I would suppose, if it's not bothering you, you could wait. My cyclical fill then drain thing made me feel bad, and also hurt in that stinging way. So much worse than having the seton, for me, and I'm glad I have it.
I've had two setons placed now. This one currently has been in for 3 weeks now. While it's still not like having "nothing" there, it's been so much better than NOT having it there. The longer I have it, the less bothersome it is *and it never was very bothersome, honestly. I go most hours of the day forgetting it's even there.
My issues are no where near my J pouch. I suppose that if it was, it might be something that could be a bigger issue. My fistula is more of a mucus fistula, with the seton in. I've never had it discharge stool... occasionally there's a bit of blood. But my discharge is very scant. I either wear nothing, or I place a 2X2 gauze pad there, so I don't get irritated *and the longer the seton is in, the less drainage it is putting out. Without the seton, it would fill mostly with bloody mixed pus drainage, and it was never a ton, again, but it was painful to me when it would do it's thing.
My understanding is that these things don't just go away, unfortunately. All of our medical knowledge, too, and perianal fistulas are something that we've not been able to conquer easily, either. I also think that having a perianal fistula has a small increase on the risk of anal cancer, which is something I shall talk to my surgeon about, too, though it's not a huge increase, from what I've read, and may be more of an issue if NOT treated. Hell, my hubby is on Enbrel, and he has an increase of cancer with that... but you just can't live life worrying about that stuff, the "what ifs?"
From what I understand, too, is that antibiotics don't work on abscesses there. The abscess is too walled off, so antibiotics are a poor choice for treatment. I stay away from antibiotics unless absolutely necessary. I see too many patients at work with resistant strains of things related to overuse or overly prescribed antibiotics, and I surely don't want C diff.
And also, honestly, if it's just an EUA, and a look-see... well. If he *doesn't* find a fistula (and my surgeon almost couldn't find the "hole" inside the anal canal, as it was so small... but it was there, and confirmed by MRI), he won't be able to place a seton, and if he does, and it's just a rubber seton band that's a draining seton (make sure it's not a cutting one... while some surgeons use them, I hear they are painful, and I'm sure it WOULD impact your trip)... well, all I can say is what I've experienced. The seton took me about a week to feel mostly normal again with it in... not that it HURT, just that it was, you know, something new to deal with. It was definitely less bothersome and less painful than my cyclical bump.
I went in all worried about it, being a patient AND a nurse, asking question after question, and my surgeon, with his dry sense of humor, put his hands up and smiled and said, "We have already used too many words to talk about this... I'll see you in the OR!" and he was right, at least for me. Compared to all of the things I've gone through in my life, with UC, surgeries, even the abscess... the seton was nothing. If you have it done now, in early May, you have two months to get used to it, and that's probably 6 weeks more than necessary to feel at ease with it. Though, we're all different, of course! But this is just my experience with it.
I have no long term plan yet. I'm actually seeing my surgeon tomorrow, for another outlet dilation, which probably didn't have anything to do with my fistula. He's thinking about a year to live with the seton, then we will revisit options, I guess. I know they are out there (LIFT surgery, plugs, etc.), but he's not feeling the urge to do anything yet. Think he just wants everything there to just settle down.
