Fistula Drainage w/seton vs. without seton

[napster]

I had a draining seton placed in June (rectal-vaginal). Prior to the placement, my drainage was quite light, and I rarely had air coming through it. Have not had an abscess for over a year. However, since the seton, there's more drainage, and worse yet, lots more air coming through.

I picture the seton "wire" totally filling the fistula tube... So, I just don't get it. If the fistula is filled - or plugged up - with this wirey-seton thing, how does even MORE drainage/air come through it with the seton in than when the fistula is an empty tube (no seton)? Or am I totally missing something?

 

[AlliRuns]

The seton prevents it from closing up so it continues to drain instead of letting pus build up and then having it swell and break open over and over.. at least that's my understanding of it.

 

[eclektick]

Alli is right, the seton keeps the fistula open to keep draining. I have 6 right now and have noticed when they are placed the drainage is heavy but it does taper after awhile: I have noticed it is worst after a bm, but that may just be me.

 

[Avw]

I agree to all of the above. The seton allows it to heal from the inside-out instead of the outside skin healing first, which causes it to abscess, swell up, and become painful again.

 

[Sailorluna]

I agree with the above. Also when the "D" is bad the drainage gets worse. For me the whole but cheek will ache while that is going on.

 

[Avw]

Sorry to hijack the thread, but out of curiosity- what kind of material and how big are your Setons? I've had large, plastic, uncomfortable ones, smaller plastic ones, and my latest is rubbery, and quite large. Feels like a deflated balloon. I think there may also be some stitches involved in this one, but I can't tell. I've also heard of "thread" like setons and I think had some a long time ago..

Any who... Fire away!

 

[lizzy]

hullo! my fistula was misdiagnosed as a bartholin cyst months ago - operated on by gynacologists- and i thought i had told my GI that basically i now had some weird extra anus arrangement (hurray my body is creating new parts for itself) which is highly embarassing as you all probs know, but i think i did to much hinting and not enough spelling it out.

i finally told my GI last week and he seemed a bit shocked but like he was going to sort it out.

just wondering if there is anything to be done! does the seton get taken out eventually? are you working? i am finding work increasingly hard.

Sorry i can't be more help with your question! Maybe in a few months I'll know a bit more.

Lizzy

 

[Avw]

Ouch Lizzy! misdiagnosed fistulas are never fun.. I can't help but think your gyno should have known something was up as soon as she opened that thing up, but that's just me! Whether the Seton stays in or is taken out depends on the person, the severity of the disease, and the surgeon's preference. Personally... I'll leave a seton drain in for the rest of my life if it means I never have to deal with another abscess!

And I have recently had to stop working and school.. because all medications have stopped working and I can't even eat anymore :-/
But hopefully things will be better in a few months!

 

[lizzy]

Sorry to hear your not able to eat! Are you taking Modulen or anything? I was having modulen with food, stopped and now my GI has said to go back on it as he says it will help to heal fistulas. Do they think it will be for long?

I think I am getting to the no work stage its just to much of a struggle! Having to take lots of tramadol to last the day. How are you finding it? I am considering getting a nintendo Wii to cheer me up!

I'm not in very much pain with the fistulas they are vaguely uncomfortable but my strictures are hurting me at the moment.

Yeah I was pretty annoyed with the gyny doctors, I asked them repeatedly to call my gastro and they said there was no need. Its a pity I hadnt read up on fistulas before I might have known what it was! As they clearly didnt!

Then she had the cheek to refer me to colorectal surgeon with the message "possible fistula...?" (I saw the email) and he has decided to operate on my without having met me or done any tests! It goes without saying that I'm not doing it! My Gastro dude is going to ring him up! Hurrah!

 

[Avw]

Well I did one round of TPN (total parenteral nutrition) via PICC line, then had to go to the ER the following day because of high fever. I think TPN is similar to Modulen. Anyway, they didn't have me on TPN at the hospital b/c i was able to eat a little, being on such strong meds. Anyway, out of the hospital Friday.. and ready to start back on TPN tomorrow. Eating just isn't worth it when it causes that much pain. Plus if I give my bowels a rest, maybe these stupid fistulas/abscesses will heal some.

Where do have strictures at? Those are one thing I've been fortunate enough to not deal with.

Well, you most certainly need to see a colorectal surgeon, but having your GI refer you to one would be far better than your gyno doing so!

 

[napster]

Thanks all for the explanations. I still can't help but picture the fistula being plugged up with the seton and as such can't get it through my thick skull how drainage can occur with it being plugged!

Lizzy - I've heard of that bartholin cyst confusion happening more than once to other women. Sorry to hear it happened to you!

My C/R doc said that my fistula will not heal by itself. The seton will be in 3-4 years, probably, before they take it out and "see what happens". It's yellow, kinda like electrical wire. Not as thick, though. I got a double-seton: two bands in case one breaks. I barely know it's there, except when going to the BR and showering, etc. I don't think I'd have a problem living the rest of my life with this in me, except for causing marital relations difficulties due to its location. No problems with working with it in.

 

[Poohpouch]

First hi to you all, nice to meet you in here
@napster; I got a seton like yours day before yesterday, after having developed an abscess (again). This kind of seton is not plugging the fistula, but just keeping it open.
What I'm wondering about is: mine is quite inflexible, not that big but with a big knot in it, with stingy ends that irritate the tissue of my inner buttocks.
Does anyone have a more comfortable type? Like more rubbery or something? I have an appointment in 2 weeks, and would like to propose to replace the one I have now.

 

[napster]

Hi poohpouch. I'm wondering what your seton is made out of. Mine appears to be something like eletrical wire - it isn't exactly flexible, but is not stiff, either. There are knots at the rectal end. The seton (the knots) does seem to aggravate my skin from time to time - and by skin, I mean the inner buttock area. Hard to describe, really. I use calmopseptine cream to try to buffer the area, and to heal it if somewhat inflamed - it does help. You need to apply it thickly and over the entire area.

Hot sitz baths help as well. I add a drop or 2 of tea tree oil, and take the baths at least once/day.

Let us know how your appt. goes and whether you get a brand spankin' new seton!

 

[Sailorluna]

Hi Pooh,
I am not sure what my current seton is made of. The first one was kind of pokey and irritated the skin the last time they had to clean the fistula track out they put in a new one and it is not pokey at all. Don't be shy about asking for one that is more comfy, they should be able to help you out. I don't know why they pick one kind over the other but I think there are a variety they can pick from.

Also, it may be helpful to rotate the seton slightly if the knot is in a bad place. Several people here have mentioned sitting in a bath and running their finger along the string as a way to move it a bit.

My seton only has a tiny bit exposed so I was never very good at shifting it myself.

Good luck finding some comfort. You may want to consider calmosept cream for the irritated skin. It is available behind the counter at some pharmacies.

 

[Poohpouch]

Hi napster and Sailorluna, thanks a lot for your replies, the calmosept is something I'll definitely keep in mind if the seton can't be replaced. For sit baths I use Badedas, works great for clearing out the operation wound but tea tree is a good idea for later on.

The one I have now is fairly short, so it's difficult to see what material it is exactly. I'll see if I can get creative today with a magnifying mirror and some extra light to get a good look at it. Napster, did you discuss a different seton with your dr.? Or was the one you have now the only option? And Sailor, how come that yours is not pokey, doesn't it have a knot or is the material more flexible than the pervious ones?

I've already shifted the knot in different positions, but that doesn't seem to help.
I really hope I get another seton, apart from the discomfort I need to be able to use my bicycle to get around (quite essential, being Dutch).
Anyway, this whole thing is heavy to handle for me right now, I don't know what it is, I can't seem to get my act together this time, I'm somehow very tired of it all.
This forum and your posts help a lot though, it's comforting to know that I'm not alone with this, thanks again.

I'll let you know what the appointment brings.

 

[Sailorluna]

Pooh,
It still has a knot (I think they all do) but it seems to be a softer/more flexible material than the one I had before which was kind of stiff. I never really talked to the surgeon about it.


Good luck with your appointment.

 

[napster]

Poohpouch: my seton is rubber. I understand they're also made out of some type of string, but my surgeon told me that the rubber is more comfortable. Since it's the only one I've had, I'm no judge on that! We didn't discuss the seton material prior to it being placed - honestly, I didn't have enough information on them to even ask about the material. I hope all goes well at your appt.

 

[lizzy]

Hi everyone,
I had a seton put in, mine is a kind of red rubber?I have had it for about 3 weeks and I have got used the feeling of it now. Although, I have just looked at it and where there was a gaping hole is now filled with a white puffy bit of skin that looks like a blister (sorry TMI) and it looks like its been bleeding. Is this "granulation"? Is that what happened to yours? I'm concerned its an absess. Sigh.
Any advice would be much appreciated.

 

[napster]

Hi lizzy - I'm not sure what your "blister" could be. Is there pain or swelling? Fever? Those would also be signs of an abscess.

My exterior fistula hole, which is just outside the vag. area, did drain bloody, yellowish-green stuff for quite some time after the seton was placed - not a lot, but enough to notice. In the last couple of months, there's been no blood, but still some whitish-greenish stuff, which I assume is still the infection.

I hope somebody else can tell you what the blister-thing might be. Otherwise, you might want to call your doctor and describe it to him - for peace of mind.

Sorry you're going through this -

 

[Poohpouch]

I took a good look at the seton and it consists of 2 rather red stiff thin threads tied together with some blue stitching thread.
Appointment is postponed, will take place in 2 weeks, can't wait to get rid of the thing, feels like a piece of barbed wire between my buttocks.
I'll keep you posted.

 

[Roxyl]

Hi guys,I am new in this site.i was just checking about fistula disease and I could find lots of informations here.I couldn't stop myself from writing after reading the painful stories of people.I am also a victim of this disease.I had my first surgery done on may 2012.Now it's already been a year and I am still struggling with it.I am an overseas student in Australia and its really hard for a student to manage everything by yourself.I live with my friend.My parents are not here.After having perianal abscess surgery on may I went for holiday on July.Though I wasn't healed but I could travel so I went back to my country to visit my family.after the surgery it healed in my right side but there's always draining in my left side.I went to see the doctor in my country as well.The doctor put some stitches in the left one which was the biggest mistake of all.The wound could only heal outside but not inside.then I came back with the same draining butt.I had ho through another surgery.then they did colonoscopy and everything.I have a seton put in before 5 weeks.But it's still draining.I always have to wipe it out to make it dry.As I have to manage everything by myself,I have to work for rent,expenses,school fees etc.This disease has really destroyed my daily life as well as love life.Every night I cry just because of this disease.I don't know when I am gonna recover.The doctor said he still needs to do more surgery.I am really sick of it.Not being able to b positive.What Sud I do??