Setons, Drains, and Surgery for Perianal Crohn’s: What to Expect
Last Updated Jan 15, 2026
Perianal Crohn’s disease can involve fistulas, which are small tunnels that connect the inside of the anal canal to skin near the anus. When a fistula is present, the goal is often to control infection and protect the muscles that help with bowel control, while creating the best conditions for healing. The details can feel overwhelming, especially when planning around work, school, travel, and daily hygiene. This overview is general education, so care team instructions should always come first.
What a seton is (and why it’s often the first step)
A seton is a thin loop (often rubber or similar material) that a surgeon places through a fistula tract so it can stay open and drain, which can lower the risk of an abscess (a painful pocket of infection). The loop usually exits near the anus and is tied outside the body, so ongoing drainage has somewhere to go. In Crohn’s disease, setons are commonly used for perianal fistulas to keep drainage controlled while inflammation is treated and next steps are planned. [1]
Seton placement is often described as “staged” care. The seton helps calm local infection and swelling, then other options can be considered, such as additional surgical repair when appropriate. Professional guidelines emphasize that adequate seton drainage is especially important when there is perianal infection, and it can help create better conditions before medication is started or before attempts at surgical closure. [2]
Seton timing varies. Some people have a seton for weeks to months, and in selected situations it may stay longer. This depends on fistula anatomy, infection risk, symptoms, and the overall Crohn’s plan. Patient education from the American Society of Colon and Rectal Surgeons notes that a draining seton may be left in place for about 8 to 12 weeks (or longer in selected cases) to allow controlled drainage and reduce inflammation before additional steps are considered. [3]
Recovery expectations and practical aftercare (drainage, hygiene, and pain)
One of the biggest day-to-day changes after perianal Crohn’s surgery is managing drainage. Drainage with a seton is common because drainage is part of the purpose. It may be helpful to plan for absorbent pads or gauze in underwear, easy-to-wash clothing, and a small “kit” for outings (gauze or pads, gentle wipes or a peri bottle, a spare pair of underwear, and a sealable bag).
Comfort and cleanliness often improve with warm water soaks. A sitz bath is a warm, shallow bath used to ease discomfort around the perineal area (the area around the anus and genitals). Warm water can relax the anal sphincter muscle and increase blood flow to the area, which may reduce irritation and support healing after anorectal procedures. [4]
Many surgical teams suggest regular warm soaks during early healing and after bowel movements. One colorectal surgery program recommends sitz baths at least three times a day and after each bowel movement, and also notes that some bleeding, discharge, or itching can occur during recovery. [5]
Pain varies, but many people describe soreness, pressure, or stinging, especially with wiping. Some hospital guidance notes that a seton itself should not be painful, and bathing and toileting can usually continue as normal. [6] If pain suddenly worsens, fever develops, or drainage changes sharply (for example, a new foul smell or rapidly increasing swelling), many teams advise contacting the surgical or gastroenterology office promptly, since those can be signs that need medical review.