Perianal fistulas represent one of the most complex and burdensome complications of Crohn’s disease.

Affecting up to 30-40% of patients, they are associated with pain, leakage, and repeated interventions, often persisting for years despite intensive medical and surgical treatment. For patients, this means a profound impact on quality of life and daily functioning. For clinicians and researchers, it remains an area of urgent unmet need — where innovation in therapies, imaging, and outcome measures is essential to move care forward.

Clinical challenges

Complex management

Achieving fistula closure while preserving continence remains difficult.

Recurrence

Even after surgical intervention or biologic therapy, recurrence rates remain high.

Prolonged treatment burden

Many patients undergo multiple procedures and years of follow-up.

Psychological impact

Anxiety, depression, and social withdrawal are common but under-recognised.

Healthcare cost

Chronic management contributes to significant system-level burden.

Patient experience

Patient insights highlight the hidden toll of fistulas:

  • Constant worry about leakage and odour
  • Pain and discomfort interfering with daily activities
  • Barriers to intimacy and relationships
  • Embarrassment that prevents open discussion with clinicians
  • Inability to understand/visualise/communicate what is going on inside their body

These lived experiences emphasise the need for patient-centred outcomes and more sensitive measures of treatment success.