In fact, a review published in 2021 in Crohn’s & Colitis 360 found that while people with IBD do not experience more rectal sensitivity than the general population when their IBD is in remission, they are twice as likely to have rectal sensitivity when the disease is active. One word of caution though: “When you have IBD, issues around the anus can easily lead to complications or signal an infection that needs to be treated, so please talk to your doctor and have it checked out,” says Serre-Yu Wong, MD, PhD, a gastroenterologist at the Icahn School of Medicine at Mount Sinai in New York City.
Common Ailments With IBD, and What to Do About Them
Perianal Dermatitis Irritation of the skin around the anus is quite common when an IBD flare leads to diarrhea. “Patients are prone to discomfort from overuse,” says Stefan Holubar, MD, a colorectal surgeon at the Cleveland Clinic. “Their diarrhea causes a lot of wiping, and that leads to perianal dermatitis. “ Additionally, diarrhea has an acidic pH, which irritates the anus as it exits. “The anus has a thin layer of protective oil that can be wiped away from overuse,” says Dr. Holubar. He recommends using butt paste with calamine lotion, or a zinc-based product to soothe the irritated skin around the anus. “It’s best to put it on as a protective layer before making a bowel movement, so the diarrhea touches the ointment rather than the skin,” he says. To decrease wiping, he also advocates using a bidet or a peri bottle to clean the area. Anal Fissures Your garden-variety anal fissures are small tears in the skin tissue around the anus that can be painful or itchy. Sometimes they leave blood in the stool. Fissures are often caused by pressure created by constipation or passing a large stool. “The opposite is the case in IBD,” says Holubar. “IBD patients have low-pressure fissures from overuse and chronic diarrhea, so the key to treating it is getting the diarrhea and the inflammation under control with medication.” However, since there is ongoing inflammation close to an open cut, there is an increased risk of infection, notes Dr. Wong. To ease irritation, Holubar recommends a sitz bath (a warm-water bath you sit in to relieve discomfort) and a protective ointment. “At home, it’s very important to keep the area clean and dry,” says Wong. “Even after a sitz bath, you can use a low-heat hair dryer to dry without wiping and then wear cotton underwear to make sure you’re comfortable, clean, and dry.” Wong insists that patients call their doctor to have their fissures checked because an underlying issue or an infection may be present. Or there may be a deep fissure leading to anal canal ulceration that requires an injection of a steroid, such as betamethasone, directly into the ulcer to get it to heal. Perianal Fistulas or Perianal Crohn’s Disease People with Crohn’s disease, but not ulcerative colitis, are at an increased risk of anal inflammation that causes fistulas, which are tiny tunnels that form between the anus and the skin around the opening of the anus. Since there is no sphincter muscle controlling the opening, fistulas can easily leak blood, stool, or pus from an abscess. And since they are open, they are easily infected and very uncomfortable. In a review published in September 2022 in the Journal of Crohn’s and Colitis, researchers found that people with perianal Crohn’s disease had a 66 percent higher chance of getting colorectal cancer, compared with people with Crohn’s disease without perianal disease. In the subgroup of patients who developed anal cancer, 50 percent had perianal Crohn’s disease. “The presence of perianal fistulas is an independent predictor of disability, complications, and poorer outcomes,” says Wong. “Because they can be dangerous, they need treatment from a medical professional.” Perianal fistulas may require a medical procedure or a seton drain, which holds the fistula open and allows it to drain as it heals. A doctor may also need to drain any perianal abscesses in the fistula. Perianal fistulas also require medicine to heal the inflammation. “If you suffer from perianal fistulas, it’s important to get the Crohn’s disease under control and to stay in touch with a colorectal surgeon,” advises Wong. “Your medical team really needs to monitor your progress and watch closely for any worsening.”
