Real Talk

My Seton Fell Out: Here's What Actually Happened

My seton slipped out on its own and I needed another surgery to replace it. Here's how it happened, the wait, and why it's not the disaster it feels like.

Photo by Pars Sahin / Unsplash

I was using the bathroom like any other day. Then I looked down and there it was, sitting in the toilet. My seton. The little loop that was supposed to be threaded through me for the next stretch of recovery had slipped out on its own.

If that just happened to you, I know the exact feeling. The stomach drop. The "wait, is that what I think it is?" The immediate spiral of did I do something wrong, is this an emergency, what now. So let me tell you how it went for me, because the short version is: it was a setback, but it was not a disaster.

Important: This content reflects personal experience, not medical advice. Every fistula case is different. If your seton comes out, call your surgeon's office. What happened to me may not be what's right for your situation.

How It Happened

The seton had only been in a couple of weeks. Not long. I hadn't done anything dramatic. No heroic workout, no fall, nothing I could point to and say "that's what did it." It just worked its way loose and came out.

That's worth saying clearly, because the first thing your brain does is hunt for the thing you did to cause it. I went through that. The honest answer is sometimes a seton slips. The knot can loosen over time, the tract changes as things drain and shift, and the loop that felt secure stops being secure. It is not necessarily anything you did.

Finding it in the toilet is its own strange moment. You spend weeks aware of this thing, managing around it, and then it's just... out. Gone. There's almost a half-second of relief before the worry kicks in.

What I Did Next

I called my surgeon's office. That's the whole move. I didn't try to fix anything, didn't try to do anything clever. A seton coming out is not the kind of thing you sort out yourself at home, and it's not the kind of thing you sit on and hope about either. You let the people managing your case know, and you let them tell you what's next.

For me, what was next was another surgery to place a new one.

The Wait Was the Hard Part

Here's the stretch nobody warns you about. From the seton falling out to the surgery to put a new one in was about a couple of weeks.

A couple of weeks doesn't sound like much. But when you've spent your recovery being told the seton is the thing keeping the tract draining and stable, going without it feels exposed. You're aware of the gap. You're waiting on a date. And in the back of your head is the question of whether things are going to be okay in the meantime or whether you're sliding backward.

That waiting is a particular kind of mental weight. It's not pain, exactly. It's uncertainty. And uncertainty in fistula recovery is its own thing to manage, because so much of this process is hurry-up-and-wait. You did everything right, the thing came out anyway, and now you're sitting in a holding pattern you didn't ask for.

The Extra Surgery

Then I had the procedure, they placed a new seton, and I was back to where I'd been. Which is a strange thing to feel good about. You're essentially paying with another operation just to return to the starting line you were already standing on.

I won't pretend that didn't sting. An extra surgery you weren't planning on, an extra recovery, an extra round of the whole routine. Four years and four surgeries into this, I've made a kind of peace with the fact that the path is rarely a straight line. But in the moment, a setback like this lands hard.

What I'd Tell Someone This Just Happened To

I'm not going to tell you what to do medically. That's between you and your surgeon. But here's what I can offer from the other side of it.

It is more common than you think, and it is rarely the catastrophe it feels like in the first minute. A slipped seton is a known thing. Surgeons deal with it. The system has a path for it, and that path worked for me.

The replacement is usually a smaller deal than the original surgery. Annoying, not devastating.

And the waiting is the part to brace for, not the procedure. If you're someone who white-knuckles uncertainty, that gap between "it came out" and "it's handled" is where the real discomfort lives. Knowing that going in helps.

This setback did not end my recovery. It was a detour. A frustrating, unplanned, why-is-this-happening detour. But a detour.

If your seton just came out and you found this at 2 AM with your stomach in knots, take a breath. Call your surgeon in the morning. You're going to be okay.