Hi everyone,

Feeling very worried about pain levels following surgery for my fistula and any help/ advice welcome!

Brief history - 44 year old woman, good health but always suffered with very slow bowels. Lovely boil near rectum three years ago. Lanced, went away, came back etc. Last October, found blood in BM and finally consulted GP who referred to CRS. Identified fistula. Underwent partial laying open and silk (thankfully) seton followed up with MRI. No more information from CRS and not able to get anything despite repeated requests. Next appointment mid-August. Had infection and then antibiotics. Then over-granulation and steroid cream. Was a 4cm x 2.5cm hole about 3.5cm deep and healing very slowly. No longer being packed daily but dressings at least twice a day and skin yet to heal over. Leaking a little but manageable.

My problem is that I'm worrying about two things: pain and what happens next. I have found the whole thing very painful and even seven weeks after surgery am struggling to sit/ drive. Can just about manage if I take codeine but not really sure that I should be driving/ working on these! Tried three types of cushions and nothing eases it. Any ideas?

Anyone else had a partial fistulotomy and seton? None of the medical staff at my GP have seen this before and keep asking me what will happen next?! As I'm now seven weeks in and still struggling, I'm really worried about what is coming next and how much it will affect working (still not back at work). Any advice or information would be really helpful!

Hi Sar73,
Usually a partial fistulotomy and a draining seton means your fistula was in such a position that it could not be fully excised during the first surgery (in order to avoid incontinence). It is a very-very common procedure, don't worry at all!
The draining seton will not usually heal the fistula by itself, but will assist the process.
The draining seton helps with the infection drain and prepares the area for surgery by gradually shrinking the fistula and making it more superficial.
After a certain period with a draining seton (3 months on average), a CRS will usually be able to perform another surgery depending on the status of your fistula.
What concerns me is the pain you describe, -which in my view- should not be so intense. Some pain is expected, but not an unbearable level. Maybe it is a secondry extension of the fistula that is causing it. Do you have fever, swelling in the wound etc?
I personally had draining seton and after a number of surgeries (FiLac), this May I had a fistulotomy with a cutting seton which eventually did the trick and now I am healed.
I know the feeling; It looks impossible to you right now, but believe me, this things heal and the key is a good CRS.
Could you perhaps visit again your CRS? Don't be afraid to ask for an appointment.

Dimitri71 wrote:Hi Sar73,
Usually a partial fistulotomy and a draining seton means your fistula was in such a position that it could not be fully excised during the first surgery (in order to avoid incontinence). It is a very-very common procedure, don't worry at all!
The draining seton will not usually heal the fistula by itself, but will assist the process.
The draining seton helps with the infection drain and prepares the area for surgery by gradually shrinking the fistula and making it more superficial.
After a certain period with a draining seton (3 months on average), a CRS will usually be able to perform another surgery depending on the status of your fistula.
What concerns me is the pain you describe, -which in my view- should not be so intense. Some pain is expected, but not an unbearable level. Maybe it is a secondry extension of the fistula that is causing it. Do you have fever, swelling in the wound etc?
I personally had draining seton and after a number of surgeries (FiLac), this May I had a fistulotomy with a cutting seton which eventually did the trick and now I am healed.
I know the feeling; It looks impossible to you right now, but believe me, this things heal and the key is a good CRS.
Could you perhaps visit again your CRS? Don't be afraid to ask for an appointment.

Thank you for your response! It's good to hear that this is more common than I thought. I'm also really pleased you are now healed!

I haven't been able to get in touch with my CRS but have spoken to my GP who has basically said I'm overdoing things and need to rest more. They have indicated that the pain/ recovery time is normal. I'm going to try and take things a little easier and hope that as the wound heals over, things get better. A bit nervous about what is coming next but... one step at a time.