the Pain and Process of Fistula Threading Therapy

Thread therapy

Hello Dr.
Ke, I would like to ask you about the issue of anal fistula seton placement.
I had surgery on January 7th of this year and have returned for follow-up appointments five times since then.
Four of those visits involved tightening the seton, which I have had done every three weeks.
If the seton does not come out before my next appointment, is that normal? Each time the seton is tightened, it is extremely painful and I break out in a cold sweat.
I hope you can provide some answers, thank you.

A Q, 30~39 year old female. Ask Date: 2016/04/19

Dr. Ke Fangxu reply Surgery

Thread therapy is quite painful.
Unfortunately, there’s no way around it.
Typically, 4 to 8 threads are placed, and they are pulled every few weeks until all the threads are removed.
Therefore, by checking how many threads are left, you can estimate how many more follow-up visits are needed.
Warm sitz baths should help alleviate the pain, and it will be much easier once all the threads are removed.

Reply Date: 2016/04/19

More Info

Fistula threading therapy, also known as fistula seton placement or seton therapy, is a common treatment for anal fistulas. This procedure involves placing a thread or a piece of material through the fistula tract to help drain any infection and promote healing. The process is often uncomfortable and can be painful, as you have experienced during your visits for line pulling.

The purpose of threading the fistula is to keep the tract open, allowing for continuous drainage of any pus or fluid that may accumulate. This helps to prevent abscess formation and allows the surrounding tissue to heal properly. The seton also helps to promote granulation tissue formation, which is essential for the healing process.

Regarding your question about the line not coming out before your next appointment, it is not uncommon for the seton to remain in place for an extended period. The timeline for the seton to come out can vary significantly from patient to patient, depending on the complexity of the fistula and the individual’s healing process. In some cases, it may take several weeks or even months for the seton to be removed, especially if the fistula is deep or complicated.

The pain you experience during the line pulling is also a common aspect of this treatment. The procedure can cause discomfort due to the manipulation of the tissue around the fistula. It is essential to communicate your pain levels to your healthcare provider, as they may be able to offer pain management strategies or adjust the technique used during the procedure to minimize discomfort.

In terms of what to expect moving forward, it is crucial to follow your doctor's instructions and attend all scheduled follow-up appointments. If the seton does not come out as expected, your doctor may decide to leave it in place longer to ensure proper healing. They may also consider other treatment options if the fistula does not respond to the seton therapy.

Additionally, it is important to maintain good hygiene in the anal area to prevent infection and promote healing. Warm sitz baths can be soothing and may help alleviate some discomfort associated with the procedure. Over-the-counter pain relievers may also provide some relief, but you should consult your doctor before taking any medication.

In summary, while the pain and discomfort associated with fistula threading therapy can be challenging, it is a necessary part of the healing process. The timeline for the seton to come out can vary, and it is essential to maintain open communication with your healthcare provider regarding your symptoms and any concerns you may have. With proper care and follow-up, many patients experience significant improvement in their condition over time.

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