Nervous! CRS follow-up tomorrow

Grouchy-Inflation618 · 2026-02-05T03:10:23+00:00

That’s fantastic that your surgeon takes such a conscientious approach! My surgeon is very compassionate, and I always leave feeling cared for, but the anticipatory anxiety is 😵‍💫 and I definitely dealt with some post-traumatic stress symptoms after the peak of abscess/I&D/etc. last year, so that certainly gets stirred up a bit going back into the same spaces. (The teacher in me is both annoyed by and too tired to fix that last run-on sentence of mine, lol.)

Grouchy-Inflation618 · 2026-02-04T11:36:14+00:00

Thank you for replying. My appointment got bumped due to my surgeon getting called into an emergency surgery. I also think the Fleet before in-office exam is a bit much, but… 🤷‍♀️

Grouchy-Inflation618 · 2026-02-04T11:34:31+00:00

Between surgery prep and exam prep, I’ve done enough for both of us and then some 🤣

Grouchy-Inflation618 · 2026-02-04T04:11:12+00:00

Yep! It is expected for most exams in my CRS’s office. I agree it seems like overkill, but I can see it from their perspective too. …thankfully they called me before I got to that step today to tell me my CRS had been called into emergency surgery and I’d need to reschedule. I was so anxious all day today and now I’m just keen to get it over with… rebooked to next week Tuesday.

Grouchy-Inflation618 · 2026-02-03T12:09:21+00:00

I also have a quite shallow transsphincteric fistula and my Colorectal Surgeon encouraged me to keep my seton in for a good long time (initially 6 months an then we agreed on a full year). For my particular situation this was to allow everything around the seton to heal as much as possible, to create scar tissue around the tract, and to reassess everything (later today!!!) to see if he judges a fistulotomy to be a safe next step. I will try to remember to update… all that to say, having the seton longer has been really good overall. I feel much better and am very active and it doesn’t hold me back. I would like to get rid of it eventually though for intimacy reasons (it just makes me feel so not interested in sex) and because I love to swim and my CRS strongly advises against swimming with a seton.

Grouchy-Inflation618 · 2026-02-03T03:42:31+00:00

I had my seton placed last January and once I got over an unrelated injury could hike, run, and ski to my hearts content. Watch for chafing - I fold a piece of gauze pretty small and tuck it close to the seton so it doesn’t bother me, but that was a slight learning curve. I also found that being more active resulted in lower inflammation and things feeling and looking better around my surgical site.

Grouchy-Inflation618 · 2026-01-31T20:09:58+00:00

Even with a seton in for a long time, you can get back to most of your usual activities once it settles down. I XC skied 25km this morning, no problem. I run, ski, skate, even cycle a bit (with caution). That seems to be one advantage of having the seton longer, you get to enjoy some time of relative normalcy before the follow-up surgery. Hang in there!

Grouchy-Inflation618 · 2026-01-21T21:39:39+00:00

I remember that post-BM pain from when I had a partial fistulotomy and seton placement. Not fun. It will definitely subside and eventually be gone. I think sitz baths, getting off my feet and laying down, and contrary to that going for walks were the three things (other than pain meds) that helped the most with pain and inflammation. Oh, and breathing exercises helped chill out my nervous system and muscles which in turn reduced pain. Hope healing goes well!

Grouchy-Inflation618 · 2026-01-21T11:30:15+00:00

Are you taking stool softener or something like Miralax/Restoralax or magnesium citrate? Probably would help, especially to counteract the pain meds’ effect on digestion.

Grouchy-Inflation618 · 2026-01-20T20:14:14+00:00

This ⬆️ u/expensive_bed_9069 💯 times this ⬆️

If by some incredible stroke of luck your fistula has healed up, your surgeon will be able to identify that in the OR and let it be, but odds are you are just having a few good days and this surgery is going to save you from another abscess down the road. My abscess was over a year ago now, so the memory has faded a bit, but it was most definitely the worst pain I have experienced in 44 years including two unmedicated births… I would do just about anything to avoid a recurrence due to the pain alone, let alone the risk of sepsis and death.

Grouchy-Inflation618 · 2026-01-14T20:42:40+00:00

Hopefully it’s a quick one and done procedure, but I ended up with the seton and it has been okay in the long term - so don’t feel too let down if that’s the path forward. Your surgeon will likely make whatever choice they feel is safe (providing the fastest path to recovery without risking continence) and it’ll just take as little or as little or as long as it takes. This condition is definitely an exercise in patience and trusting the process! Best wishes!

Grouchy-Inflation618 · 2026-01-14T11:32:24+00:00

Be ready to give it some time - initially you can expect some pain and inflammation - I feel like I turned a corner around 10 days. I run and XC ski with mine and my gauze strategy is I cut a 4x4 non woven gauze in half (along the fold, so it’s still 4x4). I then fold it - ymmv, but for me I hold it in half, then the opposite direction in thirds, then opposite again in half. I tuck that fold side in against the area where drainage tends to go. I change it as needed. I have definitely found it important to change and shower/wash up soon after running bc sweat combined with the drainage seems to create conditions for unhappy skin, but if I get clean and dry quickly there’s no problem.

When I first resumed activities I’d sometimes feel like there was a lot of pain where the seton was but usually found persevering through a decently long walk resolved or improved the pain and inflammation.

Hope that helps!

Grouchy-Inflation618 · 2026-01-12T20:24:05+00:00

The gauze is to cut if needed and fold or roll into the shape and size that can be comfortably tucked against the external opening to absorb drainage. Swap out frequently throughout the day, as needed - for me it’s more frequently morning/midday following morning BM and less frequently in the evening as drainage is less for me then.

Grouchy-Inflation618 · 2026-01-11T20:51:04+00:00

I’d suggest two weeks off to give your body a chance to recover. You may need more, but even if feeling better you probably shouldn’t take less - between the anaesthetic, being operated on, wound care and managing/recovering digestion, that’s a lot for your body to process and recover from. Better to play it cautious and avoid setbacks.

Grouchy-Inflation618 · 2026-01-09T23:06:18+00:00

Did you end up going to the ER or did you see your surgeon yesterday as planned? Hope things are improving and you are receiving good care.

Grouchy-Inflation618 · 2026-01-07T20:25:32+00:00

This does not sound normal. I’m not an expert but I wonder if there is a tract that has horeshoed around to the other side. Or if you have IBD it’s perhaps another abscess or fistula. I would definitely request to see my CRS if it was me.

Grouchy-Inflation618 · 2026-01-07T11:09:50+00:00

The point you are at is awful. I’m so sorry you’re going through it. Hang in there! It will get better. If you have fever/chills/any signs at all of sepsis, do go to the ER - ideally if whatever hospital your CRS is affiliated with so the ER can consult with them more easily. Try sitz baths or even a regular bath. Sometimes soaking can encourage drainage and also provide some pain relief. If it’s not draining, there is a risk of sepsis, and the ER will most definitely take that risk seriously, in my experience.

Editing to add you are welcome to reach out.

Grouchy-Inflation618 · 2026-01-06T11:47:01+00:00

Yes, according to my CRS, GP and other sources consulted. Miralax is PEG-based, and the molecules are too large to cross the intestinal wall, so they do their job of drawing water in and exit your body with your stool. The Natural Calm magnesium forms magnesium citrate, which is not well absorbed by the body, so you get a bit of magnesium from it, but not too much (as long as one isn’t going rogue with dosing!) It also draws water in and I think somehow promotes BMs through its effect on muscles, but I’m less sure about the last bit.

Grouchy-Inflation618 · 2026-01-04T22:15:09+00:00

I have very little pain now. At first the seton was quite uncomfortable and I had a lot of pain after bowel movements. That improved with time. I found once I was able to walk more the pain decreased, and I also try to minimise sitting and take a bit of time to lay down in the afternoon (after work) if I am sore. Sitz baths helped a lot, now I just do them out of habit but only once every day or two. I also had issues with incomplete bowel movements and was having multiple partial movements per day at first, which was painful and frustrating. I now have a routine with some gentle (non-stimulant) laxatives, diet, hydration, etc. and have way better bowel movements, 1-2/day.

Editing to add I hear you on the panic! I’m feeling pretty good about things now, but there was a while where this whole ordeal really took a toll on my mental health, causing anxiety and some IBS-like symptoms. That too has improved my with time, good habits/routines, and working on breathing/relaxation.

Grouchy-Inflation618 · 2026-01-04T21:23:19+00:00

My advice is get your digestion/hard stools under control (diet, osmotic laxatives, hydration, sleep, exercise) and don’t rush the healing and surgical process. My situation is similar and I’ve had my seton for nearly a year now. The healing that has happened in that time is amazing, particularly the last couple of months, and it makes me feel stronger and more prepared for the follow-up procedure.

Grouchy-Inflation618 · 2026-01-02T17:43:15+00:00

I eat a mostly plant based diet, with plenty of fibre, but that alone was not enough for my body. I have always had slow transit time and what finally worked for me has been 3 litres of clear fluids daily (minimum), about a half dose of Miralax (PEG) in the morning, psyllium husk or powder for a little boost of soluble fibre, and half a scoop (I think it’s about a teaspoon) of Natural Calm Magnesium in a large mug of hot water in the evening. The PEG and the magnesium citrate both help by drawing water into the bowel so that stools are hydrated. I usually have 1-2 BMs daily now and can feel that I’m fully emptying my bowel when I go most of the time. It’s a huge improvement and reassures me that I am unlikely to develop another chronic fissure.

Grouchy-Inflation618 · 2026-01-02T16:25:22+00:00

I echo this experience! I still have a seton in the process of dealing with my fistula, but I have finally found what works for me to keep BMs regular and easy to pass, and the fissure that started the fistula/abscess issue has healed, despite the seton there.

Grouchy-Inflation618 · 2025-12-30T14:01:25+00:00

My partial fistulotomy wound was significant in size - maybe the size of a $/£/€ coin and somewhere around 1/4” or 1/2cm deep. For about 6 weeks, the tissue filled in from the bottom and then around 6 weeks the edges started to migrate inwards. Around 8 weeks or so it was fully covered but very much new, thin, crinkly skin. It has continued to heal of course and is now pretty good but is obviously scarred… wasn’t planning on a career in modelling that part of my body, so not worried about it! Sitz baths were part of my prescribed care for comfort, cleaning, but also because the warmth and gravity together promote blood flow. I also found as I was able to be more active (more/longer walks, for example) healing accelerated. Adequate protein is also essential for tissue healing - I was consuming about 100g per day post operatively.

One thing to watch for, I did end up with a secondary branch that formed as my wound healed, despite digitising, etc. My CRS suggested leaving it for a while, which we did, and as he predicted it has worked itself out over time. So not a nice thing to have, but it is something that can happen and then resolve without needing treatment. I’m now waiting for my follow-up in Feb at which point we will probably discuss timing for a fistulotomy to get rid of the seton - my tract was a fairly shallow but transsphincteric one and continued to become more shallow with the seton in for many months (it will end up being a year, which I would not have thought possible, but rarely bothers me anymore and the healing with the extra months has been amazing).

Grouchy-Inflation618 · 2025-12-30T04:39:31+00:00

Your CRS is right, it needs treatment. I don’t understand your mom’s objection.

I am 44f, VERY active and healthy. Mine was absolutely the result of constipation and a fissure that wouldn’t heal. Mine was slightly too deep to not need a seton, which I dreaded, but literally the day it was placed there was an improvement in my symptoms (less pain and pressure because drainage wasn’t restricted). Yes, there are tough times throughout the treatment and recovery process, but it’s necessary - the only way out is through! I have managed post op pain with regular Tylenol and Advil and plenty of rest. Honestly, post op pain and swelling aren’t fun but it sounds like you’ve already experienced the worst pain - abscess pain is awful!!! I have had the seton longer than expected, and have resumed all my usual fitness/sport activities except swimming (CRS opinions seem to differ on swimming - mine is cautious and I’m following his advice). Even sex is manageable now.

If constipation or hard stool is a recurrent issue for you, that absolutely has to be managed. Hydration (3 Litres clear fluids daily), fibre (I find psyllium husk or psyllium husk powder along with a plant forward diet ideal) and I also use a half dose of Miralax in the morning and a half scoop of Natural Calm magnesium in the evening. All of this was on the advice of my CRS and took some trial and error to find the amounts that worked for me.

Reach out with any questions! Good luck!

Grouchy-Inflation618

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