The good news is that Crohn’s perianal fistulas can very often be treated and eventually closed. To do so, you will need to work closely with your gastroenterology doctor and/or colorectal surgeon. Treatments can include medicines, surgical procedures, or a combination of the two. It’s important to know, though, that the first treatment may not work, and you may need to try another one. Watch the video to get an overview of the different treatment options.
If you don’t have a gastroenterology doctor or colorectal surgeon, click below to find one near you who specializes in treating Crohn’s perianal fistula.
Medicines
Antibiotics
Medicines are an important way to treat Crohn’s perianal fistulas. Antibiotics, such as metronidazole or ciprofloxacin, are often a first step for many people. They can reduce the amount of leakage of stool, blood, and mucus. Some people’s fistulas may even close after taking antibiotics. Doctors usually recommend taking antibiotics for 4-8 weeks to see if it will work. However, even if the antibiotics do heal the fistula, it’s possible that they may come back after stopping the treatment.
“I have a lot more energy and I am able to spend more time with my son. I'm able to go to work. So having gotten the fistula treated was a massive improvement for my life.”
– Patient with Crohn's perianal fistula
Biologic Medicines
Biologic medicines known as anti-TNFs (e.g., adalimumab, infliximab, certolizmab) can heal Crohn’s perianal fistulas. These medicines are usually started if antibiotics did not work. Before doing so, it’s important that any abscesses (i.e., pockets of infection) are drained and treated. If anti-TNFs do not work, there are other biologic medicine options such as ustekinumab or vedolizumab that may be considered; discuss this with your doctors.
"The doctor put me on biologics and it did the thing."
– Patient with Crohn's perianal fistula
Surgical Procedures
Most people will need to have an outpatient surgical procedure to treat their Crohn’s perianal fistula. As many as 9 in 10 people with a fistula will need to have at least one procedure. Although certain medicines may be effective in closing the fistulas, surgical procedures ultimately may be needed if the medicines do not work.
The most common outpatient surgical procedure is placement of a seton. A seton is a small, soft, flexible tube that is threaded through the fistula. This lets pus drain out, which helps prevent future infections and allows the fistula to heal over time. Aside from seton placement, there are other specialized surgical procedures. These include fistulotomy, ligation of the intersphincteric fistula tract (LIFT), and endorectal advancement flap, among others. Make sure to talk with your doctors about which procedure is best for you and what to expect afterwards.
Future Treatments—Injectable Stem Cells
Darvadstrocel is a treatment for Crohn’s perianal fistula that is currently approved for use in patients in Europe and Japan. It may become available for patients in the US in the future. Darvadstrocel contains stem cells that are injected directly into the fistulas. It is given just one time, and the procedure is done at an outpatient surgery center. The stem cells reduce inflammation and help new tissue to grow. Over time, this allows the fistula to heal and close.