When you have a fistula it is likely it will keep producing pus and form one abscess after the other. Draining the abscess is first priority, but what about the fistula? Especially when you have Crohn's, doctor's try to keep you out of the operating room because surgery does more harm than good. With a fistula it's the same. First of all because a fistula is an active infection, secondly because the surgical options are limited. When you have a fistula in ano, it is likely the tunnel tract goes through one or both of your sphincters. Cutting through your sphincter could cause incontinence. So when you're fistula is still active you will probably be treated with medication first to get the infection under control. When this doesn't work enough they will probably suggest to place a seton before taking more extreme meassures such as a fistula surgery, which I will discuss in another post. A fistula surgery is also not a good option when the fistula is still active because it is more likely that the infection will be locked in and eventually cause even more damage.
What is a seton?
A seton is a rubber string/wire/cord that is used for continuously drainage of the fistula. The seton will be placed through the fistula tract and will run in a loop with both ends tight together on the outside of the fistula. Keeping the fistula tract open can help prevent pus and other infections from piling up inside the tract. To place a seton the surgeon must first find the internal opening of the fistula tract. This is where the seton has to run through. The other opening has to be created and will probably be at or nearby the same place where your abscess was drained.
Two types of seton
There are two types of seton. A loose seton and a cutting seton. The choice between both depends on the placing of the fistula. A low fistula can be treated with a cutting seton. In this case the seton will be tightend every once in a while and will slowly cut out the fistula tract without harming the sphincters. When you have a high fistula this won't work and a loose seton will be placed. Loose doesn't mean that the seton is very loose, it's still tight, but it won't be tightend any further. I've found a very helpfull youtube FILM that explains among other exactly the choice between the two types.
Taking care of the seton
When you have a fistula in ano the seton will run through your butt, through your rectum and will be tight together on the outside near your ano. Because the seton keeps the fistula open, pus can run through all day and night, so you will probably have to use sanitary towels to keep you from leaking. It also makes going to the bathroom a little bit more challenging because of the placing of the seton. Just using toiletpaper isn't enough anymore, you will have to keep it clean by flushing it with water. Either from a bottle or using the shower. When you have a loose seton you also have to make sure to turn it a little from time to time to prevent it from getting stuck.
For how long?
My surgeon told me my seton would be nescessary for about 3 months. It has now been a year and my seton is still in my butt because the fistula tract is still active. I've read many forums and blogs about people with a seton and the most common comment is that the loose seton is used for a much longer period than first told. My guessing is that it has something to do with the limitation in surgical options, a seton has hardly any side-effects, the severity of a fistula and the recurring rate. Therefore it's much easier to leave a seton in place. But that's just my guessing;)
How does it feel?
I have to be honest, my after surgery pain was quite severe. Maybe also because this was my 5th surgery in the same area. I always have surgery with a spinal anesthetic so the after surgery pain starts about 4 hours after surgery when the anesthetic is out of my system. For me it's best discribed as being raped with a tree trunk in my ano, as a matter of speaking. So thank god for morfine! Always remember that in these days in 2013 it's not necessary to be in so much pain, so make sure you get the right amount of painkillers. The most severe pain will go away in a couple of days and will make place for the discomfort and getting used to the feeling of the seton at every move you make. There are some lucky ones that don't feel the seton at all, if so, I am sincerely happy for you:-) In all the other cases I guess it's just a matter of getting used to the feeling. It's not painfull, just not very comfy especially when you take a long walk in very warm weather. Now there are times I forget I have a seton.
Life with a seton
I have had no restrictions after my seton was placed. I can use the bathtub, go swimming, sport, have sex, eat and drink normally, etc. You just have to figure out for yourself at what time you think you're ready for taking part in activities again. I have to admit that because of the placing of the seton and the fact that pus is still coming out of the opening I sometimes feel less sexy than before. But then I keep in mind that I'm glad there is such a thing as a seton to prevent me from beeing in the hospital with an abscess every month. Now it's only every two months;) If you are in a relationship or single and dating, the seton shouldn't hold you back on being intimate. If you are with te right person he/she will understand your initial insecurity and support you.
