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I'm not getting a clear picture, and I don't want this. I have Crohn's, a possible abcess I am feeling between pouch and vagina, and leaking the acidic watery fecal matter thru the vagina. I'm on a 14 day clear liquid fast and is helping greatly and I don't feel pain or the abcess too much anymore, but definitely have the fistula. I don't understand this seton procedure but I want to know about it. Dr. Worsey is saying that is a possible for me. 

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There are two kinds of setons: cutting setons and draining setons. Both are loops of thread or other thin material that runs along the length of the fistula and connects up outside. J-pouchers usually get draining setons. The purpose of a draining seton, which is tied loosely, is to keep the fistula channel open to prevent the painful build-up of pus under pressure within the fistula. Setons are a nuisance, but are often better than an untreated fistula. They don’t stop the fistula from draining, though.

Scott, you are a dear one, and always a wealth of info. After reading that setons are just not that successful, are uncomfortable, and Humira may make my pouch stricture worse, I am going to continue to heal myself. I have a friend/colleague who offers THC/CBD suppositories. It just makes sense that if my stricture and fistula are right up inside the anus, these suppositories just may work, and besides, I'll have a happy anus. Hee hee, far out man. Do you have any experience or knowledge about these suppositories. I'm following my intuition on this one, and it feels right! Certainly better than messing with my immune system! I'm de-stressing too, which is key to healing auto-immune. Thanks again, Scott. You're a gem, not to sound too old-fashioned!

I don't blame you for trying to avoid a seton.  Everything that Scott said.  However.  I had 2 setons, one an R-V, and one a perianal.  The setons did keep the exterior fistula hole from the cycle of closing and then bursting (either on its own or with the help of a surgeon), which was a very painful experience for me.  My setons were both draining setons, and were not painful.  Honestly, after I got used to the idea, I rarely noticed they were there, outside of when bathing or wiping after a BM.  They were both put in during an EUA (Exam Under Anesthesia).  

The fistulas continued to drain, so there was a need to keep the area clean (bidet was great), and barrier cream helped a lot to avoid irritation.  These practices would be helpful even without a seton.  I'm not trying to convince you to have one, no - but - if ever you decide to do it, my personal experience is it wasn't as bad as I had feared.  I had my R-V seton for 7 yrs, my perianal one for a year.  (I then bit the bullet and had my pouch removed.)

It’s certainly right to take good care of yourself, but that usually doesn’t substitute for good medical care. There’s no good evidence to suggest that the suppositories will help, but they aren’t likely to do much harm. Depending on the THC levels they might make you feel stoned (which may or may not be part of what you’re going for).

If your fistula is causing you pain then a seton is probably worth a try. It can also help prevent an abscess developing which can be a bigger problem. If your fistula is truly painless it still might be worth asking the doctor what benefit he thinks the seton offers. In any case, a seton is easily removed, and shouldn’t be confused with fistula surgery. Fistula surgery doesn’t seem to have a great success rate.

n/a posted:

The fistulas continued to drain, so there was a need to keep the area clean (bidet was great), and barrier cream helped a lot to avoid irritation. 

N/A, I wondering which barrier cream you found most helpful with the seton. I've had 3 draining setons placed within the last 6 months (3 separate EUAs). I also have a bidet which helps tremendously. However, I have issues with barrier creams and the muscus-like (thicker) drainage of stool from the setons. I've tried Ilex, Calmoseptine, Z-Guard, and Resinol. They all seem to result in a gloppy mess near the setons. Any advice would be greatly appreciated!

Aquaphor Healing Ointment is more clear, and in my opinion, creates less of a mess, especially if you don't over-apply it.  I also was able to tuck a cotton round (they're used for makeup removal) over the area where the seton came out - or you could use a small piece of gauze -  and that helped to both collect any discharge which prevented it from spreading and causing extra irritation, and also prevented the "gloppiness" of the barrier cream from spreading.  Hope this helps.

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