What is a cutting seton?

A cutting seton is a special type of surgical thread used to treat anal fistulas. It is placed through the fistula and gradually tightened over time to slowly cut through the tissue while allowing healing behind it. This method helps the fistula close naturally while minimising damage to the anal sphincter muscles.

Cutting setons are typically used when a fistula passes through the anal sphincter muscles. This helps to prevent incontinence while ensuring the fistula is properly treated.

Why might you need a cutting seton?

Your doctor may recommend a cutting seton if you have an anal fistula, which is an abnormal connection between the anal canal and the skin around the anus. Fistulas are often caused by:

• An abscess that has burst and created a tunnel

• Crohn’s disease or other inflammatory bowel conditions

• Previous surgery or trauma that affected the anal area

• Infections in the anal glands that have not healed properly

A cutting seton is used when a fistula is too deep or complex for simple drainage and needs a gradual closure.

How does a cutting seton work?

• A thin surgical thread is placed through the fistula tract

• The seton is gradually tightened over time, encouraging the fistula to close slowly while preventing infections or abscesses

• This allows the muscles to adjust and heal, reducing the risk of incontinence

• The process may take several weeks to months, depending on the size and complexity of the fistula

How is a cutting seton placed?

The procedure is performed under general or local anaesthetic as a day case, meaning you can usually go home the same day

• The surgeon examines the fistula and may use a proctoscope to assess the area

• A cutting seton (surgical thread) is placed through the fistula tract

• The seton is tied securely and may be tightened at follow-up visits

• You may need several appointments to adjust the seton until the fistula is fully healed

What happens after the procedure?

• You may have some mild discomfort or swelling around the area

• There may be some leakage of pus or fluid, which is normal as the seton allows drainage

• You can eat and drink as normal after the procedure

• Pain relief and stool softeners may be recommended to help with bowel movements

• You should avoid straining, heavy lifting, and intense exercise for a few weeks

Most people return to normal activities within a few days, but follow-up visits will be needed to adjust and monitor the seton.

How do you care for your cutting seton?

• Keep the area clean and dry to prevent infection

• Wash gently with warm water after bowel movements

• Avoid using scented soaps or wipes that may cause irritation

• Wear a pad or soft tissue to absorb any drainage

• Take stool softeners if needed to reduce discomfort

If you experience increased pain, swelling, or signs of infection, contact your doctor

How long will the cutting seton stay in place?

The length of time depends on the size and location of the fistula

• A cutting seton is gradually tightened over weeks or months

• The fistula closes as the seton cuts through the tissue while healing behind it

• Once the fistula has fully healed, the seton is removed

Your consultant will monitor your progress and decide when the seton can be removed

Are there any risks?

Cutting seton treatment is safe and effective, but as with any procedure, there are some risks

• Mild discomfort or leakage around the seton site

• Infection or irritation, which is rare if proper hygiene is maintained

• Bleeding after bowel movements, which usually settles on its own

• Minor scarring after healing

• Incontinence risk, which is minimised by careful monitoring and adjustments

If you experience severe pain, fever, or excessive bleeding, seek medical advice

Why choose the Midlands Bowel Clinic?

• Expert colorectal surgeons experienced in treating complex anal fistulas

• Advanced diagnostic tools, including MRI and endoanal ultrasound for precise assessment

• Personalised treatment plans tailored to your needs

• Comprehensive aftercare and follow-up support to ensure the best outcome

Contact us

If you have an anal fistula and need advice on cutting seton treatment, please contact the Midlands Bowel Clinic. We are here to help.