Surgical Treatment

Because CD cannot be cured by surgery, the guiding surgical principle is to do as little as possible while relieving symptoms as completely as possible. Risks of iatrogenic injury combined with disappointing surgical results prompt a conservative approach in nearly all patients. We agree completely with Alexander-Williams' observation that "fecal incontinence is the result of aggressive surgeons and not progressive disease."

Although some perianal lesions heal spontaneously without specific treatment, surgery has an important role. Anorectal surgery in IBD is primarily a management tool for complications. The goal of operative intervention is preservation of sphincter function along with elimination of perianal symptoms.

Which patient deserves operative intervention? First, perianal pathology must be symptomatic. Many CD patients will have what has been coined as a "dry fistula." These asymptomatic patients have no current complaints, and therefore, no treatment is warranted or prudent. Second, all perianal sepsis must be drained or controlled. Third, rectal disease must be absent or in a state of quiescence. Fourth, the diagnosis must be secured. As previously discussed, the use of MRI or EUS and EUA increases the accuracy of our diagnostic skills. Once the diagnosis has been made, the proper surgical intervention can be undertaken. There is also a separate chapter on anorectal disease with and without IBD (see Chapter 91, "Anorectal Diseases").

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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