Should I treat my perianal fistula?

Hey there I am new to this forum and this is my first time posting. I am a 20 year old male that has been diagnosed for about 4 years and have had a perianal fistula for 3 years or so. My Crohn's is not too severe and neither is my fistula. It doesn't cause me too much discomfort or pain, just the discharge every day. I was wondering if I should have it surgically treated or just leave it be. Im afraid leaving it as it is will cause me complications in the future and also afraid surgically treating it might result in incontinence.

Thanks for reading and good luck to you all.

Hi Jon. Welcome to the forum!

I think you'll find this to be a great place with great folks. I'd recommend a post at some point in the Your Story forum. It's a great way to get to know some members and to get to know your way around.

I would visit your GI and be very up front about your concerns. Any surgical intervention I discussed with my colorectal surgeon surrounded incontinence as one of the chief concerns - for me and my surgeon. There are lots of things to consider, and I can only suggest that they are considered with your doctor. Not doing anything has aspects to consider as well.

I know that having my crohn's under control was one of the factors that seemed to increase the efficacy of various options. Are you on biologics?

Ditto on what sawdust said. Whatever path you take has factors that need to be considered.

The only "medication" I'm on is probiotics. I plan on taking Humira once I finish my studies in about a year and a half.

JonC89 said:

The only "medication" I'm on is probiotics. I plan on taking Humira once I finish my studies in about a year and a half.

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I'm not advocating or discouraging the use of any medications, but I've been at this long enough to be one of the leftover "bottom up" patients. I don't think it's the way newer patients are typically approached anymore. I understand that the biologics - of which Humira is one - have a propensity to help fistulas with less need for surgical intervention.

I'm sure these are all things your GI will consider with you. Since I'm not on any of the biologics, My GI and CR Surgeon opted the surgical route, but either way, these things can be literal pains in the butt - quite pesky. I hope you get the answers, direction, and expertise you need soon!

Surgery isn't always successful without help of medications. I have had two surgeries and never had any medication more than flagyl. I still have fistulas, wish I never had the surgeries.

Hi Jon,
Just curious, when you say surgical treatment are you talking about getting a seton drain or having a fistulotomy or lift treatment? Have you talked to a colorectal surgeon regarding your options? We are all different and having crohns can limit our options.
For my fistulas the seton drain is all that can be done. It keeps the fistula track draining well and prevents abscess from forming.
Also, why are you waiting to begin the humira treatment?

Hey Jon, I have the same problem as you. I was dx w crohns last year after i did colonoscopy bc of my perianal fistula. My case is also mild so i started with pentasa for the crohns and antibiotics for the fistula (as I would get mild fevers once in a while). The antibiotic didnt close my fistula so the doc wanted me on remicade which i disagreed since the fistula does not bother me and has no pain.
So i just had my second colonoscopy last week to evaluate my situation and 90% of rectum ulcers are clear! I have decided to give my fistula more time now that the underlying wounds have healed. My doctor said I cant have surgery to close it since my MRI showed its a complex fistula (its a 3 in 1).
Im happy to hear you have had no problem with it for 3 years. I hope we find a way to close it though. Good luck!

The surgical treatment for fistula in Crohn's disease tends to be very conservative, the reason for this is we don't heal in that area as well as someone who doesn't have crohns and therefore if you go laying open fistula tracts you are very often left in a worse shape with an open wound that won't heal. Personally I would just leave alone if it isn't really causing you any bother. If I can answer anything else for you please give me a shout. Cheers Ryan.

bigtruck said:

The surgical treatment for fistula in Crohn's disease tends to be very conservative, the reason for this is we don't heal in that area as well as someone who doesn't have crohns and therefore if you go laying open fistula tracts you are very often left in a worse shape with an open wound that won't heal. Personally I would just leave alone if it isn't really causing you any bother. If I can answer anything else for you please give me a shout. Cheers Ryan.

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My fistulas didn't cause me much pain at all until I had them laid open the first time. Probably because I had them for so long that I got use to them. After the first surgery initially healed and then started becoming active fistulas again, they were much more painful than they originally were, my theory was because all the scar tissue was gone.

JonC89 said:

Hey there I am new to this forum and this is my first time posting. I am a 20 year old male that has been diagnosed for about 4 years and have had a perianal fistula for 3 years or so. My Crohn's is not too severe and neither is my fistula. It doesn't cause me too much discomfort or pain, just the discharge every day. I was wondering if I should have it surgically treated or just leave it be. Im afraid leaving it as it is will cause me complications in the future and also afraid surgically treating it might result in incontinence.

Thanks for reading and good luck to you all.

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How are things going? Have you had any surgery.