Anal Crohn’s Disease
Crohn’s disease is a chronic inflammatory process of the digestive tract that, along with the similar condition known as ulcerative colitis, affects over two million people in the US. Both of these conditions are often grouped together and referred to as Inflammatory Bowel Disease. Many people affected by Crohn’s don’t realize they have it because the condition can go into remission for years at a time. Instead, they think they are suffering from an occasional bout of diarrhea or bloating. Additionally, there is no way to know when it will reoccur because there are no obvious triggers for the condition, and it can come and go throughout a person’s lifetime.
Though Crohn’s disease is an inflammatory process of the digestive tract, the main portions of the body affected are the small intestine, colon and rectum, and less commonly, the anus. Crohn’s most often occurs in conjunction with intestinal and colorectal involvement. Usually the intestinal disease precedes or occurs at the same time as the anal disease. However, about 10% of Crohn’s patients present with signs and symptoms of only the anal disease.
Who Can Be Affected
Although Crohn’s disease can technically affect anybody, most patients are between the ages of 16 and 40. It can affect both men and women equally and is more likely to occur if you have a related family member suffering from the same issue.
Despite this tendency to repeat itself in families, Crohn’s disease is not usually classified as a genetic disorder. Instead, it seems more likely caused by either a bacterial growth or an immune-system deficiency. The exact cause or trigger for Crohn’s disease is unknown.
Signs and Symptoms of Crohn’s Disease
The symptoms of Crohn’s disease encompass a variety of gastrointestinal issues and anal problems. The symptoms may wax and wane over the years, but in general, the severity and course of the anal disease typically reflects the course of the intestinal disease (especially rectal disease). Symptoms of intestinal disease such as rectal bleeding, mucous, purulent discharge, fevers, and lower abdominal and pelvis pain often overlap with anal disease. Additionally, symptoms of Crohn’s disease may overlap with common anal disorders like hemorrhoids, fissures and abscesses.
Patients may develop anal pain, swelling, bleeding, discharge and anal tightening. This is often the result of chronic inflammation that results in ulcers or fissures, infections such as abscesses, draining sinuses or fistula tracts, tags, and scarring and fibrosis in the muscular wall and surrounding tissues.
Treatment and Management
Crohn’s disease can’t be cured, but it can be managed principally by medications and when appropriate, judicious use of surgery. This is especially true for Crohn’s since the anus, unlike a segment of small intestine, cannot be removed without the need for a permanent stoma (colostomy or ileostomy bag). Medical regimen involving agents such as antibiotics, steroids, mesalamine analogs, antimetabolites, and biologic injectables like Remicaide are the mainstay of medical management. The role of the gastroenterologist (medical doctor for the GI tract) is vital in optimizing medical therapy. Your colon and rectal surgeon will work closely in coordinating any surgical care with a gastroenterologist in order to ensure the best outcomes possible.
In Anal Crohn’s patients where surgery is advised, the primary role of surgery is to help alleviate and control infection in hopes of allowing medical therapy to treat the disease process. This may take the form of draining abscesses and placing drains or tubes in cavities or fistulas. Patients experiencing fistulas may require follow up procedures to address the fistula in a manner that minimizes damage to the sphincter muscles. In severe cases which do not respond to medical and lesser surgeries, the rectum may need to be removed to alleviate pain and infection.
If you have symptoms that could be connected to Anal Crohn’s disease or you have been diagnosed in the past and are experiencing an active period, talk to your doctor. He or she will help you understand the options available for treatment and management to determine what works best for your needs and lifestyle. Remember that Crohn’s disease changes from patient to patient and it’s important that your own unique circumstances are taken into consideration when making a diagnosis and recommending a treatment course.
The Saleeby & Wessels Proctology Approach
At Saleeby & Wessels, we have 55+ years experience in the non-surgical and surgical treatments of diseases of the colon, rectum and anus. Our board-certified colon and rectal surgeons are experts in helping you manage conditions, such as Crohn’s Disease. We have completed advanced rectal and colon surgical training, as well as general surgical training, and passed the examinations of the American Board of Surgery and the American Board of Colon and Rectal Surgery. We want you to have confidence in trusting us with your colon and rectal health concerns. Our goal is to provide you with solutions to your problem by treating your symptoms and helping you be proactive about your colon and rectal health going forward. We provide you with the care and understanding you need and are committed to putting our patients first – every step of the way.