Perianal Crohn’s disease (PCD) is an autoimmune condition where a person has inflammation around the anus. It can cause skin tags, fissures, abscesses, and perianal fistulas.
People may require a combination of treatments for PCD, such as antibiotics, abscess drainage, and in some cases, surgical procedures.
In this article, we look at the symptoms of and treatment for PCD, including dietary suggestions and tips for managing the condition.
According to the Crohn’s & Colitis Foundation (CCF), around 25% of people with Crohn’s disease will develop PCD.
Around 26% of individuals with Crohn’s disease will develop a perianal fistula, which is when a connective tract, or opening, forms in the anal area. In around 5% of people, this will be the only symptom of PCD.
PCD symptoms can include:
- discharge of pus
- bowel incontinence
Individuals with PCD may also be more likely to experience other symptoms and complications of Crohn’s disease, such as:
- symptoms outside of the intestines
- perianal abscesses
- deep anal canal ulcers
- steroid resistance
- fistulas and strictures
Treatment for PCD focuses on treating signs of the condition, such as fistulas or abscesses, and may include a combination of the following:
Antibiotics may help prevent any complications from infections in PCD. Doctors may choose antibiotics as a first-line treatment, although a person may require other treatments alongside antibiotics.
According to a 2015 article, metronidazole is the most researched antibiotic for treating PCD, and it may lead to an improvement within 6–8 weeks.
Although metronidazole is successful at closing fistulas in around 50% of cases, it is not suitable for long-term use, as it may lead to side effects, such as:
- metallic taste in the mouth
- peripheral nerve damage
After 4 months of stopping metronidazole, the recurrence of perianal fistulas is around 80%.
Doctors may combine metronidazole with ciprofloxacin, which some research has shown led to improvement of severe fistulas in 60% of cases, and to fistula closure in 20% of cases. However, the results did not last after stopping the medication.
Long-term use of ciprofloxacin may cause:
Draining any abscesses is an important first step in treating PCD and can help prevent infections, including sepsis.
A doctor may use a seton, which is a thin rubber drain that they place in the fistula to keep it open, preventing further abscesses from forming.
Doctors usually remove setons once medical treatment has begun to manage a person’s Crohn’s disease.
According to the CCF, TNF inhibitors may be the best option for reducing perianal drainage and improving fistula healing.
In trials, the TNF inhibitors adalimumab and certolizumab were effective in fistula healing, and treatment with infliximab had a 36% success rate at closing fistulas. Vedolizumab and ustekinumab may also be effective.
In severe cases of PCD, or if a person has complications, a colostomy or an ileostomy may be necessary.
Both a colostomy and an ileostomy divert a portion of the bowel to an opening in the wall of the abdomen, which medical experts call a stoma. A doctor attaches to the stoma a pouch that collects bodily waste.
An individual with PCD requires a nutritious diet, as nutrient deficiency can be a common problem due to inflammation affecting how the body absorbs nutrients.
People with PCD need to follow a diet that contains:
- protein and healthy fats
- calcium, vitamin D, magnesium, and vitamin K to protect bone health, as steroids may increase the risk of osteoporosis
- vitamin C, vitamin B12, folic acid, iron, and zinc, as poor nutrient absorption may result in a deficiency in these vitamins
People may also find that uncomfortable symptoms of PCD affect their eating habits. Some tips to manage this include:
- eating small meals every 3–4 hours
- staying well hydrated by drinking small quantities of water regularly throughout the day
- eating whole grains, as well as a range of fruit and vegetables, when not experiencing a flare-up
- avoiding caffeine, high fiber foods, raw fruits and vegetables, or gas-producing vegetables when experiencing symptoms such as diarrhea or uncontrolled bowel movements
Learn more about nutritional deficiencies with Crohn’s disease here.
According to the Academy of Nutrition and Dietetics, there is no specific diet that causes or treats any type of Crohn’s disease. However, certain foods may trigger symptom flare-ups, including:
- high fiber foods
- foods high in fat
- carbonated beverages
People may find it useful to keep a food diary to track which foods trigger symptoms. This can also help a dietitian or nutritionist develop an eating plan with a person.
Individuals can speak with a nutritionist about including prebiotics and probiotics or any other supplements they may need.
Learn about the best foods for Crohn’s disease flare-up here.
Following a doctor’s advice, attending regular checkups, and taking any medication as the doctor prescribes can help people manage PCD.
The CCF also offers the following tips for managing a Crohn’s flare-up:
- Track symptoms and any potential triggers, as well as when in the day symptoms are more likely to happen.
- Exercise regularly.
- Avoid smoking, as this can worsen symptoms.
- Manage stress using techniques such as breathing exercises, yoga, or cognitive behavioral therapy.
- Use a moist towel instead of toilet tissue to reduce irritation to the anal area.
- Shower using a hand shower or use a perianal cleansing product, such as Balneol.
- Before going to bed, apply an ointment to protect the skin around the anus, such as Vitamin A&D ointment or Desitin.
- Bathe in warm salt water to soothe any anal pain or tenderness.
- When traveling or out and about, plan an itinerary and know where all the closest restrooms will be.
- Carry an emergency kit containing items such as toilet tissue, spare underwear, and baby wipes to help ease anxiety.
- Carry an “I can’t wait” card from the CCF, which allows people to use the nearest available restroom if no public restroom is available.
- If needing leave for medical reasons, speak with the employer about the Family and Medical Leave Act.
- Find a local or online support group that can help provide a network of people going through similar experiences.
Learn more about support groups for people with Crohn’s disease here.
Complications of PCD can include infections such as cellulitis, which is a bacterial infection of the skin. Individuals may also have recurrent abscesses.
A severe complication of a perianal abscess is bacterial sepsis. This is a life threatening condition, and it requires immediate medical attention. Treatment for bacterial sepsis may include intravenous antibiotics.
Treatment for PCD — and in some cases, surgery — can help prevent and manage complications.
Individuals with perianal Crohn’s disease have inflammation around the anus, which can result in perianal fistulas, abscesses, fissures, and skin tags.
A person may experience pain and itching around the anus, as well as pus discharge and loss of control of bowel movements.
Certain medications — and sometimes, surgery — can help treat PCD and prevent complications. Dietary and lifestyle changes may also help manage the condition.