Anal is the terminal region of the gastrointestinal tract (digestive tract). It serves as an opening to the outside world. Through the anal canal feces (body waste products or stool) are discharged from the body. Anal problems arise during mild Crohn’s disease symptoms (such as diarrhea) and mostly during chronic (severe) Crohn’s disease symptoms and complications.
Diarrhea is a common symptom of Crohn’s disease. It causes the anus to remain continuously moist. Moist environment is suitable for growth of micro-organisms and this result in itching of anus. Anal itching also occurs due to hemorrhoids, fissures, abscess, fistula and skin tag as explained below.
Hemorrhoid refers to the swelling of the veins present in and around the anus and anal canal (rectum). During bowel movement the body pushes blood towards the rectal area in order to activate the digestive system which helps to move the stool out of the body.
In Crohn’s patients, diarrhea results in frequent bowel movement with straining. This result in bulging of the veins so that they are close to the surface of the inner rectal wall and pressure created due to straining can cause crack in the surface and bleeding occurs.
There are two types of hemorrhoids, internal and external. Internal hemorrhoids normally do not cause pain but they may bleed and are present inside the rectum. External hemorrhoids are located in the anus and they bleed during bowel movement. When inflamed they feel like hardened lump. Hemorrhoids also cause pain and anal itching.
This refers to a cut, split or ulcer (sore) that develops in the anus and this can extend to the anal sphincter (a ring of circular muscle which closes the anus and control excretion). In Crohn’s patients, anal fissures occur due to ulceration of hemorrhoids and they may itch.
Fissure becomes chronic if it is present for more than six weeks. Chronic fissure do not heal easily because in chronic stage the sphincter tears and goes into spasms (strong and painful contractions), separating the tear more and causing vicious, sharp and stinging pain during bowel movement.
After bowel movement this pain lasts for a few hours. Also blood supply to the anus decreases and this slows down healing. Sometimes an anal fissure and a hemorrhoid can develop at the same time. Other than chronic anal fissure other complicated Crohn’s disease symptoms of anal fissuredisorder include anal fistula, anal stenosis and development of skin tag which are discussed below.
Abscess means painful accumulation of pus. It develops when a small gland, present inside the anus, gets infected by bacteria. The gland becomes filled with pus. This gland can enlarge in size and cause fever, pain, and even difficulty in bowel movements.
Patients also experience drainage of fluid or pus and itching of the anal skin. If anal abscess is not treated properly or healed, it bursts inwardly and, in more than half cases, leads to fistula formation that is discussed below.
Anal fistula is an abnormal tunnel-like structure that joins the anal canal to the small intestine or colon (region of large intestine) or to the surrounding exterior skin of the body. Fistulas bring irritating fluids from the Crohn’s disease infected intestine or colon to anal area.
The fistula that forms between the anus and the external skin surrounding the anus cause drainage of pus through this external opening. Anal abscesses mostly cause fistula formation as discussed above. Pain and bleeding with bowel movement; swelling of anal region; drainage of pus; chills; fever; and fatigue are symptoms of this Crohn’s disease complication.
Anal skin tags:
These are flaps of skin or flesh, generally forming around the rectum. They are usually harmless and do not have symptoms. Anal tags occur because of anal fissure or untreated, external hemorrhoid swelling. Anal skin tags are often confused with hemorrhoid.
Irritation and itching occurs if these are rubbed or subjected to any kind of friction. If the tags swell then they can cause discomfort and pain. If left untreated they may become inflamed and can lead to other anal complications.
(also known as rectal stenosis or proctostenosis): This refers to the abnormal narrowing or contraction of anal canal (rectum) which causes difficulty to pass stool out of the body. This occurs due to spasm of anal sphincter as explained above in anal fissure or due to contraction of already inflamed anal skin.
In such conditions the patient pushes or strains so to create extra pressure to cause bowel movement. This result in hemorrhoids which further makes the anal canal narrower. Consequently pressure and straining increases which may ultimately result in fistula formation, where the anal canal connects with the exterior skin surrounding the anus.
15%-40% of Crohn’s patients suffer from rectum complications. In very rare cases parienal (related to regions immediately surrounding the anus) manifestations (symptoms or alterations associated with diseased state) are seen to be the initial stage Crohn’s disease symptoms.
Initial stage parienal manifestation can be treated with medications but if it reaches chronic stage then mostly surgery is required. Crohn’s patients should routinely check for parienal and rectum Crohn’s disease symptoms.
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