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. You may need this before a final surgery to fix the fistula. At which time, the seton is removed.

Setons 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. In some cases, a seton may need to be changed every 4-6 weeks in outpatient surgery. Some people have setons for 6 months or longer. There is no time limit to keep the tract open and avoid future abscess.

Getting Ready for Surgery

If you smoke, you should try 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.

After Surgery

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 may need to use a special cream to protect your skin before you have a skin problem. You may want to try A&D® Ointment, Desitin®, or Sensicare®. Apply cream to dry skin so you do not trap moisture under the ointment.

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 Relief

Pain varies from person to person. Your doctor will work with you on a pain management plan.

Activities

Please follow the guidelines we will give to you the day of the surgery. They may include:

• Taking off work a few days to a week.

• Having someone help watch your children for 1-2 days.

• Wearing loose clothes.

• No sitting or standing for longer than 1 hour.

• No lifting more than 10 pounds.

• Avoid all tobacco including second- hand smoke.
  

Prevent Constipation

Opioid pain medicines can cause constipation. You will want to use a stool softener (docusate sodium) to prevent this problem, up to 4 tablets per day. 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

• Problems with bowel movements.

• Excess swelling.

• Fever over 100.4F for two readings, taken by mouth, four hours apart.

• Pain not relieved by pain pills.

• Bleeding that does not stop after 10 minutes of applied pressure to the rectal area.
  

Who to Call

Digestive Health Center: (608) 242-2800

After hours, weekends, or holidays this 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.