So I've had a fistula for years. It is one of those anastomosis to perianal bastards 
It cropped up in the exact place I had a abscess about 5 years prior and I've been living with it for about 10 years now. I had the fibrin glue and the seton and plug. The seton and plug didn't work but it did reduce the discomfort for years. I was pregnant last year and the fistula went away! It was great. I think it must have been the increased blood flow, decreased inflammation, not eating for 3 months, and then less pouch activity. Unfortunately having a newborn and breastfeeding seemed to really upset my pouch and the fistula came back with a vengeance. I thought I had a stricture at first but then the fistula drained Then I thought I had two cases of pouchitis but I am beginning to suspect that it was really inflammation from the fistula (cipro cleared it up either way). Anyway, I am at the point where I am sick of the constant inflammation and discomfort. I get horrible burning/itching if I really need to go to the bathroom, it hurts when I go to the bathroom, then it gets inflamed. Its ruining my virtually nonexistent sex life and interfering with my ability to play with my baby. Anyway, I am ready to call the surgeon and see what can be done about it. He wasn't very positive about a fix when I asked him about it several years ago but I wasn't as uncomfortable then. Do setons help with the burning? Its not ideal but I would be willing to put up with one to reduce the general inflammation and pain. Any other options people have had success with?
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Avoid the usual lay-open surgery they do on non-pouch people for an anal fistula. They did one on me with my pouch and it damaged my sphincters and left me incontinent
My son has a fistulia right now but his is all internal. Any ideas on how to handle that? Right now he has a drain in his butt, we are hoping for less output. If not, he has exploritory surgery scheduled for May 12. The hope is to put a stich in if they can see the leak. If not, he will go on TPN for a few weeks and then back to an ostomy. Not happy at all.
Sounds awful I don't know anything about ones that are internal like that but in general keeping things draining helps the most. I've heard bulking things up can help and I think it does for me too because mine gets worse if I have the runs or if I strain too much. Try to get him to avoid all the foods that bother his pouch (anything that causes gas) and he could try metamucil biscuits. They even taste good and I know some people swear by them.
Ive had a similar type abscess turned fistula since 2012-2013.
Only have had a seton. Three colorectal surgeons (my original doc, who's a rockstar, and two others) essentially told me there's considerable high risk with "cutting" or surgically altering our population down there with fistulas.
We already have less sphincter tone just due to the nature of the surgery (even if you're continent). If they cut through one, incontinence could be the result (see JJA up there...)
So I begrudgingly live with a seton. My GI has spoken of upcoming glue plugs utilizing stem cells that are getting good results... I'm watching for that. He said I'd be a good candidate to try that when more widespread. So I hold on to some hope. ��
So sorry you're going through this. I've had my jpouch-perianal fistula for 5+ years now. At the beginning, without the seton, I went through the usual cycle which involved the fistula closing, pain with the pressure, then popping/relief. Repeat. With the seton, I really have no pain, but it still interferes with martial relations due to its location. I still have some drainage, but no poo-drainage for the most part, mostly small amts of mucous/pus, which is taken care of with a small cotton round. I also have a bidet which helps immensely to keep the area clean as it can be, and use quite a bit of skin protection ointment.
Is your fistula draining large amts of stool, which causes the pain?
My first CRS immediately recommended taking the pouch out, but he really did not have enough experience with jpouches and Pouch fistulas that I would listen to him. My 2nd CRS (Cleveland Clinic) also did not think any of the usual fistula "fixes" out there would work with my fistula. She recommended pouch redo (not for me, personally), or put in a seton for a few years and see how that worked out - fine, really, except for the above-noted interference.
I'm waiting for new advances in repairs, as well. Am also considering pouch removal, but keep putting that thought out of my mind while my pouch is operating fairly smoothly.
Please let us know how things progress with you, and best of luck with this situation.
N/A your fistula sounds a lot like mine. I don't typically have a lot of stool but if my pouch gets upset I have some and it hurts and makes it inflammed. I am making an appointment with a surgeon I've seen at Johns Hopkins to see what he suggests but I am leaning towards the seton. I am not at all interested in major surgery and unwilling to risk my otherwise perfect pouch. I am hoping there are advancements in the treatment of fistulas. Currently they are treated the way they have always been; keep it open or cut it open 
I have one of those BlueBidet sprayers. I love it! Also calmoseptine.
Oops, mine isn't perianal, it's perineal. The docs call it pouch-vaginal but it does not go through vag.
Yes, in my humble opinion, it feels quite a bit better to have a seton than it did to have abscessing/popping. I am also not interested in "trying" this or that (surgery, plug, lift, what-have-you) - the seton, while not a perfect solution, seems to be the least harmful and easiest thing to do until something that is proven comes along. We can always hope for that!