It took me about a month to realize why I was increasingly uncomfortable sitting at the computer. Since I had battled inflammatory bowel disease (IBD) for decades, it really shouldn’t have been a surprise that I was, once again, suffering from perianal complications associated with Crohn’s disease. If there’s one aspect of this disorder that patients don’t like to talk about, it’s a hurting, bleeding rear end.
What is Crohn’s Disease?
IBD patients have either Crohn’s disease or its cousin, ulcerative colitis. Crohn’s has no cure. It causes inflammation in the lining of a patient’s digestive tract, resulting in severe diarrhea, pain in the abdomen, and malnutrition for some.
The goal of treatment is long-term remission, according to the Mayo Clinic. While the illness most often initially strikes those younger than 30, some Crohn’s patients are 70 or older.
The exact cause remains unknown. However, heredity and the triggering of an over-the-top immune response by microorganisms are strong suspects.
What are Perianal Complications?
I had perianal complications of Crohn’s years before being diagnosed with the disease. At age 20, I had surgery for a rectal fistula. An operation five years later fixed an anal fissure. None of my physicians at that point caught on that I had the disease. Perianal complications, along with scarring from the two surgeries, continued to plague me periodically.
After I gave birth to my daughter, my episiotomy wouldn’t heal. Fortunately, a gastroenterologist who had treated many Crohn’s patients made the diagnosis. The mystery was solved.
Hemorrhoids, fistulas, fissures, generalized inflammation, and episiotomies that won’t heal are the primary perianal complications of Crohn’s disease. The illness can occur anywhere in the digestive tract from mouth to anus. “Perianal” refers to the area surrounding the anus. Complications outside the digestive tract can also occur.
The World Journal of Gastroenterology (WJG) reports that somewhere between 25 and 80 percent of Crohn’s patients experience perianal inflammation.
A fistula begins with a deep sore or ulcer in the intestinal tract. It can develop into a tunnel to other organs like the bladder, skin, and vagina. According to the Crohn’s Colitis Foundation of America, around 30 percent of Crohn’s patients develop fistulas. WJG indicates that 25 to 30 percent of those with perianal fistulas require surgery.
Fissures can be superficial or deep. They always appear in the area of the anus.
After I experienced difficulty sitting, I had to go to the bathroom eight to 10 times a day. Having a bowel movement hurt. It stung. It bled. I had at least one “accident” every day. My rear end began to throb 24/7.
Patients generally don’t talk about these symptoms with family members or even other patients. Sometimes they’re too embarrassed to try to explain them to their doctors, which only delays treatment and potential relief.
Which Types of Treatment are Available?
Some Crohn’s perianal complications resolve spontaneously. I wasn’t so lucky. When I noticed the most recent problems, I was already on three medications for Crohn’s disease: Asacol (an anti-inflammatory), Imuran (an immune suppressor), and Flagyl (an antibiotic). My physician added Budesonide (a steroid) and Canasa® (a suppository for inflammation) to the mix.
In addition to these medications, certain topical creams help reduce discomfort for some patients. So do multiple sitz baths each day and, with medical approval, over-the-counter anti-diarrheals. Patients might take Cipro, another antibiotic. Some take other immune suppressors like 6-mp, biologic drugs such as Humira®, or various combinations of medications.
The newest therapies include carbon dioxide ablation therapy and injecting fibrin glue into fistulas. Some patients with anal fistulas have also received a type of bioprosthetic plugs.
The objective of medical treatment is getting the disease under control in the hope that this will resolve any complications. Sometimes, however, attention gets diverted to focusing on the specific problems a perianal complication causes.
When medical intervention doesn’t resolve the perianal complications associated with Crohn’s disease, surgical therapy might be necessary. The outcome is usually less than ideal when the patient has active disease at the time of surgery. For patients with severe, persistent complications, surgery might include resecting part of the rectum or removing it in its entirety.
