11 Days since Seton placement and it has been ... fine.
Hello,
since we don't generally hear too much about successful procedures (i assume mostly because people don't report it or seek advice anymore) i wanted to make a short post about my experiences. Not to take something away from people with difficulties, but to help some folks to be less anxious about an upcoming procedure. Everybody is build differently, every story is different.
M38, Germany, generally healthy, normal weight and somewhat good shape physically. Intersphincteric fistula, non-complex. Proctologist described it as "textbook". All specialist appointments and the surgery was performed at a large hospital.
Besides placing the seton, surgeons also removed all abscess, the fistula canal outside of the sphincter area as well as any affected external tissue around the area. The wound measured around 3cm by 3cm with a dept of 0.5cm after surgery. The only thing left of the original fistula is a short canal, around 0.5cm through the spincter-region. I did not expect this approach, but most of the affected tissue is now gone and started healing. Only the short section needs to be rectified in a future procedure.
Not going to much into detail leading up to this so far, just my experiences, starting with the important parts:
I don't feel the seton. I know it's there, i can touch it with my hands while cleaning, but i don't feel it. It does not rub against any skin or irritates in any other way. The gauze i use to keep the wound open and dry is way more noticeable, but it isn't really bad at all.
BM were a non-issue from the start. It feels different, but not painful at all. I never had much issues with BM or hard stool before, nevertheless i took stool softeners for a couple days, but there were not needed at all. Did not have to change my diet at all. I have not experienced any leakage so far.
Pain was mostly minimal, with one exception due to a minor complication. I was on painkillers for 5 days, and been without since. Cleaning sometimes stings a bit, but this subsides rather quickly. During days 3 to 5 it felt like to wound was "glued together" causing some minor pain during quick movements. This went away after day 5. Sometimes i feel some miner stinging during cleaning, but this fades away rather quickly. Days 3 to 5 were to worst for pain.
Minor complication: Stayed at the hospital overnight, got released in the morning. Around noon i changed dressing and noticed a new bleeding from the wound, blood was dripping down from the area. Gauze could not contain it, so i went back to the hospital. During the surgery they cut through a small artery which held initially, but opened later. A couple minutes and stitches later and the issue was resolved. No active bleeding anymore. The stitched area however is highly susceptible to pressure and will cause stronger pain when something (like gauze) presses against it. This started on day 5, i figured out the issue after half a day with moderate pain.I rearranged the way i dressed the wound and the pain stopped almost immediately. I have to be careful with dressing, or the pain will be back, but this is manageable.
Drainage seemed a lot initially, but sharply dropped of around day 6. It's mostly minimal now. I use a small sheet of normal non-woven gauze between the butt cheeks to keep the sides of the wound to contact each other and another bit of gauze on top to soak up all the excess drainage. This will generally last through half of the day without staining underwear. It is comparable to the amount i had before surgery.
Laying and sleeping on my side is easily possible.
Cleaning: The most annoying part. I clean the wound 3 to 5 times a day, depending on BM. (morning, midday, evening and additionally after BM). I was told not to use a sitz-bath but a movable shower head or bidet instead to shortly rinse the wound an clean up. (Was told the point is not to get everything perfectly clean and free of bacteria, which is impossible anyway, but just to regularly remove most of it.) I should avoid to soak the wound with water, just to clean and dry up afterward.
I completely avoided sitting for the first week. Started recently with shorter periods of sitting down (eating, short drives for groceries). No problems or pain with it. I just use soft pillow to distribute my weight a bit better. After around 30 minutes of sitting i feel a bit itchy, i take this as my signal to get up now.
Day 7 was the turning-point, everything sharply improved each day thereafter. Everything feels fine now, only the need to regularly clean the wound impedes my overall daily life. I still limit myself to no heavy physical work and only short periods of sitting. Other than this, it is mostly back to business as usual. My work is partly office and partly on-site. I was off-work for the first week, slowly eased into remote working after day 7 and will start with the on-site work sometime next week.
A friend of mine is a general practitioner and offered to take a look at the wound today. She said it seems to be healing quite good, no problems so far. My checkup with the proctologist is due in 2 weeks, the decision when and how to proceed will be made at this appointment.
At this point it does not really seem to matter much if the seton will be removed in 6 weeks, 12 weeks or even 6 months from now on. It has only been 11 days, but I'm already feeling better then i had before the surgery.
I hope this helps to calm down some of you. I'm in a much better mental state now, and things would have been a lot easier if i didn't stress out too much before the surgery. Feel free to reach out for questions.