Perianal Problems in Patients with Ulcerative Colitis

Perianal problems in patients with inflammatory bowel disease are usually attributed to Crohn's disease (CD) or indeterminate colitis (IC). Perianal disease associated with ulcerative colitis (UC) was initially described nearly 5 decades ago, and many reports1,–8 have documented a high prevalence of such problems in patients with UC (Table 1). For example, Edwards and Truelove2 reported that 32% of their 624 patients with UC suffered from various perianal complications, whereas Bockus et al3 reported an incidence of 18%. Overall, early studies suggested that the rate of perianal complications in patients with UC was in the range of 20% to 25%.4 These high reported rates of perianal problems in UC were misleading, however, because colonic CD was only first recognized in the early 1960s9,10 and proper descriptions of IC occurred in the late 1970s.11,12 Clearly, many patients thought in the past to have UC and perianal disease really had either CD or IC. In fact, perianal complaints are often considered adequate confirmation of the diagnosis of CD, especially if there is suppuration and/or unusual features.13,–18 On the other hand, it is clear that some patients with UC do, indeed, suffer from perianal problems.19