there! and i hope your situation turns out to be like all my other tightening during the last many weeks, just a day of discomfort, then manageable... instead of the mess i'm going through this week :(
Posted 4/18/2011 11:21 PM (GMT 0)
update - went to the doctor's today, he sure seemed relaxed after his vacation :P told him about the pain i had in the last week or so. Guess what he said?

"sorry you were in pain, we may have tightened it too much the last time"

umm.. sorry.... tighten too much? !@$!#@!$$$ and the fix?

"we'll just skip this week and let you recover a little more"

umm.... so i went to see him for nothing? i asked how the next tightening would be

"we would like tighten a little less next time"

Ok, so it would just prolong my suffering? ok, is my seton high enough so that it can be removed and opened up to heal?

"it's not high enough, you had a high fistula, it's getting lower now, but you will have to see it through"

No shortcuts for me... i'm guessing this is good for him, as every visit is $$$ to him.

so no extra pain for today, i'm still getting over the last week or so, i'm actually off vicodin today, and while it's uncomfortable still, i'm at least not in a drug haze.

sigh

ps. i hate doctors, yes, all of them. :P
Posted 5/1/2011 2:27 AM (GMT 0)
it dropped out today. After 12 weeks, it's over, the difference of having a seton in place, vs not having one is night and day. I can walk and stand around for longer than 15mins, no more gravity pulling somewhere it shouldn't. There is still some healing to go with the wound still open, but it's getting there, discharge is much less than before, and i'm very happy. For anyone recovering from this, hang in there - there is a light at the end of the tunnel. It took longer than i had expected, and the doctor wasn't really informative, so i was reaching the end of my sanity - but it's almost done, hope it heals up well, and i don't get another abscess anytime soon. Thanks for hearing me whine, and also all the folks who had kind words to say. I'm going to breath a sigh of relief and go back to lurking for a while!
Posted 5/1/2011 8:47 PM (GMT 0)
Woo Hoo!! Happy for you!! I know the feeling!! Now the trick is to take good care of it so it heals right! Been there and done that! Lucky for me mine fell out in 2 weeks! I am so happy for you!
Kisses and Hugs
Heather
Posted 5/2/2011 4:25 AM (GMT 0)
thanks for the well wishes heather - the last 2 days have been amazing, i can grocery shop now, and walk without pain... it's been great.

reading your previous post that a cutting seton moves 1/2 - 1mm per week... wow... mine was 12mm high... ouch... no wonder i've been in such discomfort. i hope it closes up well, don't want to get anything else again...

thanks once again for the well wishes!
Posted 11/8/2016 5:03 PM (GMT 0)
Hi Jericho,

Sorry to hear of your discomfort, I feel for you, believe me. I have this done in 1974, bulging abscessed fistula, all they did is lance it during surgery and pack it with ? iodine gauze, it was open for a month-maybe 3. It did hurt, drained and all that, but it finally healed. The think opened one more time less than a year later, but then it finally healed for good. As you know it's tough, it's location is 'dark, warm and moist' takes forever it feels to heal. Don't give up!
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