This handout explains fistula treatment with setons and home care instructions.
Setons For Fistula Treatment
A seton is made of rubber or string-like material used to treat a fistula. It can be used by itself, combined with a fistulotomy, or used in stages (for example, first the seton, then later surgery.)
Setons can help the fistula heal by keeping the tract open. This allows fluid to drain and the fistula to heal. You may need a seton before the final surgery to fix the fistula. The doctor will remove the seton during the final surgery.
Setons are also 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.
In some cases, we may need to change the seton every 4-6 weeks in outpatient surgery. Some people need setons for 6 months or longer. There is no time limit, as keeping the tract open prevents future abscesses.
Drainage
Expect drainage until the fistula heals. Wear pads to manage the drainage and check it regularly. The drainage can cause a skin rash so you may want to use a protective cream before any skin problems start. Apply the cream to dry skin so you don’t trap moisture under the ointment.
Some options of protective creams include:
A&D Ointment
Desitin
Sensicare
Bathing
Sitz baths 3-4 times a day will help keep the area clean, promote drainage, and may help with the pain. Apply the ointment after these soaks.
Pain
Pain varies from person to person. Your care team will work with you on a pain management plan.
Activities
Follow the guidelines we give you the day of the surgery. They may include:
Taking off work for a few days to a week.
Having someone help watch your children for 1-2 days.
Wearing loose clothes.
Avoiding all tobacco including second- hand smoke.
Constipation
Opioid pain medicines can cause constipation. You will want to use a stool softener (docusate sodium) or laxative to prevent this problem. Drinking enough fluids will also help to prevent constipation.
When to Call
Call the clinic if you have:
Problems with bowel movements
Excess swelling
A fever over 100.4°F for two readings, taken by mouth, four hours apart
Severe pain
Bleeding that does not stop after 10 minutes of applied pressure to the anal area
Who to Call
Digestive Health Center
(608) 242-2800
After hours, weekends, or holidaysthis number will be answered by the paging operator. Ask for the colorectal surgery doctor on call. Leave your name and phone number with area code. The doctor will call you back.
The toll-free number is:(855) 342-9900.