Perianal Crohn’s disease (PCD) is an autoimmune disease that causes inflammation around the anus. It can cause skin tags, fissures, abscesses, and perianal fistulas.
Treatment of PCD may require a combination of antibiotics, abscess drainage, and sometimes surgery.
This article describes the symptoms of PCD and its treatment, including dietary suggestions and tips for managing the condition.
According to the Crohn’s and Colitis Foundation (CCF), twenty five% 80% of people with Crohn’s disease develop PCD.
Approximately 26% of patients with Crohn’s disease develop perianal fistulas. A perianal fistula is a condition in which a connecting canal, or opening, forms in the anal area. In about 5% of people, this will be their only symptom of PCD.
Symptoms of PCD can include:
People with PCD are also more likely to experience other symptoms and complications of Crohn’s disease, including:
Treatment for PCD focuses on treating symptoms such as fistulas and abscesses and may include a combination of the following:
Antibiotics
Antibiotics may help prevent complications from infection with PCD. Doctors choose antibiotics as the first-line treatment, but some people may need other treatments along with antibiotics.
according to Articles from 2015Metronidazole is the most studied antibiotic for the treatment of PCD and can lead to improvement within 6 to 8 weeks.
Although metronidazole successfully closes the fistula in about 50% of cases, it is not suitable for long-term use because it can cause side effects such as:
The recurrence rate of perianal fistulas 4 months after discontinuation of metronidazole is approximately 80%.
Doctors may use a combination of metronidazole and ciprofloxacin, which some studies have shown improves severe fistulas in 60% of cases and closes them in 20% of cases. However, the effects did not persist even after stopping the drug.
Long-term use of ciprofloxacin may cause the following symptoms:
abscess
Draining the abscess is an important first step in PCD treatment and helps prevent infections, including sepsis.
Your doctor may use a seton, a thin rubber drain placed in the fistula to keep it open and prevent further abscess formation.
Once treatment is started to manage Crohn’s disease, doctors usually remove the seton.
TNF inhibitor
by CCFTNF inhibitors may be the best option to reduce perianal drainage and improve fistula healing.
In trials, the TNF inhibitors adalimumab and certolizumab were effective in healing fistulas, and treatment with infliximab had a 36% success rate in closing fistulas. Vedolizumab and ustekinumab may also be effective.
surgery
If PCD is severe or has complications, a colostomy or ileostomy may be necessary.
Colostomy and ileostomy both move part of the intestine into an opening in the abdominal wall, which medical professionals call a stoma. Your doctor will attach a bag to your stoma to collect your waste.
Click here to learn more about Crohn’s disease surgery.
People with PCD need a nutritious diet because nutrient deficiencies can be a common problem due to inflammation that affects how the body absorbs nutrients.
People with PCD should follow a diet that includes: It contains:
The unpleasant symptoms of PCD can also affect your eating habits. Here are some tips to manage this:
- Eat small meals every 3-4 hours
- Stay well hydrated by drinking small amounts of water regularly throughout the day
- Eat whole grains and a variety of fruits and vegetables when you are not experiencing a flare-up
- Avoid caffeine, high-fiber foods, raw fruits and vegetables, or vegetables that produce gas if you have symptoms such as diarrhea or loss of bowel control
Click here to learn more about nutritional deficiencies caused by Crohn’s disease.
trigger foods
by Academy of Nutrition and Dietetics, there is no specific diet that causes or cures any type of Crohn’s disease. However, certain foods can cause a flare-up of symptoms, including:
You may find it helpful to keep a food diary to keep track of which foods trigger your symptoms. This also helps nutritionists and dieticians create meal plans with people.
Individuals can consult a nutritionist about taking prebiotics, probiotics, or any other supplements they may need.
Learn more about the best foods for Crohn’s disease flare-ups.
Following your doctor’s advice, attending regular check-ups, and taking medications as prescribed by your doctor can help you manage PCD.
of CCF We also offer the following tips for managing Crohn’s disease flare-ups:
- Track your symptoms, potential triggers, and when they’re most likely to occur.
- Regular exercise.
- Avoid smoking as it may worsen symptoms.
- Manage stress using techniques such as breathing exercises, yoga, and cognitive behavioral therapy.
- Use a damp towel instead of toilet paper to reduce irritation to the anal area.
- Shower using a hand shower or use a perianal cleansing product such as Balneol.
- Apply a protective ointment to the skin around the anus, such as Vitamin A&D ointment or Desitin, before bed.
- Soak in warm salt water to relieve pain and tenderness in your anus.
- When traveling or going out, plan your itinerary and know where the nearest restroom is.
- To ease anxiety, carry an emergency kit with items like toilet paper, extra underwear, and baby wipes.
- Carry your CCF “I Can’t Wait” card with you. This allows you to use the nearest available toilet if a public toilet is not available.
- If you need time off for medical reasons, talk to your employer about family and medical leave laws.
- Find a local or online support group that can provide you with a network of people going through similar experiences.
Learn more about support groups for people with Crohn’s disease.
Complications of PCD can include infections such as cellulitis, a bacterial infection of the skin. Some people have recurrent abscesses.
A serious complication of perianal abscess is bacterial sepsis. This is a life-threatening condition and requires immediate medical attention. Treatment of bacterial sepsis may include intravenous antibiotics.
Treatment (and sometimes surgery) for PCD can help prevent and manage complications.
Patients with perianal Crohn’s disease have inflammation around the anus, which can lead to perianal fistulas, abscesses, fissures, and skin tags.
You may experience pain and itching around the anus, as well as discharge of pus and loss of control over your bowel movements.
Certain medications and sometimes surgery can also help treat PCD and prevent complications. Dietary and lifestyle changes may also help manage symptoms.