Most patients with Crohn's disease present with weight loss, abdominal pain and diarrhoea. An isolated anal lesion is the first manifestation in 5% of patients. Most will develop intestinal symptoms, sometimes many years later . The spectrum of anal complaints is great. Fissures and oedematous skin tags are most common. In the general population most anal fissures are located in the posterior midline. In patients with Crohn's disease, fissures may occur eccentrically. They are deep, indolent and rarely painful unless an abscess is present. Skin tags are usually asymptomatic, but if they become painful or interfere with anal hygiene, they can be excised. They also are an excellent source for biopsy specimens for the presence of granulomata. Other common clinical manifestations include anal stricture, ulceration, complex fistulae, abscesses and finally faecal incontinence. Haemorrhoids are not a common feature of anal Crohn's disease. Management of these varied clinical manifestations is discussed.
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