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03-11-2014, 07:22 AM   #1
lexfrancis
 
Join Date: Mar 2014
Location: London, United Kingdom
Just had seton surgery

Hi.

I joined this site yesterday, before having a seton inserted, just to get a better idea of what I was in for. I first had an abscess in march 2013, then another around August, and the last one in November which was drained through an incision. I had a seton put in place yesterday which was inserted through that incision.

I've been told that setons are usually left in place for 3 to 4 months, however I have seen comments on this site from people who have had them for up to 2 years. My surgery was described in the notes as uneventful, they also said that there was no puss to drain, so I'm optimistic about not having to have the seton in place for very long.

I'm posting here to ask about something that's worrying me. I've just had a look at the seton in the mirror for the first time, and it looks like it has been placed right over a hemorrhoid, pressing down on it quite tightly. It seems like this is what has been causing the pain I've been in. Can this be harmful? Is it safe to try adjusting it? Why would the surgeons have done this?

Thanks
03-11-2014, 08:45 AM   #2
nogutsnoglory
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Location: New York

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Are you sure it's a hemorrhoid or might it be just be inflamed tissue from disease and aggravation in the area? I am sure your surgeon wouldn't have placed it there if there was any danger and they may have had no choice but to put it there. I would not manipulate the seton as it will hurt, bleed and possibly come loose. At worst you don't want to tear the abscess further. Doing warm sitz baths will help and you can ask if a cream may help with numbing the pain.
03-11-2014, 05:55 PM   #3
justbreathe8
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Join Date: Jan 2014
Location: chicago, Illinois

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I got a seton in October, December, and February (currently have 3) the first one was a silk seton and it caused extreme irritation and I watched a bump form and watched it get bigger until my surgeon changed it to a rubber seton (it's bright orange) because he said its less likely to irritate. 2 more rubber setons later, the bump has gone down significantly but it is still there. The rubber setons don't run up against it so its more comfortable. I specifily asked him why it's still there and he said its most likely due to the fact that the setons are in and it's my body's reaction to them. And I have def noticed that the days I have more pain, it's gets more swollen and the days when I'm almost pain free, it is very small. So it's definitely possible that the bump is causing you pain. I highly doubt it is a hemmeroid though. And it could be possible that it wasnt there when the seton was put in and the irritation from the seton caused the bump. I would go in for an appointment and ask your surgeon about it and tell him it is causing you pain and see what he says. Do you have a silk seton (black string) also, yes you can adjust it. I think it moves best after sitting in a warm sitz bath. But if the knot is not on the bump, I'm not sure that adjusting it would do much. I adjust mine at least once daily because the knots always slide I to one of the two holes which makes me u comfortable and as soon as I move them where they should be I'm fine
03-11-2014, 05:56 PM   #4
justbreathe8
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Maybe ask your dr if you can move it before you try. Just in case yours is different. But my surgeon recommended moving it to encourage drainage
03-12-2014, 01:46 PM   #5
lexfrancis
 
Join Date: Mar 2014
Location: London, United Kingdom
I think i have a silk seton. It's black. The lump has been there for over a year. It's never caused me much grief. I do notice it bulge a little when I have to strain hard, so I'm pretty sure it's a hemorrhoid. I've seen a doctor, she recommended using anusol. The seton pressing down on it is causing a lot of soreness, but my main concern is going to the toilet. If I have to strain at all, the lump might bulge out. I'm worried that that might be excrutiating, or that the lump could burst. The doctor just told me to eat plenty of fibre and veg to prevent myself from having to strain. I'm really annoyed that the surgeons did it this way, the least they could have done was tell me about it, give me advice, some cream or something to shrink the pile. They didn't bother coming to see me afterwards, I was just sent home. I'm reluctant to take baths because I still have the open wound from where I had the abscess drained. Is it ok to take a bath with the wound there? I've been trying to get hold of the surgeon I'm registered with to ask him about it, he hasn't called me back yet. And I have made a half hearted attempt to adjust it, but it's in quite tightly and I didn't want to tug anything too hard, so I haven't been able to move it off the pile. I think that would make it more uncomfortable anyway.
03-12-2014, 04:20 PM   #6
justbreathe8
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Yea, I totally understand your worry and frustration!! Hopefully the surgeon calls you back soon! And if you notice the bump getting extremely large, you could always go to the ER. And I agree with you, its frustrating that the surgeons aren't very communicative and expect everyone to know what to do, or they think its not such a big deal…but it is!! Ya, def don't pull too hard on it, you don't want anything to get worse. When I had my first seton the hole was very large, but they said I should do a sits bath after 24 hours. Im not sure what your surgeon would recommend. Maybe its best to wait and ask him. But at least now you have some questions to ask when he calls back!! Good luck, let us know what he says!
03-21-2014, 06:17 PM   #7
lgpcarter
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It is most likely a skin tag, a common thing with Crohn's. Much like a hemorrhoid, but not quite the same. I had lots, some my surgeon removed when he put my setons in because they were in the way. They usually leave them be, though, as they come back and often don't heal well.

Don't worry, they won't burst if you have to strain a bit. They are probably inflamed from the surgery - will likely get better as you heal.

Sitz baths will definitely help. Either the toilet insert or the full tub. Yes, okay with the open sound, and will help to clean it. I found d baths very soothing after my surgery (2 setons and 1 fistulotomy + tag removal)

I would give surgeon a call if you are worried about it.
__________________
Diagnosed in with Crohn's in large and small bowel in 2000.

Seton placement (2) and fistulotomy December 2013. Setons removed July 2014.

Laparoscopic Right Hemicolectomy July 2016, 25 cms removed

Current meds: Entyvio every 8 weeks, Imuran 50 mg, Flagyl and Cipro 500 mg twice a day
Previously: Remicade, Humira, Simponi, Pentasa, Sulphasalazine, Entocort, Stelara, Methotrexate, Prednisone
03-21-2014, 08:15 PM   #8
lexfrancis
 
Join Date: Mar 2014
Location: London, United Kingdom
Lgpcarter I was sure it was a hemorrhoid. I'd been using anusol until a few days ago, it's shrunken down a little and become much less painful. However I'm not sure if it was the anusol that made the difference or if it just got better on its own, because it continued to improve after I stopped using the anusol. I also noticed that straining made no difference to the pain, so maybe it was just a skin tag.

Justbreath I tried to call my surgeon's secretary a few times, but it always went to voicemail. Left a few messages but no reply. It's the NHS, not very good. Every specialist in London is probably dealing with 150 odd patients at once. The problem has improved a lot though, pretty much back to how it was before the surgery, so I'm not really worried about it. My gp had a look at it, he isn't concerned about the skin tag either. He was more concerned about the fact that the wound hasn't healed, as it's been there since November. He was surprised that the surgeon didn't say anything about it. So he's going to contact my surgeon and request that he sees me earlier. The wound actually became infected at some point in the last week and I've been on antibiotics. That seems to have improved as well. I'm good for now, not dealing with much pain. I just wish the surgeon would take the time to tell me about everything. They'll answer questions but it's always the case that you don't know all the questions to ask. They should be giving people as much info as they can, but that doesn't seem to be the protocol. For me it was a 2 minute discussion before surgery and that's literally all I saw of him. Best thing to do is do some research, and write down as many detailed questions as you can about your condition. As you can probably tell I'm pretty annoyed. I'm just venting lol.

Anyway thanks for the replies. It's just nice to talk to people going through the same thing.
03-21-2014, 08:23 PM   #9
justbreathe8
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well thats good news that you are feeling better at least. and hopefully since your GP is contacting the surgeon that you'll get seen sooner and get some answers. Good luck!
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