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Seton placement: what to expect

Published 13 March 2026 ·Last reviewed 13 March 2026 by the editorial team ·How we create our content

At a glance

Having a seton placed for an anal fistula is a common procedure. A seton is a thread or loop that is placed through the fistula tract to keep it open, allow drainage, and prevent abscess formation. The procedure is relatively brief and usually performed as a day case.

This guide covers what happens before, during, and after seton placement so you know what to expect.

Before the procedure

Pre-operative preparation

  • Pre-operative assessment — blood tests, medical history
  • Fasting instructions — typically from midnight the night before
  • Bowel preparation if advised by your surgeon
  • Arranging transport home

What to bring

  • Loose, comfortable clothing
  • Absorbent pads — you will need these from the start
  • Someone to drive you home

The procedure

Anaesthesia

Seton placement is typically performed under general anaesthetic, though regional or local anaesthesia with sedation may be used. The anaesthetist will discuss options with you.

What happens

  1. Examination under anaesthesia (EUA): The surgeon examines the fistula tract thoroughly — often using a probe to map its course
  2. Abscess drainage: If there is an abscess present, it is drained at the same time
  3. Seton threading: The seton is passed through the fistula tract — entering through one opening and exiting through the other
  4. Securing: The seton is tied loosely or secured so it stays in place

The procedure typically takes 20 to 40 minutes, depending on the complexity of the fistula.

Types of setons

  • Draining (loose) seton: A soft loop that keeps the tract open for drainage. It is not designed to cut through tissue and sits loosely.
  • Cutting seton: A tighter loop that gradually cuts through the tissue it encircles. This is tightened over time at follow-up appointments.

Your surgeon will explain which type is being used and why.

After the procedure

In the recovery area

  • You wake from anaesthetic or the sedation wears off
  • Pain medication is provided
  • You rest until cleared to go home

The first 24 to 48 hours

  • Pain: Soreness and tenderness around the seton site — manageable with prescribed pain relief
  • Discharge: Blood-tinged fluid is normal — have pads ready
  • Rest: Take it easy, avoid strenuous activity
  • Sitz baths: Most surgeons recommend starting sitz baths the same day or the next day

The first bowel movement

This is a common anxiety point. People describe:

  • Dreading it more than the procedure itself
  • Finding it either surprisingly manageable or uncomfortable but brief
  • Sitz baths afterwards providing significant relief
  • The importance of keeping stools soft with stool softeners started before the procedure

The first week

  • Pain typically settles significantly within five to seven days
  • Discharge continues — this is expected and part of the seton’s function
  • Sitz baths two to three times daily
  • Short walks increasing gradually
  • Follow-up appointment usually within one to two weeks

Living with a seton

The adjustment to life with a seton takes time. Key aspects:

  • Hygiene: Keeping the area clean is a daily priority — see our seton hygiene guide
  • Discharge management: Pads and regular changes — this becomes routine
  • Pain: Varies from barely noticeable to moderate, depending on the day — see our seton pain guide
  • Activity: Most daily activities resume within one to two weeks
  • Follow-up: Regular appointments to assess the fistula and, for cutting setons, to tighten the seton

When to contact your surgical team

Seek medical attention if you experience:

  • Increasing pain, swelling, or redness near the seton
  • Fever or chills
  • Discharge that becomes foul-smelling or changes significantly
  • The seton appearing to have moved or fallen out
  • Any symptoms that concern you

Common questions

What is a seton?

A seton is a thread, loop, or rubber band placed through the fistula tract — from the internal opening inside the rectum, through the tract, and out through the external opening on the skin. It keeps the tract open and draining, prevents abscess formation, and allows the area to heal gradually. Different types of setons serve different purposes — some are purely for drainage, while others slowly cut through tissue.

Is seton placement painful?

The procedure is performed under anaesthesia, so you will not feel pain during placement. Post-procedure discomfort varies — most people describe tenderness and soreness for the first few days that is manageable with prescribed or over-the-counter pain relief. The first bowel movement after placement is commonly described as the most uncomfortable moment.

How long does a seton stay in?

The duration varies widely depending on the type of seton and the treatment plan. Draining setons may stay in for weeks to months. Cutting setons are designed to gradually work through tissue over a longer period. Your surgeon will discuss the expected timeline for your specific situation.

Can I exercise with a seton?

Many people resume gentle exercise within a few weeks of seton placement. Walking is usually the first activity to return. More vigorous exercise — particularly activities involving the lower body or sitting — may take longer to become comfortable. Your surgeon can advise on what is appropriate and when.

Will I have discharge with a seton?

Yes. Discharge is normal and expected — the seton is specifically designed to keep the fistula tract open and draining. Managing this discharge with pads, good hygiene, and regular cleaning is part of daily life with a seton.

When to seek care Heavy bleeding or feeling faint? Get emergency help now. Emergency: 911

Not sure how urgent it is? Get help today.

  1. Emergency

    Heavy bleeding, black tarry stools, feeling faint, severe pain or trouble breathing.

    Call 911 or go to the ER.

  2. Today

    Fever, pain getting worse, a hot swollen lump, or trouble passing urine.

    Call your doctor or go to urgent care.

  3. Soon

    Bleeding or bowel changes nobody has checked, or anything lasting 3 weeks.

    Book a doctor’s appointment.

Feeling overwhelmed? Call or text 988, any time.

See all the signs

For this topic, get medical advice if you notice:

  • Increasing pain, swelling, or redness near the anus
  • Fever or chills
  • Pus or foul-smelling discharge
  • New or worsening symptoms after surgery

Recording how you feel is not the same as being checked. These are the signs that need a doctor’s attention.

Call 911 or go to the emergency room now if you have:

  • bleeding that will not stop, a lot of blood (the toilet water turns red, or you pass large clots), or any bleeding with feeling faint or dizzy
  • fainting, a racing heart or trouble breathing
  • confusion or slurred speech, extreme shivering, no urine in a day, or blotchy skin
  • sudden severe belly pain, or a swollen, hard belly with vomiting or not passing stool or gas
  • you cannot pass urine at all, or your bladder feels full and painful and you can’t empty it
  • redness, swelling or severe pain spreading quickly around your anus, genitals or groin, especially with a fever or feeling very ill
  • a fever with a painful swelling near your anus if you have diabetes or a weakened immune system (for example, from chemotherapy or transplant medicines)
  • black, tarry stools

Call your doctor or go to urgent care today (or the ER if you can’t be seen today) if you have:

  • a temperature of 100.4°F (38°C) or higher, chills, vomiting, or feeling generally unwell
  • pain that is getting worse over days, or severe pain that stops you sitting or sleeping
  • a hot, swollen or very tender lump near your anus or at the top of the crease between your buttocks, or foul-smelling discharge
  • trouble urinating
  • bleeding that is getting heavier or more frequent, or blood mixed into your stool
  • feeling much more tired than usual, looking pale, or getting out of breath more easily than you used to
  • not passing stool for several days, or new belly pain

Make an appointment with your doctor if:

  • you have never had these symptoms checked by a doctor or nurse — whatever your age
  • you have had rectal bleeding for more than 3 weeks
  • your bowel movements have been looser, thinner or more frequent than usual for 3 weeks or more, or you have lost weight without trying
  • symptoms have not settled after a week or so, or keep coming back
  • you notice a new lump near your anus, between your buttocks or in your belly, or an itch or discharge that does not clear
  • you have new leakage or trouble controlling your bowels
  • you are 45 or over, or have a family history of bowel cancer or inflammatory bowel disease, and any of these symptoms are new for you

If you are unsure, it is always reasonable to ask. If things feel overwhelming, call or text 988 (Suicide & Crisis Lifeline) or chat at 988lifeline.org, any time. If you don’t feel safe, call 911.

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Seton pain: what is normal

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Seton hygiene: keeping the area clean

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Anal fistula: patterns and care

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