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10-16-2011, 08:24 AM   #1
Sailorluna
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Location: Coon Rapids, Minnesota

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Infected fistula

Hi all, I had my setons put in a month ago and everything had seemed to be healing ok. The last week or so I have had increasing fatigue and my buttcheek by the rectal fistula started to get sore. I had some left over Flagyl and took one on Thursday and Friday and it seemed to help with the fatigue but not the pain. Yesterday I got a fever. I took two Flaygl and will take two more today... but that is all I have left. I will call the GI surgeon Monday. I thought that you could not get an infection there as long as it is draining.

Also how much epsom salts are you supposed to use? I think that I do not use enough.
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Symptoms since 98
Resection and diagnosis June 2010
3 fistulas
abscess drained 6 times (so far...)
currently 2 seton in place 1 since 9/11 the other 4/14
1 strange small air pocket with an 8 cm sinus track leading into the great unknown
methotrexate weekly
folic acid
2 lomotil
2 Welchol
B12 injections (monthly)
Remicade

_____
Goodbye Humira
Goodbye Cimzia
Goodbye Azathiprine
10-16-2011, 08:44 AM   #2
annak87
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Are you still getting drainage? I had a seton that was too small that it didn't allow it to drain properly and it formed another abscess. I had the same pain, fatigue, fever whenever this happened to me but my drainage stopped. So that may be the case if you're not having drainage but if you are, I'm not sure what could be going on. Either way I would definitely call your surgeon tomorrow, especially if you're running a fever.

And I'm not sure about the epsom salts. I've never used them in my sitz baths but maybe someone else can give you some insight.

Really sorry you're dealing with this. Setons are helpful but really not fun to deal with. I hope you get some answers and relief soon!
10-16-2011, 10:54 AM   #3
PaulsPain
 
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Location: Minnesota

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I have had a seton for over a year now. I have had two experiences which caused issues with it.

- Not soon after getting it I had one of the knots(the seton ends are held together with some type of strings) heal into the tissue. It got infected big time. I wasn't sure what was going until I was able to tell and pull the knot out.

-I have had several times where I thought I was getting an abscess in the same place - kind of what your describing. I went to see my CRS and he told me that I need to yank on the seton to get the tract draining more. He did that and it provided instant relief at the appointment. Now if I have issues I gently pull on it to try to get more drainage going. He told me to do it weekly. It doesn't exactly feel great so I only do it as needed......

Good luck.
__________________
Crohn's confirmed in Nov 10. Mainly in peri-anal region - fissures, fistula's, abscess.

Current Meds: Azathioprine 25mg every other day.
Remicade - Dose every 8 weeks.

Surgeries: Lateral internal sphincterotomy, skin tag removal, 2 fissurotomy, and fistulatomy - Jan 2010, Abscess drained and draining seton for fistula - Sept 2010
10-16-2011, 01:57 PM   #4
Mark63
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Location: Harlow, United Kingdom
Hi,

You need to talk to your Surgeon and let them know about this problem. It certainly sound as if there is an un-drained area of infection. It could be that the seton is not providing sufficient drainage of the main tract. Alternatively, it could be that there is a branch off the main tract that is causing the problem.

I've also had the disappearing knot problem and that can be pretty uncomfortable. If that happens I pull the string one way or another until the knot reappears and then give things a good clean-up
__________________
Diagnosed late 1980ís
Azathioprine & Infliximab not tolerated
Humira since Aug 2010, weekly since Jun 2011
12 EUAs, setons removed & fistulotomy Dec 2012
10-16-2011, 07:01 PM   #5
RFarmer
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Join Date: Apr 2011
Location: Tennessee
Hi Sailorluna...

It's usually either one of two culprits, of which both have been mentioned:

a) Your seton-knot could be caught inside the fistula, and the fistula might be becoming inflamed because of the general foreign-object like-quality of butt-piercings. The body doesn't like those. So sometimes, when the knot gets into the fistula, or sometimes even when it's not, the skin will enflame and go a little nuts. I'd call your doctor.

b) Your fistula could be closing around the seton. They don't always work as intended, and different surgeons use different types. My colorec prefers long, plasticy, flat ones, because the fistula has a harder time closing around a flat seton than a circular one. Otherwise, you could have an alternative pocket in there which the seton will not help. When I had mine placed, the surgeon actually carved a second fistula out, because there was a pocket of stuff that the seton wouldn't drain. When she carved it out, she made a path from the skin, to the seton'd fistula. Hurt for a while, but it kept me from having an abscess AND seton at once.

As for the epsom salts: How is your post-op healing going? Is there a lot of granulation tissue? Do you have a sitz bath? Initially, I was told to only use a little less than a table spoon, because the granulation tissue is really sensitive. However, now, when I'm in pain, I use probably two tablespoons, mixed in good with the hot water. If I'm getting a bath, I usually pour in a cup or two, depending on how much water is in it.

As for the yanking that was mentioned: excellent idea. But you don't have to yank hard. I just slowly pull on it, until it's uncomfortable. Then, I slide it in and out (pull out of the fistula, by gliding your finger along the seton and making friction) for a few minutes, and I'm good. Of course, do this in a hot, salty bath. Keeps the pain low, and the holes dilated.
Good luck.
10-16-2011, 11:38 PM   #6
Rivers
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Hi there, well you already got some great advice.
I probably would take the Flagyl too. Cipro is probably better systemically though in case you think you might be septic. I have had sepsis twice (unrelated to fistulas) and its scary because it can come on so quickly. Fever is a warning sign so it is good you are listening to your body.

Definitely call your doctor in the morning and let them know how you feel. If its over 100 degrees you might want to call the MD on call/page just to be safe.

I usually dump 2 cups epsom salts in the regular bath tub and soak for 20 minutes. I dont do it daily, but a few time a week and it helps with pain and helps keep things draining. I hope you feel better.
10-18-2011, 12:53 PM   #7
Sailorluna
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Thanks everyone. I am ok - fever is gone and there is no infection. They said the entrance just pretty irrated around it. I am getting more Flagyl just in case because I am going on a work trip next week.

The fistula that is giving me problems is very close to my anus. It is just a small hole really and the amount of exposed seton is tiny, maybe 1/2 inch - maybe less. The woman I saw today (the surgeons assistant) told me that I should stop trying to move it because it wont be able to anyway. I've been trying what you suggested Ben and I can get it to move a tiny bit.

What is granulation tissue? I know some of you have had large amount of flesh removed when you got your seton is it related to that? I did not have that done - maybe because of where it is?

Thanks for the advice all - I will keep on with the sitz baths. I start remicade in mid November so hopefully all this will go away.
10-26-2011, 04:20 PM   #8
Rivers
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I bit on granulation tissue, it looks like an ulcer, I definitely have this.

http://en.wikipedia.org/wiki/Granulation_tissue
10-29-2011, 11:12 PM   #9
RFarmer
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Join Date: Apr 2011
Location: Tennessee
Granulation tissue is that nasty pinkish, sore stuff than grows in before a scar, when you cut yourself, or scrape yourself. Except, with CD/UC perianal fistulae, the granulation tissue doesn't want to disappear.

It's place is to fill in the space, until new skin can replace it (like a seton plug, kinda), but with a lot of us, it'll just keep granulating (called hypergranulation)... Really fun.

Even if you didn't have any flesh removed during OP, it's possible it's granulating inside the fistula, or around the opening of the fistula... If you can see really pink, swollen looking scar tissue: that's granulation. It kind resembles an infection, minus the green stuff :/ Inside fistulas can also granulate too, but it's hard to tell if you've got a big old tube of granulation, or a big old tube of... not granulation :/
11-01-2011, 12:11 PM   #10
Rivers
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Yeah, I saw my Colo-rectal surgeon last week and he said granulation tissue is good, it means things are healing nicely, and never to scrub it off or anything.
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