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.