Clinical features of perianal Crohn disease

Type of lesion	Typical location	Common clinical presentations	Perianal inspection	Digital rectal examination
Simple perianal fistula	Perianal skin	Perianal drainage	Single cutaneous opening	Internal opening may be palpated
Complex perianal fistula	Perianal skin or buttocks	Perianal drainage Perianal pain	One or more cutaneous opening(s)	Internal opening(s) may be palpated
Perianal abscess	Varies*	Perianal pain, unrelated to bowel movements Fluctuation beneath perianal skin Cutaneous drainage of pus from fistula Fever may be present	Cutaneous area of erythematous induration and/or fluctuance Cutaneous opening if associated with fistula or spontaneous drainage	Diffuse tenderness may be present Palpable fluctuant mass or fullness
Anal fissure	Anal canal	Rectal bleeding possible May be painless	Tear or laceration in the anoderm Bleeding may be visible	Tenderness of anal canal may be present
Anorectal stricture	Anal canal	Fecal urgency and/or frequency Tenesmus Difficult evacuation	Normal	Narrowing of anal canal

This table does not substitute for the clinical judgment of the treating specialist. Refer to UpToDate content on the diagnosis and management of perianal Crohn disease.

* The location of perianal abscess varies (eg, superficial, ischiorectal, intersphincteric).

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Clinical features of perianal Crohn disease