Fistula Treatment with Setons
A seton is made of rubber or string-like material. It is used to treat a fistula. It can be used alone, combined with a fistulotomy, or used in a staged fashion (first this…then…). Setons promote healing of the fistula tract by keeping it open. This allows it to drain and heal from the inside out. This may be needed before doing a final surgery to fix the fistula. At which time, the seton is removed. Second, they can also be used to slowly move through a fistula when the anal sphincter muscle is involved.
The slow healing creates a scar, closing the tract as it heals, from the inside out. A seton may be changed every 3-4 weeks in outpatient surgery. It can take 4 or more changes before the tract is healed. Some people have setons for 6 months or longer. There is no time limit to keep the tract open and avoid future abscess, especially in the case of crohns disease.
Getting Ready for Surgery
If you smoke, you need to quit. Smoking delays wound healing. We can help you quit. You may need to do bowel prep before surgery. We will discuss the details with you.
Expect drainage until the fistula heals. You will want to wear pads to manage and check the drainage. The drainage can cause a skin rash. You will need to use a special cream to protect your skin before you have a skin problem. You may want to try A & D® Ointment, Aquaphor®, or Sensicare®. Apply cream to dry skin so you do not trap moisture under the ointment that can cause more skin problems.
Sitz baths 3-4 times a day will help keep the area clean and may help with the pain.
Apply the ointment after these soaks.
Pain varies from person to person. Your doctor will order pain pills for you.
Please follow the guidelines we will give to you the day of the surgery. They may include:
- Plan to take off work a few days to a week.
- Do your household and outdoor chores ahead of time, or make plans for someone to help you for 1-2 weeks.
- Have someone to help watch your children for 1-2 days.
- Wear loose clothes.
- Avoid sitting or standing for periods of more than 1 hour.
- You may have to limit lifting to no more than 20 pounds.
- Avoid all tobacco including second hand smoke.
Pain pills can cause constipation. You may use a stool softener (docusate sodium) to prevent this problem. Drinking enough fluids will also help to prevent constipation. You may also need to use a laxative. You can buy these over the counter at your local drugstore. Follow the package directions.
When to Call the Doctor
- Problems with bowel movements.
- Excess swelling.
- Temperature by mouth over 100.4°F for two readings taken four hours apart.
- Pain not relieved by pain pills.
- Bleeding that does not stop after 10 minutes of applied pressure to the rectal area.
Digestive Health Center: (608) 890-5000.
After hours, weekends or holidays this number will be answered by the paging operator. Ask for the doctor on call or ask for Dr. Harms, Heise, Kennedy, or Foley. Leave your name and phone number with area code. The doctor will call you back.
If you live out of the area, call (855) 342-9900.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 11/06/2013
Copyright © 11/06/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7123
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