Anorectal Crohn’s Disease

Emily Steinhagen, Andrea Chao Bafford

Key Concepts

  • Control sepsis: Infection must be addressed before starting immunosuppressive medications.
  • Treat underlying luminal disease and control diarrhea, but avoid steroids for perianal Crohn’s disease.
  • Perineal care: Perineal hygiene should include gentle cleansing with sitz baths or showers and skin protection with barrier creams.
  • Avoid surgery in patients who are asymptomatic or in the setting of active proctitis.
  • In patients who are optimized, fistulas may be treated with long-term draining setons, advancement flaps, or LIFT.
  • Skin tags or hemorrhoids should generally not be treated.
  • Diversion may appropriate as component of the management of perianal Crohn’s disease for some patients.

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Last updated: January 26, 2022