Seton Placement: Procedure, Types, Recovery and Care
Updated: 3 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: November 2026 · How we review
Quick Answer: What is seton placement?
Seton placement is a minor surgery to treat an anal fistula, an abnormal tunnel between the inside of the anus and the skin around it. The surgeon threads a thin piece of surgical material, called a seton, through the tunnel to keep it open so it can drain. Most people go home the same day.
What the research says
Seton drainage results vary widely in Crohn's disease. A systematic review of 10 studies with 305 people with Crohn's perianal fistulas found complete fistula closure after seton drainage ranged from 13.6% to 100% and recurrence from 0% to 83.3%; combining temporary seton drainage with immune-modulating and anti-TNF medicines may improve closure. (de Groof et al., Colorectal Disease, 2016) [2]
Setons may work better alongside modern medicines, but results vary widely. A review of 56 studies on complex Crohn's perianal fistulas reported complete response rates of 13% to 75% with a seton alone and 23% to 100% with a seton plus infliximab, while recurrence ranged from 4% to 68% with a seton alone and 0% to 50% with a seton plus infliximab. (White et al., Inflammatory Bowel Diseases, 2025) [3]
Adding a seton to abscess drainage may prevent fistulas. A meta-analysis of 14 randomized trials on high perianal abscesses found that incision plus seton drainage gave a higher cure rate than incision and drainage alone in 9 studies, and lower rates of fistula formation in 6 studies and abscess recurrence in 6 studies. (Shi et al., Annals of Palliative Medicine, 2021) [4]
Key takeaways
A seton is a thin thread or drain placed through an anal fistula to keep it draining. [1]
There are two main types: a draining seton and a cutting seton. [1]
The procedure takes about 30 to 60 minutes and is usually done as an outpatient. [1]
A seton is often a temporary bridge to a later fistula repair, but some people keep one long term. [1]
What is seton placement?
An anal fistula usually forms after an abscess, a pocket of pus near the anus. Seton placement treats the fistula by threading a thin piece of surgical material through the tunnel. The seton keeps the tunnel open so it can drain, which reduces infection and inflammation and lowers the risk of new abscesses. [1]
Providers may recommend a seton for complex fistulas or for fistulas that pass through the anal sphincter muscles, the muscles that control bowel movements. A seton is often a temporary "bridge": once the infection improves, the seton can be removed and the fistula closed. In some cases, the seton stays in long term to manage symptoms. [1]
Learn more about the condition itself in our anal fistula guide.
What are the types of seton?
There are two main types of seton: [1]
The two main types of seton.
Type | How it works | Main goal |
Draining seton | A thin thread or rubber drain is passed through the tunnel and tied in a loop, snug enough to stay in place but loose enough to drain | Keep the fistula open and draining while infection improves |
Cutting seton | The skin between the inner and outer openings is cut, and braided silk or elastic is tied snugly around the sphincter and retightened regularly | Slowly cut through the fistula over time |
Sources: [1]
What are the benefits of seton placement?
Seton placement allows the fistula to heal while protecting the sphincter muscles, which may help avoid fecal incontinence (leaking stool). Other benefits include: [1]
Constant drainage of pus and fluid
Less pain and swelling
Prevention of new abscesses
Preparing the fistula for future treatment
If your surgeon later recommends opening the tunnel completely, our guide to fistulotomy explains that next step. For an overview of all repair options, see anal fistula surgery: procedures, recovery, and success rates.
What happens during seton placement?
Seton placement is an outpatient procedure, so most people go home the same day. It typically takes 30 to 60 minutes, depending on how complex the fistula is. [1]
The main steps of seton placement.
You receive anesthesia so you do not feel any pain.
The surgeon finds the internal and external openings of the fistula.
The surgeon may use a small probe to trace the tunnel.
The surgeon places either a draining seton or a cutting seton.
Sources: [1]
Seton placement at a glance
Item | Typical detail |
Purpose | Drain and treat an anal fistula |
Anesthesia | Yes, so you feel no pain |
Operating time | About 30 to 60 minutes |
Hospital stay | Usually none (home the same day) |
How long the seton stays | Weeks or months before another repair, or long term |
Sources: [1]
How long does a seton stay in?
How long a seton stays in depends on your treatment plan. Some people have another surgery to repair the fistula several weeks or months later, while others keep a draining seton long term. [1]
What is recovery like after seton placement?
Most people recover at home. Minor pain, swelling and drainage are normal while the seton is in place. Your provider may recommend: [1]
How to care for a seton at home.
Over-the-counter pain medicine
Warm sitz baths
Keeping the area clean as instructed
Eating high-fiber foods and drinking plenty of fluids
Avoiding heavy lifting for a short time
Follow-up visits to check healing and make sure the seton is working
A seton that is placed correctly should not stop you from having bowel movements, although you may notice some drainage or mild discomfort, especially at first. [1]
What are the risks of seton placement?
Possible risks and complications of seton placement include: [1]
Risk | What it means |
Ongoing pain or soreness | Discomfort around the anus while the seton is in |
Skin irritation | Redness or soreness of the nearby skin |
Bleeding | Blood from the area around the seton |
Infection | Germs cause a new or worsening infection |
Continued drainage | Fluid keeps draining from the fistula |
Fistula returns | The tunnel comes back after treatment |
Sources: [1]
Seton placement is not always a cure. It is often one step in a larger treatment plan. [1] People with Crohn's disease, which can cause anal fistulas, often need a seton alongside medicines; see our Crohn's disease guide.
When should you call a doctor after seton placement?
Contact your healthcare provider if you have: [1]
Fever or chills
Increasing pain
Heavy bleeding
More swelling around the anus
Signs of a new abscess or infection
Conclusion
Seton placement is a short outpatient procedure that threads a thin seton through an anal fistula so it can drain and heal while the sphincter muscles stay protected. For many people it is a bridge to a later repair, and for others it is a long-term way to control symptoms.
If you have an anal fistula or keep getting abscesses near the anus, ask a colorectal surgeon whether a seton could be part of your treatment plan.
Keep learning: Read our anal fistula guide to understand why fistulas form and how they are diagnosed.
FAQ
What is seton placement?
Seton placement is a surgery that threads a thin piece of surgical material through an anal fistula to keep it open so it can drain and heal.
Why is a seton used for an anal fistula?
A seton keeps an anal fistula draining, which reduces infection and inflammation, prevents new abscesses and protects the sphincter muscles.
What is the difference between a draining seton and a cutting seton?
A draining seton is tied loosely so the fistula drains, while a cutting seton is tied snugly and tightened over time to slowly cut through the fistula.
How long does seton placement take?
Seton placement usually takes 30 to 60 minutes, depending on how complex the fistula is.
Is seton placement an outpatient procedure?
Yes. Seton placement is an outpatient procedure, so most people go home the same day.
How long does a seton stay in?
A seton may stay in for several weeks or months before another repair surgery, or long term to manage symptoms.
Can you poop with a seton in place?
Yes. A properly placed seton should not stop bowel movements, though some drainage or mild discomfort is common at first.
What is recovery like after seton placement?
Recovery after seton placement happens at home, with minor pain, swelling and drainage eased by pain medicine, sitz baths, fiber and fluids.
What are the risks of seton placement?
Risks of seton placement include ongoing pain, skin irritation, bleeding, infection, continued drainage and the fistula coming back.
When should I call my doctor about my seton?
Call your doctor about a seton for fever or chills, increasing pain, heavy bleeding, more swelling or signs of a new abscess or infection.
Does seton placement hurt, and what anesthesia is used?
You receive anesthesia before seton placement, so you do not feel pain during the procedure. Afterward, minor pain, swelling and drainage are normal, and your provider may suggest over-the-counter pain medicine and warm sitz baths [1].
How do I prepare for seton placement?
Before anal fistula surgery, you usually go to a pre-assessment clinic, where the team checks your health, asks about your medical history and medicines, and talks with you about the surgery in more detail. [5]
Related Reading
Anal Fistula: Symptoms, Causes, Treatment & Complete Guide explains the condition a seton is placed to treat.
Crohn's Disease: Symptoms, Causes, Flares vs. Remission and Treatment — What You Need to Know covers the bowel disease behind many complex anal fistulas.
References
Cleveland Clinic. Seton Placement: What It Is, Surgery, Recovery & Care. Cleveland Clinic. Last updated September 4, 2026. https://my.clevelandclinic.org/health/procedures/seton-placement
de Groof EJ, Sahami S, Lucas C, et al. Treatment of perianal fistula in Crohn's disease: a systematic review and meta-analysis comparing seton drainage and anti-tumour necrosis factor treatment. Colorectal Dis. 2016;18(7):667-675. PMID 26921847. https://doi.org/10.1111/codi.13311
White I, Karki C, Geransar P, et al. Impact of Seton Use on Clinical, Patient-Reported, and Healthcare Resource Utilization Outcomes in Complex Crohn's Perianal Fistulas: A Systematic Literature Review. Inflamm Bowel Dis. 2025;31(6):1556-1566. PMID 39298676. https://doi.org/10.1093/ibd/izae186
Shi Y, Zhi C, Cheng Y, et al. A systematic review and meta-analysis of incision and seton drainage in the treatment of high perianal abscess. Ann Palliat Med. 2021;10(9):9830-9840. PMID 34628909. https://doi.org/10.21037/apm-21-2229
Guy's and St Thomas' NHS Foundation Trust. Anal fistula treatment - Surgery. Guy's and St Thomas' NHS Foundation Trust. Last reviewed June 2023. https://guysandstthomas.nhs.uk/health-information/anal-fistula-treatment/surgery
Medical disclaimer
This article is for general education only and does not replace advice from a qualified healthcare professional. Talk to your doctor about your own diagnosis and treatment, and seek emergency care right away for severe or sudden symptoms.
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