What is perianal inflammatory bowel disease?

Perianal inflammatory bowel disease occurs in about 1 in every 4 or 5 children with Crohn’s disease, a type of chronic inflammatory bowel disease (IBD). Crohn’s disease can cause inflammation (redness, swelling, and pain) anywhere in the gastrointestinal (GI) tract, from the mouth to the anus (the end of the GI tract). 

When inflammation from Crohn’s disease happens near the anus, it can cause things like a fistula, abscess, fissure or stricture.

• A fistula is a small, abnormal tunnel between the skin near the anus and the end of the GI tract. Fistulas usually happen because of an abscess, which is a pocket filled with infected fluid.
• An anal fissure is a small tear or cut in the skin inside the anus.
• An anal stricture occurs at the end of the GI tract, causing it to get small and tight because of swelling and scar tissue.  

Some children experience perianal disease as the first sign they have Crohn’s disease, while others may have perianal disease but not much inflammation anywhere else in their GI tract. 

There are likely many factors that cause perianal IBD in children, and specialists at CHOP are learning more about it every day through research. 

What are the signs and symptoms of perianal IBD?

The signs of perianal IBD can be different for each child. For example, children with a perianal abscess may experience fevers or chills and may feel pain in their bottom when they have a bowel movement, sit or walk. 

Children with perianal fistulas may have pus or blood coming from the area around their anus, and/or the skin near the anus might be red. Sometimes, there are one or more holes just under the skin that can be seen or felt. If the fistulas reach the bladder, children may get urinary infections and have foul-smelling urine.  

Anal fissures can cause bleeding and pain, especially during bowel movements.  

Anal strictures may make children feel like they need to have a bowel movement right away, and they may have trouble pushing or going to the bathroom. 

Children with perianal IBD may also have swollen skin tags around the anus. While these don’t generally cause pain, these swollen tags may make having a bowel movement more difficult.  

How is perianal IBD diagnosed?

Our team of gastroenterologists take a thorough health history of each child, perform a physical examination, and conduct a variety of tests to diagnose perianal IBD. Testing may include blood work, stool samples, imaging studies (such as X-rays and 3-D images), as well as a colonoscopy with a biopsy to test tissue in the lab.   

Sometimes, children need to be asleep during an examination so clinicians can look at the area carefully without causing pain. This is called an examination under anesthesia. Our child life specialists provide age-specific educational resources to assist in coping and psychosocial support with procedures. 

How is perianal IBD treated? 

The main goals of managing perianal disease in children are to: 

• Improve symptoms
• Help skin and tissues heal
• Enhance the patient’s overall quality of life

Treatments vary and can be customized to the child’s specific condition, their symptoms and severity of their perianal IBD. Most often, a combination of medicines and surgery is used.

However, in some cases perianal disease can persist – even with medicine and surgery. Long-term or chronic perianal IBD can make life more difficult for children, so many specialists work together to help.

At CHOP – and in partnership with University of Pennsylvania Hospital – we offer a unique treatment option called hyperbaric oxygen therapy (HBOT) for children with persistent perianal IBD.

HBOT helps soft tissues heal by instructing the body to make more stem cells to fix the damage. HBOT can be used to treat other health problems, such as wound healing, and has helped some children with perianal disease. This is a rare treatment that may be added to a child’s care plan. 

Another rare treatment available at CHOP is stem cell therapy for perianal fistula. This is done by injecting stem cells into and around the perianal fistula to help with healing. This therapy is currently part of a clinical trial at CHOP for young adults aged 18 or older. 

What is the follow-up care for perianal IBD?

Any child treated for perianal IBD at CHOP can continue care here to manage their disease over a long period of time – sometimes into young adulthood. Depending on how many different specialists your child needs, they may be seen in a multidisciplinary clinic where many experts work together, or they may see specialists one appointment at a time. 

At the Center for Pediatric Inflammatory Bowel Disease, physicians collaborate with dietitians, nurses, researchers, psychologists and social workers who specialize in taking care of children with all forms of IBD. This team can help your child and your family and are an important part of your child’s care plan. Our goal is to provide your child with the best care possible to help them feel better and stay healthy. 

Why choose CHOP for perianal IBD?

The Perianal IBD Program offers expert multidisciplinary care for children who have or are suspected of having perianal inflammatory bowel disease (IBD). Our program includes nationally recognized experts from CHOP’s Center for Pediatric Inflammatory Bowel Disease and Very Early Onset IBD Program who provide personalized evaluations, advanced diagnostic tests and individualized treatments to children, teens and young adults with perianal IBD.