From the Guidelines
Perineal fistulas are primarily caused by inflammatory bowel disease, particularly Crohn's disease, as well as infections, trauma, and other factors, with management depending on the underlying cause and severity of the condition. The causes of perineal fistulas can be multifaceted, including:
- Inflammatory bowel disease (IBD), with Crohn's disease being a significant contributor, as noted in the study by 1
- Infections of the anal glands leading to perianal abscesses that don't heal properly
- Trauma during childbirth, especially following episiotomy or severe tears
- Surgical complications after procedures like hemorrhoidectomy or fistulectomy
- Radiation therapy to the pelvic region
- Malignancies in the anorectal area
- Sexually transmitted infections Less common causes include tuberculosis, actinomycosis, lymphogranuloma venereum, and hidradenitis suppurativa. According to the most recent guidelines by 2, the management of perianal fistulas, especially in the context of Crohn's disease, should start with the insertion of a seton followed by medical treatment, preferably anti-TNF, and consideration of surgical closure in the absence of proctitis. This approach aims to control sepsis, create a patent tract, and potentially achieve closure with medication or surgery, thereby improving patient quality of life and reducing the risk of complications.
From the Research
Causes of Perineal Fistulas
The causes of perineal fistulas can be attributed to various factors, including:
- Crohn's disease, which is a type of inflammatory bowel disease that can cause perianal fistulas in up to 43% of patients 3
- Perianal abscesses, which can lead to the formation of fistulas if left untreated or not properly drained 3, 4
- Trauma or injury to the perineal area, such as during childbirth, which can cause perineal tears and increase the risk of developing a fistula 5
- Surgical procedures, such as episiotomy or instrumental delivery, which can also increase the risk of perineal trauma and fistula formation 5
- Infections, such as anal abscesses or rectal inflammation, which can spread and cause fistulas to form 3, 4
Risk Factors
Certain risk factors can increase the likelihood of developing perineal fistulas, including:
- Having a history of Crohn's disease or other inflammatory bowel diseases 3, 4, 6, 7
- Experiencing perineal trauma or injury during childbirth 5
- Having a high body mass index (BMI) or being overweight 5
- Having a history of previous perineal surgery or episiotomy 5
- Experiencing constipation or difficulty with bowel movements 5
Associated Conditions
Perineal fistulas can be associated with other conditions, including:
- Crohn's disease, which can cause perianal fistulas and other complications such as abscesses and strictures 3, 4, 6, 7
- Perianal abscesses, which can lead to fistula formation if left untreated or not properly drained 3, 4
- Rectal inflammation, which can increase the risk of fistula formation and other complications 3, 4
- Urinary or fecal incontinence, which can be a symptom of perineal fistulas or other associated conditions 5