My experience with a Fistula Seton Placement

Day 9: Totally uncomfortable!!! Cramps like crazy. Poopin is easier though. GAHHHHHH

I will itch from healing or if I didn't wipe well enough and a bit of stool gets caught up in the seton.

Day 14: Looks like I'm forming granulation tissue around the external opening. I was pretty worried what it was until I figured it out using trusty Google.

I've noticed as time goes on that I've been passing gas and now stool through the fistula with seton in there. This was not possible before. I noticed a bunch of seeds in my wiping last night. Fig, sesame and probably blackberry seeds. And a piece of undigested celery probably from dinner last night. I have a feeling that I forced poo into the fistula by bearing down when pooping, because I felt something in the fistula when I went to pinch a loaf. Never felt that before.

I have a hypothesis that the fistula swelling is going down after surgery and hence the hole is more accessible to gas and stool. I'm not sure how I'm going to handle this but I hope that it starts closing up over the seton.

Question: Does anyone find that they experience more leakage after a deep bath? I'm wondering if I am collecting water into my wound and then leaking it afterwards. Very uncomfortable.

Day 20: Had visit with the colorectal surgeon. Asked her a bunch of questions and got answers. She was very helpful. Looks like I will be going for a plug because my tract is very thin and relatively long. Then she said if that didn't work we can go for the LIFT with no penalty. She also mentioned that the flap wasn't a good idea because my internal opening was low, so creating the flap out of the rectum might lose too many nerves and lead to loss of control. When I heard this I felt reassured that she is keeping all aspects of the surgery in her mind and not just advocating cutting like a general surgeon. My fistula starts in my anterior right above the dentate line and exits right at the border of the external sphincter. She drew me a picture and it looks like she thought it passed through both the external and internal sphincter. I cringed because I was hoping it would be an interspheric fistula, but it's not and I need to deal with it.

1) Is poo leakage normal?
Yes. The seton is there SO you can leak poo. She called it a poo "superhighway" and said it's good that stuff is leaking through. An untreated fistula is a tunnel full of stuck poop, which is why it keeps getting infected. Nuts, seeds, all these foods that can pass through the seton are normal.

2) Should I use a donut to sit on?
She preferred a soft pillow instead of a donut.

3) How long will leakage last?
Checkup in 3 months. She said these things can take a while. Keep things clean and keep taking baths.

4) Granulation tissue normal?
Normal.

5) Itching after BM normal?
She suggested using a cotton ball to keep the leakage off my skin. I told her gauze caused pain and she agreed... "Use cotton balls" was her final answer. She hooked me up with one after the exam. Feels pretty darn good right now if i do say so myself!

6) Gushing blood normal?
Not really, she suggested maybe there was blockage or a backup that resulted in this? She didn't seem too concerned. She did say if anything looked/felt strange to schedule a follow-up.

I can't wait for this to be over but at the same time I don't want to let myself think that way. I want to fully accept this string up my ass. I think I can live with it. Just give me one more week and a little more healing.

Be strong, y'all!

Update, approximately 4 weeks post seton placement.

Last Friday and Saturday were painful as I had to do a lot of standing since I was a groomsman in my buddy's wedding. However, Sunday was really good. I felt great and leakage was declining, cramps were minimal. However, I've started developing more granulation tissue, which was almost engulfing the knot. I called the advise nurse and they suggested moving the knot around towards my anus, which undoubtedly provided relief but feels kinda strange being back there.

Has anyone actually put the knot up inside their anus? I'm wondering if that's safe to do.

Anyway, Tues Weds Thurs I had a lot of butt/back cramps so I've tried doing more stretching and yoga poses. We will see if it helps. By the way, I've stopped drinking coffee completely and only drinking green tea sometimes, and the itching after BM has gone away (maybe because the granulation tissue hurts so much?)...

Hi all

I had a Seton insitu four years ago. I was diagnosed with Ulcerative Colitis at the age of 17 (I am now 30) and five years ago I was having a very painful rectum and what I thought was a flare up. Turned out it was an abscess and once it was drained, I felt better. This was October 2010 and in November 2010 they put a seton in (a blue stich that goes in a 'hole' by my rectum and links in, with the fistula and back out through my anus)

I have been on Humira for a year but just finished my last injection in April and I am now on Mercaptopurine.

My seton is now a part of me. I have come to the fact that due to the severity of my fistula, that it's not going to be leaving my body any time soon- but medical advancements and remissions are a good thing to be hopeful for.

I have named my seton HIB. Hole in Bum! I use non woven swabs which i fold and place between my butt cheeks. I change this every time I go to the toilet or if i feel it is damp and requires changing. I have problems occasionally with granulation tissue but can get this cauterised from time to time. I've had 6 surgeries regarding my seton, SInce the last one, the 'hole' is certainly bigger and i have more discharge. I am told now that the discharge that is on my dressing is in fact epithelial cells and not pus. I watch out for any infections and from time to time if I do become ill, i sometimes can get a 'collection' build up- this can feel like a hard marble around the HIB. I was instructed to have regular warm baths, as this helps 'soften' the area and means you can press on it whilst in the bath to help with any discharge.

I'm trying to be brief here as I could go into a lot more detail of my seton story and my disease.

I have met NO ONE with a seton. I live in the UK just outside London and people that I have come across in clnics or when I was in hospital - no one had a seton.

I will say this about the knot- I DO NOT, want it in my anus. I prefer it out and away from the actual HIB. You may still 'feel' it as its still fresh, but i can barely feel or acknowledge mine, other than that I am still aware of teh dressing as I check to make sure it's stiil in the right place. At night, I cut a dressing to a smaller size and then I tape it to my butt cheek. I have been doing this for 4 years and I cannot NOT have a dressing or a tissue between my bottom unless I want the discharge or fluid to go onto my underwear.

I am female- so I notice that when i am due for my period, the HIB area can be a little more sore- this is common, tissue can swell up when due on and my new surgeons tell me this is not unheard of. I just have more hot baths around this time to ease.

When I first had the seton put in, yes, i was very sore and I had a district nurse visit to help me with the dressings as it has to heal from the 'out-in'. But i was tender for about a month, but the first two weeks were probably the most 'painful'.

The pain lessens. I have some discomfort if I am unwell, or if I sit on my bottom on a flat surface too long (I mean hours or stand for hoooours). But its mild compared to the first few weeks after surgery.

I have had no faecal matter come out of my seton/HIB. However, I can no longer pass wind properly without pressing down on the dressing to cover the seton completely to pass a lot of wind. My surgeon told me that this was a sign that the fistula damage was quite extensive. Going to the toilet and wiping- no problems.

It will be sore for a good month or two. I had mine 'reopened' once or twice as there was an issue with the disease etc and yes, the stinging, deep almost sick like pain, is quite something to feel- but it does subside. I am still learning to live with my seton but the blue stitch that I live with is comfortable enough that I can still get on with my life and do activities.

GOing on the beach takes preperation, i dont like to sit on the sand like i used to, but there's ways round to gain comfort levels. I wish I could leave the house without any gauze or worry about my seton, but it becomes a live by lifestyle that this is something that I cannot change just yet- I'm still getting better every day and I am in hope that one day, I can have the thing gone or get to the stage where I dont have to wear ANY dressing! :)

I will check back to see how everyone is doing.

around 6 years now with mine!!!.. keep fighting the good fight :)

Use a shower massage in the shower and blast it clean with hot water....feels so good!!!

Emmababes66, sounds like you have been through quite a lot. It is discouraging to have the fistula return.What does your CRS rec at this point?? I had a cutting seton placed in July. Still in place. Occ it doesn't drain through the fistulotomy tract that CRS made when she placed the seton and I get a lot of pain, like when I have an abscess. Eventually, it slowly drains, and i get some relief. CRS says he's gotta go back in and tighten seton. So, you had a second seton placed in 2014? that stayed in 9 days? Was that a cutting seton or supposed to be a draining seton?

also forgot to mention i was given movicol to drink and GTN ointment to use
the cream i was given was because after the abscess had healed and i was still getting pain my surgion told me i had a fisula-in-ano and the cream was to help it heal .
the GTN ointement was for when i had the abscess , it used to help the fistula as it contains a anethetic

Hello all , I have 4 setons in place at the moment! I've had 5 operations since July 2014 and the last one was in October (20th). I've been in a lot of pain all weekend so went to doctor this morning!!! And she sent me to hospital after seeing colorectal surgeon he decided to keep me in for another operation ! ( number 6) scheduled for 10 o'clock tomorrow!! The 4 setons I have are extremely complex and it looks like I've got an infection again ! !!!!!!! This is doing me in , I've been off work for 10 months now !! I'm a Crain driver and sitting still is very difficult and so is standing for more than 10-15 min, I fell for you all, finding this web site and Reading your messages has given me hope ! I will message tomorrow after operation ! Good luck one and all .


Jason 42 year old bloke .