The Effect of Perianal Disease on Quality of Life, Fecal Incontinence, and Sexual Function in Crohn’s disease patients

The Effect of Perianal Disease on Quality of Life, Fecal Incontinence, and Sexual Function in Crohn’s disease patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of Perianal Disease on Quality of Life, Fecal Incontinence, and Sexual Function in Crohn’s disease patients Shlomo Yellinek, Lital Berger, Ofra Carmel, Yehudit Chammah, Rosi Goldenberg, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8591206/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Feb, 2026 Read the published version in Digestive Diseases and Sciences → Version 1 posted 7 You are reading this latest preprint version Abstract Purpose To evaluate the impact of perianal Crohn’s disease (PCD) activity on quality of life (QoL), fecal continence, and sexual function in patients with Crohn’s disease (CD), and to identify factors associated with impaired patient-reported outcomes. Methods A cross-sectional analytical study was conducted, from an existing CD patient database at Shaare Zedek Medical Center who diagnosed with and without perianal disease and were seen in IBD clinic between June 2023 to August 2024.The patients agreed to participate and answered validated questionnaires that assessed QoL (SIBDQ), fecal incontinence (WEXNER), and sexual function (IIEF for men, FSFI for women). A total of 150 CD patients were recruited, including 47 with PCD (active and non-active) and 103 without PCD. Results Patients with active PCD had significantly lower QoL compared to those with non-active PCD and without PCD (p = 0.001). Two major risk factors for decreased QoL were identified: age over 40 (p = 0.024) and only conservative treatment (without chronic medication) (p = 0.031). Although no significant difference was found in fecal incontinence between groups, 64.2% of PCD patients reported some degree of incontinence. Sexual function scores were lower in PCD patients, particularly women, though the difference was not statistically significant. Conclusions Active PCD significantly reduces QoL in CD patients, with older age and absence of chronic treatment contributing to poorer outcomes. These findings highlight the need for optimized treatment strategies to improve patient well-being. Further research should explore additional clinical and psychological aspects affecting CD patients with perianal involvement. Perianal Crohn’s disease Quality of life Fecal incontinence Sexual function Patient-reported outcomes Figures Figure 1 Key Message Perianal Crohn’s disease is a severe phenotype linked to high morbidity and healthcare use. Its impact on quality of life is known, but the roles of disease activity, incontinence, and sexual function remain unclear. Active perianal disease significantly worsens quality of life, unlike inactive disease. Older age and lack of maintenance therapy further reduce patient-reported outcomes. How can this study help patient care? Distinguishing active from inactive disease is crucial. Early detection, ongoing therapy, and structured assessment of continence and sexual health can improve quality of life. Introduction Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract, characterized by a relapsing-remitting course that can affect any part of the digestive tract, from the mouth to the anus [ 1 ]. The disease is often diagnosed in young adulthood and is associated with significant morbidity due to its intestinal and extra intestinal manifestations [ 1 ]. The etiology of CD is multifactorial, involving genetic predisposition, environmental triggers, immune dysregulation, and gut microbiota alterations [ 1 ]. Perianal involvement in CD occurs in approximately 20–40% of patients, presenting as abscesses, strictures, and fistulas [ 2 – 4 ]. PCD is recognized as one of the most debilitating manifestations of CD [ 5 ]. It is often refractory to standard medical therapy, requires combined medical-surgical approaches, and carries a high risk of recurrence [ 5 , 6 ]. The introduction of biologic therapies, particularly anti-TNF agents, and advanced proctological techniques have significantly improved treatment outcomes, although clinical management remains challenging [ 6 ]. PCD is associated with increased hospitalization rates, multiple surgical procedures, greater use for immunosuppressive therapy, and reduced quality of life (QoL) [ 7 , 8 ]. Beyond physical symptoms, PCD can cause significant psychosocial distress, sexual dysfunction, and impairment in daily activities [ 8 , 9 ]. The intimate nature of symptoms often results in underreporting due to embarrassment or stigma. Fecal incontinence, often a consequence of both disease activity and prior surgery, can further reduce QoL and social participation [ 10 – 12 ]. Although several studies have evaluated the impact of CD on QoL, relatively few have focused specifically on continence and sexual function among patients with PCD [ 4 , 8 , 13 ]. Given that CD disproportionately affects younger individuals in their reproductive years, understanding the extent to which PCD influences these aspects of life is crucial for improving patient care [ 14 , 15 ]. This study aims to fill this knowledge gap by evaluating QoL, fecal incontinence, and sexual function in CD patients with and without PCD, while identifying potential risk factors that contribute to poorer outcomes. Methods An observational, analytical cross-sectional study was conducted at the gastroenterology unit of Shaare Zedek Medical Center, Jerusalem, a 1200 bed, national IBD excellence referral center, tertiary Hospital, between June 2023 and August 2024. Eligible participants were adults aged 18 years or older with a confirmed diagnosis of Crohn’s disease, established according to accepted clinical, endoscopic, histologic, and radiologic criteria. Patients were recruited consecutively during routine outpatient follow-up visits. Exclusion criteria included a diagnosis of indeterminate inflammatory bowel disease (IBD-U), hospitalization for acute disease flare, urgent surgical indication, or incomplete follow-up and medical records. Patients were classified into three groups according to perianal disease status at the time of assessment: The first group included patients without any history or clinical evidence of perianal disease. The second group consisted of patients with non-active perianal disease, defined as a documented history of perianal involvement without signs of current activity, such as drainage or ulceration, and with only residual findings such as scars without active infection. The third group comprised patients with active perianal disease, characterized by the presence of actively draining abscesses or fistulas, perianal ulceration, anal stricture or Siton in situ. All participants were asked to complete validated, self-administered questionnaires assessing quality of life, fecal continence, and sexual function. The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) was used to evaluate health-related quality of life across physical, social, and emotional domains, with scores ranging from 10 to 70, where higher values indicate lower quality of life [ 16 ]. Fecal continence was assessed using the Wexner score, ranging from 0 (perfect continence) to 20 (complete incontinence) [ 17 ]. Sexual function was evaluated in male participants using the short form of the International Index of Erectile Function (IIEF), which ranges from 1 to 25, with lower scores reflecting greater erectile dysfunction [ 18 ]. Female sexual function was measured using the Female Sexual Function Index (FSFI), which ranges from 2 to 36, with lower scores indicating more severe dysfunction [ 19 ] In addition to patient-reported outcomes, clinical and demographic data were retrieved retrospectively from electronic medical records. Variables collected included age, sex, disease duration, disease location and behavior according to the Montreal classification [ 20 ], presence of extraintestinal manifestations, family history of IBD, current and past medical therapies (including the use of biologics), surgical history, and pregnancy history whene applicable. Statistical analysis was performed using appropriate methods for the distribution and type of data. Continuous variables were expressed as mean ± standard deviation and compared between groups using T-test for normally distributed data or the Mann–Whitney U test for non-parametric distributions. Comparisons among the three perianal disease groups were conducted using one-way analysis of variance (ANOVA) or the Kruskal–Wallis test, as appropriate. Categorical variables were summarized as frequencies and percentages, and differences between groups were assessed using the chi-square test or Fisher’s exact test. Pearson’s correlation coefficient was used to evaluate associations between continuous variables. Multivariable analysis of covariance (ANCOVA) was employed to assess the independent effects of multiple clinical and demographic variables, while adjusting for potential confounders. All tests were two-tailed, and a p-value < 0.05 was considered statistically significant. The study protocol was approved by the institutional Helsinki ethics committee (approval number SZMC-0020-19), and all participants provided written informed consent prior to enrollment. Results A total of 150 patients with Crohn’s disease were enrolled in the study. The mean age of the cohort was 31.0 ± 8.7 years, and the majority were female (86%, n = 129). Forty-seven patients (31.3%) had Perianal Crohn’s disease (PCD), of whom 21 (44.7%) were classified as having active disease and 26 (55.3%) as having non-active disease. The remaining 103 patients (68.7%) had no evidence or history of perianal involvement (Table 1 ). Baseline demographic and clinical characteristics were largely comparable between patients with and without PCD, the proportion of male patients was significantly higher in the PCD group compared with the non-PCD group (23.4% vs. 9.7%, p = 0.025)., penetrating disease behavior was more prevalent in PCD patients (34.0% vs. 14.6%, p = 0.003). No statistically significant differences were observed between the groups with respect to age, disease duration, Montreal disease location, presence of extraintestinal manifestations, family history of IBD, chronic medical therapy use, surgical history, or pregnancy rates (Table 1 ). When quality of life (QoL) was assessed using the SIBDQ, no significant difference was found between the overall PCD group and patients without perianal disease (33.34 ± 13.86 vs. 31.73 ± 12.42, p = 0.478) (Table 2 ). However, subgroup analysis according to perianal disease activity revealed a clear and statistically significant gradient. Patients with active PCD had the highest mean SIBDQ score (41.43 ± 13.38), indicating poorer QoL, compared with those with non-active PCD (26.81 ± 10.53) and those without perianal disease (31.73 ± 12.42) (p = 0.001) (Table 2 ). Of 150 Crohn's patients, 137 answered the WEXNER questionnaire, 64.2% in the group of patients with perianal disease reported some degree of fecal incontinence (score above 0 on the WEXNER questionnaire). Although active PCD patients had slightly higher WEXNER scores, indicating worse Fecal continence, these differences did not reach statistical significance (Table 2 ). Among active PCD patients, the mean score was 5.16 ± 4.75 compared with 2.57 ± 3.01 in patients with non-active PCD (p = 0.171). Sexual function assessments demonstrated similar patterns. Among women, the mean FSFI score was 23.55 ± 8.61 for the entire female cohort. Women with PCD had lower mean scores than those without PCD (21.71 ± 8.26 vs. 24.10 ± 8.72), although this difference was not statistically significant (p = 0.276). In men, the mean IIEF score was 18.58 ± 5.92, with no significant differences between PCD and non-PCD groups (17.20 ± 8.35 vs. 19.57 ± 3.87, p = 0.870) Multivariate analysis of covariance (ANCOVA) was performed to identify independent predictors of QoL, as measured by the SIBDQ. Active PCD was strongly associated with lower QoL, even after adjusting for other variables (p < 0.001). Age greater than 40 years (p = 0.024) and the absence of chronic maintenance medical therapy (p = 0.031) were also independently associated with poorer QoL (Table 3 ). Patients receiving chronic medical therapy, particularly biologic agents, tended to report higher QoL than those managed conservatively without long-term pharmacologic treatment (Fig. 1 ). Discussion Perianal Crohn’s disease (PCD) is widely recognized as one of the most debilitating manifestations of Crohn’s disease, particularly when active fistulas, abscesses, or ulcerations are present [ 9 , 14 , 21 ]. International data further underscore this burden; for example, the survey by Spinelli et al. demonstrated that persistent perianal fistulas substantially interfere with daily activities, social functioning, and emotional health [ 22 ]. Against this clinical and psychosocial background, our study sought to evaluate how perianal disease status influences patient-reported outcomes in a contemporary cohort. In this cross-sectional analysis of 150 patients with Crohn’s disease, active PCD was strongly associated with poorer health-related quality of life (QoL), as measured by the SIBDQ, whereas a history of PCD without active symptoms did not significantly impair QoL compared with patients without perianal involvement. These findings suggest that it is the persistence of active perianal manifestations—rather than the mere presence of past disease—that primarily drives reductions in patient-reported well-being. Interestingly, when PCD patients as a whole were compared with those without perianal disease, we observed no significant difference in QoL scores. This may reflect the fact that a large proportion of PCD patients in our sample were in remission at the time of assessment. These results emphasize that effective management of PCD, with control of active symptoms, can mitigate its detrimental impact on quality of life [ 1 , 23 ] Regarding fecal continence, 64.2% of PCD patients reported some degree of incontinence. We did not observe statistically significant differences in Wexner scores between groups, although patients with active PCD had numerically higher scores, suggesting a trend toward worse continence. The absence of statistical significance could be explained by the relatively small number of patients who completed the Wexner questionnaire, potential underreporting due to embarrassment, or multifactorial causes of incontinence unrelated solely to perianal involvement [ 21 ]. Previous studies, including those by Kamal et al., have reported higher rates of fecal incontinence among IBD patients with PCD, but the strength of this association appears to vary depending on study population, disease severity, and surgical history [ 12 ]. Sexual function outcomes in our study did not differ significantly between groups, although women with PCD tended to have lower FSFI scores than those without PCD. This trend is consistent with earlier work by Riss et al., which suggested that sexual dysfunction in IBD patients may be more common among those with perianal complications [ 14 ]. However, our study’s limited sample size for sexual function assessment, particularly among men, restricts the strength of conclusions in this domain. It is also important to note that the majority of our cohort consists of Orthodox Jewish and Muslim patients, many of whom come from conservative cultural backgrounds in which sexuality is regarded as a sensitive or private matter. In such contexts, sexual concerns may be under-reported or framed differently, which could influence the overall reporting of sexual function in our sample [ 24 – 28 ]. Given the young age at which Crohn’s disease often presents, and the potential psychosocial and relational impact of both the disease and its treatments, sexual health should remain a routine consideration in patient care, even if patients do not spontaneously raise the issue. Beyond perianal disease activity, we identified two additional independent predictors of poor QoL: age greater than 40 years and the absence of chronic maintenance medical therapy. The association with older age may reflect cumulative disease burden, the presence of comorbidities, or differences in coping strategies [ 3 ]. The link between lack of maintenance therapy and reduced QoL is noteworthy, particularly as the majority of patients on maintenance treatment in our cohort were receiving biologic agents, most commonly anti-TNF drugs. These treatments have been shown in multiple studies to improve both objective disease control and patient-reported outcomes [ 5 – 7 ]. Our findings therefore reinforce current recommendations favoring early and sustained use of effective medical therapy for PCD, particularly in cases with high risk of recurrence. The clinical implications of these findings are significant. First, they underline the importance of actively screening for perianal disease activity during routine follow-up visits, rather than relying solely on patient self-report, given the potential reluctance to discuss sensitive symptoms. Second, they suggest that prompt and aggressive treatment of active PCD may yield meaningful improvements in patient quality of life. Third, they highlight the need to address broader aspects of patient well-being, including sexual health and continence, even when these are not volunteered by the patient. Nonetheless, certain limitations must be acknowledged. The single-center design and recruitment from a tertiary referral hospital may limit generalizability, as such populations may include patients with more complex or severe disease. Furthermore, the reliance on self-reported measures introduces the possibility of recall or social desirability bias. Additionally, the relatively small sample size for sexual function questionnaires, particularly among men, limits the ability to detect subtle differences. Future research should include larger, multicenter, prospective studies to confirm our findings and explore the longitudinal relationship between PCD activity and quality of life. Investigations into interventions aimed specifically at improving continence and sexual function in this population are also warranted. Finally, given that some patients with non-active PCD in our study reported QoL comparable to those without perianal disease, further exploration of the factors that enable such resilience may help inform supportive care strategies. Conclusions In this cross-sectional study of patients with Crohn’s disease, active perianal disease was independently associated with a substantial reduction in health-related quality of life, while non-active perianal disease did not significantly impair patient-reported outcomes. Older age and the absence of chronic maintenance medical therapy emerged as additional predictors of poorer quality of life. Although differences in fecal continence and sexual function between groups were not statistically significant, trends toward worse outcomes in active perianal disease highlight the importance of further investigation. These findings underscore the central role of disease activity control in optimizing quality of life for patients with perianal Crohn’s disease and support the integration of targeted perianal assessment and treatment strategies into routine clinical care. Clinicians should routinely inquire about perianal symptoms, continence, and sexual health, even in asymptomatic or remissive patients, to identify issues that may otherwise go unreported. Multidisciplinary care, involving gastroenterologists, colorectal surgeons, specialized nurses, and mental health professionals, is likely to yield the most comprehensive improvement in outcomes. Declarations The authors declare that they have no conflicts of interest related to the subject matter of this article. No external funding or financial support was received from any organizations, institutions, or companies in the preparation, writing, or publication of this manuscript This study was approved by the Institutional Review Board of Shaare Zedek Medical Center (Approval number: 0094-22-SZMC). Informed consent was obtained from all individual participants included in the study. Author Contribution Y.S. and B.L. contributed equally to the conception and design of the study, data acquisition, data analysis, and drafting of the manuscript. O.C. contributed to study conception, supervised the research, and critically revised the manuscript. C.Y. and G.R. contributed to data collection, database management, and preliminary analyses. M.T. contributed to study design, clinical interpretation of the data, and manuscript revision. B.S.A. contributed to clinical oversight, interpretation of results, and critical revision of the manuscript. 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Kimmy Caplan and Nissim Leon (New York: Routledge, 2024). https://doi.org/10.4324/9781003315643 Tables Table 1 Baseline Demographic and clinical characteristics in study participants Patient characteristics Total n = 150 Perianal disease n = 47 Non perianal disease n = 103 P value Age , mean ± SD Age 40, n (%) 31.0 ± 8.66 133(88.7) 17(11.3) 30.36 ± 7.93 41(87.2) 6(12.8) 31.29 ± 9 92(89.3) 11(10.7) 0.544 0.708 Year of disease , mean ± SD 9.33 ± 6.48 10.53 ± 6.42 8.79 ± 6.47 0.127 Sex , n (%) male female 21(14) 129(86) 11(23.4) 36(76.6) 10(9.7) 93(90.3) 0.025* Location of Disease , n (%) Ileal Colonic Ileocolonic Upper GI 86(57.3) 13(8.7) 50(33.3) 7(4.7) 25(53.2) 4(8.5) 18(38.3) 3(6.4) 61(59.8) 9(8.8) 32(31.4) 4(3.9) 0.448 1 0.405 0.679 Phenotype , n (%) Non- stricturing non-penetrating Stricturing Penetrating 87(58) 32(21.3) 31(20.7) 18(38.3) 13(27.7) 16(34) 69(67) 19(18.4) 15(14.6) 0.003* EIM , n (%) 96(64) 30(63.8) 66(64.1) 0.977 Family history of IBD , n (%) 80(53.3) 21(44.7) 59(57.3) 0.151 Chronic Treatment , n (%) 124(82.7) 40(85.1) 84(81.6) 0.594 Any Surgery , n (%) 44(29.3) 15(31.9) 29(28.15) 0.639 Pregnancy , n (%) 47(31.3) n = 36 15(41.7) n = 93 32(34.4) 0.442 SD, standard deviation; EIM, extra-intestinal manifestation; IBD, Inflammatory bowel disease * p < 0.005 Table 2 Questionnaire scores of Crohn's patients according to study groups. Questionnaire mean ± SD NO Perianal disease (n) Active Perianal disease (n) Non-Active Perianal disease (n) P value SIBDQ 31.73 ± 12.423(103) 41.43 ± 13.38(21) 26.81 ± 10.53(26) 0.001* Wexner 3.46 ± 4.12 (95) 5.16 ± 4.75 (19) 2.57 ± 3.01(23) 0.171 FSFI 24.10 ± 8.72(47) 25.64 ± 4.71(5) 19.52 ± 9.21(9) 0.352 IIEF 19.57 ± 3.86(7) 17.5 ± 7.77 (2) 17 ± 10.44(3) 0.949 SIBDQ, Short Inflammatory Bowel Disease Questionnaire: Wexner: Fecal continence Wexner score; FSFI: Female Sexual Function Index; IIEF: International Index of Erectile Function; * p < 0.005 Table 3 SIBDQ questionnaire scores according to study variable groups. N (150) SIBDQ mean ± SD P value ANCOVA P value Perianal disease No Perianal disease Active Perianal disease Non-Active Perianal disease 103 26 21 31.73 ± 12.423 41.43 ± 13.38 26.81 ± 10.53 0.001* < 0.001* Age Age 40 133 17 31.33 ± 12.57 39.29 ± 13.33 0.024* 0.012* Chronic Treatment Yes No 124 26 31.20 ± 12.738 37.15 ± 12.556 0.031* 0.039* SIBDQ, Short Inflammatory Bowel Disease Questionnaire * p < 0.005 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Feb, 2026 Read the published version in Digestive Diseases and Sciences → Version 1 posted Editorial decision: Revision requested 26 Jan, 2026 Reviews received at journal 26 Jan, 2026 Reviewers agreed at journal 19 Jan, 2026 Reviewers invited by journal 16 Jan, 2026 Editor assigned by journal 13 Jan, 2026 Submission checks completed at journal 13 Jan, 2026 First submitted to journal 13 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8591206","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":576669567,"identity":"26e8d515-ea61-42f5-9dd7-42ebeb3f69cd","order_by":0,"name":"Shlomo Yellinek","email":"","orcid":"","institution":"Shaare Zedek Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Shlomo","middleName":"","lastName":"Yellinek","suffix":""},{"id":576669572,"identity":"99adbadc-c4e8-4164-9baa-e379d84dc299","order_by":1,"name":"Lital Berger","email":"","orcid":"","institution":"Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Lital","middleName":"","lastName":"Berger","suffix":""},{"id":576669578,"identity":"c33649d7-a213-4b7c-aa78-3d89c011c464","order_by":2,"name":"Ofra Carmel","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYDAC5gNAogLB5+EjqIUtAUicQdLCRpQWxjZkAUI6+Nl4H374Oa/OXrf9AOPjil8MMgS1SLaxG0v2bjvMbHYmgdnwbB8RDjO438YgzbjtAJvZDQY2ycYeYrQcY2P+zTinjockLWzSjA3MEmAtDT+I0CLZxsZm2XPssIHZmcRmw8YGCcJa+NnYmG/8qKmzNzt++ODDhj829vyEtCABxgZgBEmQoAEC/pCsYxSMglEwCkYAAABc1jIqsZhCyAAAAABJRU5ErkJggg==","orcid":"","institution":"Shaare Zedek Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Ofra","middleName":"","lastName":"Carmel","suffix":""},{"id":576669591,"identity":"1b4202d1-54b5-41c9-9d12-d1cb3f7f7cd4","order_by":3,"name":"Yehudit Chammah","email":"","orcid":"","institution":"Shaare Zedek Medical 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12:39:49","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":91267,"visible":true,"origin":"","legend":"","description":"","filename":"f205aeead6ae419faeeb2e6a49764a841structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8591206/v1/1250ace8755bef9a6019c479.xml"},{"id":100684337,"identity":"9df96265-64a4-497a-a6f0-1df9c38f5c35","added_by":"auto","created_at":"2026-01-20 12:42:19","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101657,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8591206/v1/3f87c4975f3f8d4a2295fe2f.html"},{"id":100684297,"identity":"5b34a2f9-ac87-4a80-aba6-e4580273891a","added_by":"auto","created_at":"2026-01-20 12:41:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":129703,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMultivariate analysis of covariance (ANCOVA), Distribution of SIBDQ scores in patients with and without regular drug treatment according to perianal disease involvement\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e* p\u0026lt;0.005; Perianal disease activity, p=0.001; Age, p=0.012; Chronic treatment, p= 0.039\u003cbr\u003e\n \u0026nbsp;\u003cstrong\u003ea,\u003c/strong\u003e patients over the age of 40; \u003cstrong\u003eb\u003c/strong\u003e, patients aged 40 and under\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8591206/v1/056c8727b0ee9d17c43fc2d2.png"},{"id":103251005,"identity":"c7f678bb-4131-4526-a3c2-70ad56c2241e","added_by":"auto","created_at":"2026-02-23 16:00:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":761379,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8591206/v1/5d0bf188-748a-44ea-a717-1771c4646605.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of Perianal Disease on Quality of Life, Fecal Incontinence, and Sexual Function in Crohn’s disease patients","fulltext":[{"header":"Key Message","content":"\u003cp\u003e Perianal Crohn\u0026rsquo;s disease is a severe phenotype linked to high morbidity and healthcare use. Its impact on quality of life is known, but the roles of disease activity, incontinence, and sexual function remain unclear.\u003c/p\u003e\u003cp\u003e Active perianal disease significantly worsens quality of life, unlike inactive disease. Older age and lack of maintenance therapy further reduce patient-reported outcomes.\u003c/p\u003e\u003cp\u003eHow can this study help patient care?\u003c/p\u003e\u003cp\u003eDistinguishing active from inactive disease is crucial. Early detection, ongoing therapy, and structured assessment of continence and sexual health can improve quality of life.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eCrohn\u0026rsquo;s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract, characterized by a relapsing-remitting course that can affect any part of the digestive tract, from the mouth to the anus [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The disease is often diagnosed in young adulthood and is associated with significant morbidity due to its intestinal and extra intestinal manifestations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The etiology of CD is multifactorial, involving genetic predisposition, environmental triggers, immune dysregulation, and gut microbiota alterations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePerianal involvement in CD occurs in approximately 20\u0026ndash;40% of patients, presenting as abscesses, strictures, and fistulas [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. PCD is recognized as one of the most debilitating manifestations of CD [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It is often refractory to standard medical therapy, requires combined medical-surgical approaches, and carries a high risk of recurrence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The introduction of biologic therapies, particularly anti-TNF agents, and advanced proctological techniques have significantly improved treatment outcomes, although clinical management remains challenging [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. PCD is associated with increased hospitalization rates, multiple surgical procedures, greater use for immunosuppressive therapy, and reduced quality of life (QoL) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBeyond physical symptoms, PCD can cause significant psychosocial distress, sexual dysfunction, and impairment in daily activities [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The intimate nature of symptoms often results in underreporting due to embarrassment or stigma. Fecal incontinence, often a consequence of both disease activity and prior surgery, can further reduce QoL and social participation [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough several studies have evaluated the impact of CD on QoL, relatively few have focused specifically on continence and sexual function among patients with PCD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Given that CD disproportionately affects younger individuals in their reproductive years, understanding the extent to which PCD influences these aspects of life is crucial for improving patient care [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This study aims to fill this knowledge gap by evaluating QoL, fecal incontinence, and sexual function in CD patients with and without PCD, while identifying potential risk factors that contribute to poorer outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAn observational, analytical cross-sectional study was conducted at the gastroenterology unit of Shaare Zedek Medical Center, Jerusalem, a 1200 bed, national IBD excellence referral center, tertiary Hospital, between June 2023 and August 2024. Eligible participants were adults aged 18 years or older with a confirmed diagnosis of Crohn\u0026rsquo;s disease, established according to accepted clinical, endoscopic, histologic, and radiologic criteria. Patients were recruited consecutively during routine outpatient follow-up visits. Exclusion criteria included a diagnosis of indeterminate inflammatory bowel disease (IBD-U), hospitalization for acute disease flare, urgent surgical indication, or incomplete follow-up and medical records.\u003c/p\u003e \u003cp\u003ePatients were classified into three groups according to perianal disease status at the time of assessment: The first group included patients without any history or clinical evidence of perianal disease. The second group consisted of patients with non-active perianal disease, defined as a documented history of perianal involvement without signs of current activity, such as drainage or ulceration, and with only residual findings such as scars without active infection. The third group comprised patients with active perianal disease, characterized by the presence of actively draining abscesses or fistulas, perianal ulceration, anal stricture or Siton in situ.\u003c/p\u003e \u003cp\u003eAll participants were asked to complete validated, self-administered questionnaires assessing quality of life, fecal continence, and sexual function. The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) was used to evaluate health-related quality of life across physical, social, and emotional domains, with scores ranging from 10 to 70, where higher values indicate lower quality of life [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Fecal continence was assessed using the Wexner score, ranging from 0 (perfect continence) to 20 (complete incontinence) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Sexual function was evaluated in male participants using the short form of the International Index of Erectile Function (IIEF), which ranges from 1 to 25, with lower scores reflecting greater erectile dysfunction [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Female sexual function was measured using the Female Sexual Function Index (FSFI), which ranges from 2 to 36, with lower scores indicating more severe dysfunction [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn addition to patient-reported outcomes, clinical and demographic data were retrieved retrospectively from electronic medical records. Variables collected included age, sex, disease duration, disease location and behavior according to the Montreal classification [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], presence of extraintestinal manifestations, family history of IBD, current and past medical therapies (including the use of biologics), surgical history, and pregnancy history whene applicable.\u003c/p\u003e \u003cp\u003eStatistical analysis was performed using appropriate methods for the distribution and type of data. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and compared between groups using T-test for normally distributed data or the Mann\u0026ndash;Whitney U test for non-parametric distributions. Comparisons among the three perianal disease groups were conducted using one-way analysis of variance (ANOVA) or the Kruskal\u0026ndash;Wallis test, as appropriate. Categorical variables were summarized as frequencies and percentages, and differences between groups were assessed using the chi-square test or Fisher\u0026rsquo;s exact test. Pearson\u0026rsquo;s correlation coefficient was used to evaluate associations between continuous variables. Multivariable analysis of covariance (ANCOVA) was employed to assess the independent effects of multiple clinical and demographic variables, while adjusting for potential confounders. All tests were two-tailed, and a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003e The study protocol was approved by the institutional Helsinki ethics committee (approval number SZMC-0020-19), and all participants provided written informed consent prior to enrollment.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 150 patients with Crohn\u0026rsquo;s disease were enrolled in the study. The mean age of the cohort was 31.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7 years, and the majority were female (86%, n\u0026thinsp;=\u0026thinsp;129). Forty-seven patients (31.3%) had Perianal Crohn\u0026rsquo;s disease (PCD), of whom 21 (44.7%) were classified as having active disease and 26 (55.3%) as having non-active disease. The remaining 103 patients (68.7%) had no evidence or history of perianal involvement (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBaseline demographic and clinical characteristics were largely comparable between patients with and without PCD, the proportion of male patients was significantly higher in the PCD group compared with the non-PCD group (23.4% vs. 9.7%, p\u0026thinsp;=\u0026thinsp;0.025)., penetrating disease behavior was more prevalent in PCD patients (34.0% vs. 14.6%, p\u0026thinsp;=\u0026thinsp;0.003). No statistically significant differences were observed between the groups with respect to age, disease duration, Montreal disease location, presence of extraintestinal manifestations, family history of IBD, chronic medical therapy use, surgical history, or pregnancy rates (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen quality of life (QoL) was assessed using the SIBDQ, no significant difference was found between the overall PCD group and patients without perianal disease (33.34\u0026thinsp;\u0026plusmn;\u0026thinsp;13.86 vs. 31.73\u0026thinsp;\u0026plusmn;\u0026thinsp;12.42, p\u0026thinsp;=\u0026thinsp;0.478) (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, subgroup analysis according to perianal disease activity revealed a clear and statistically significant gradient. Patients with active PCD had the highest mean SIBDQ score (41.43\u0026thinsp;\u0026plusmn;\u0026thinsp;13.38), indicating poorer QoL, compared with those with non-active PCD (26.81\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53) and those without perianal disease (31.73\u0026thinsp;\u0026plusmn;\u0026thinsp;12.42) (p\u0026thinsp;=\u0026thinsp;0.001) (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOf 150 Crohn's patients, 137 answered the WEXNER questionnaire, 64.2% in the group of patients with perianal disease reported some degree of fecal incontinence (score above 0 on the WEXNER questionnaire).\u003c/p\u003e \u003cp\u003eAlthough active PCD patients had slightly higher WEXNER scores, indicating worse Fecal continence, these differences did not reach statistical significance (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among active PCD patients, the mean score was 5.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75 compared with 2.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01 in patients with non-active PCD (p\u0026thinsp;=\u0026thinsp;0.171).\u003c/p\u003e \u003cp\u003eSexual function assessments demonstrated similar patterns. Among women, the mean FSFI score was 23.55\u0026thinsp;\u0026plusmn;\u0026thinsp;8.61 for the entire female cohort. Women with PCD had lower mean scores than those without PCD (21.71\u0026thinsp;\u0026plusmn;\u0026thinsp;8.26 vs. 24.10\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72), although this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.276). In men, the mean IIEF score was 18.58\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92, with no significant differences between PCD and non-PCD groups (17.20\u0026thinsp;\u0026plusmn;\u0026thinsp;8.35 vs. 19.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87, p\u0026thinsp;=\u0026thinsp;0.870)\u003c/p\u003e \u003cp\u003eMultivariate analysis of covariance (ANCOVA) was performed to identify independent predictors of QoL, as measured by the SIBDQ. Active PCD was strongly associated with lower QoL, even after adjusting for other variables (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Age greater than 40 years (p\u0026thinsp;=\u0026thinsp;0.024) and the absence of chronic maintenance medical therapy (p\u0026thinsp;=\u0026thinsp;0.031) were also independently associated with poorer QoL (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Patients receiving chronic medical therapy, particularly biologic agents, tended to report higher QoL than those managed conservatively without long-term pharmacologic treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePerianal Crohn\u0026rsquo;s disease (PCD) is widely recognized as one of the most debilitating manifestations of Crohn\u0026rsquo;s disease, particularly when active fistulas, abscesses, or ulcerations are present [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. International data further underscore this burden; for example, the survey by Spinelli et al. demonstrated that persistent perianal fistulas substantially interfere with daily activities, social functioning, and emotional health [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Against this clinical and psychosocial background, our study sought to evaluate how perianal disease status influences patient-reported outcomes in a contemporary cohort.\u003c/p\u003e \u003cp\u003eIn this cross-sectional analysis of 150 patients with Crohn\u0026rsquo;s disease, active PCD was strongly associated with poorer health-related quality of life (QoL), as measured by the SIBDQ, whereas a history of PCD without active symptoms did not significantly impair QoL compared with patients without perianal involvement. These findings suggest that it is the persistence of active perianal manifestations\u0026mdash;rather than the mere presence of past disease\u0026mdash;that primarily drives reductions in patient-reported well-being.\u003c/p\u003e \u003cp\u003eInterestingly, when PCD patients as a whole were compared with those without perianal disease, we observed no significant difference in QoL scores. This may reflect the fact that a large proportion of PCD patients in our sample were in remission at the time of assessment. These results emphasize that effective management of PCD, with control of active symptoms, can mitigate its detrimental impact on quality of life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eRegarding fecal continence, 64.2% of PCD patients reported some degree of incontinence. We did not observe statistically significant differences in Wexner scores between groups, although patients with active PCD had numerically higher scores, suggesting a trend toward worse continence. The absence of statistical significance could be explained by the relatively small number of patients who completed the Wexner questionnaire, potential underreporting due to embarrassment, or multifactorial causes of incontinence unrelated solely to perianal involvement [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Previous studies, including those by Kamal et al., have reported higher rates of fecal incontinence among IBD patients with PCD, but the strength of this association appears to vary depending on study population, disease severity, and surgical history [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSexual function outcomes in our study did not differ significantly between groups, although women with PCD tended to have lower FSFI scores than those without PCD. This trend is consistent with earlier work by Riss et al., which suggested that sexual dysfunction in IBD patients may be more common among those with perianal complications [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, our study\u0026rsquo;s limited sample size for sexual function assessment, particularly among men, restricts the strength of conclusions in this domain. It is also important to note that the majority of our cohort consists of Orthodox Jewish and Muslim patients, many of whom come from conservative cultural backgrounds in which sexuality is regarded as a sensitive or private matter. In such contexts, sexual concerns may be under-reported or framed differently, which could influence the overall reporting of sexual function in our sample [\u003cspan additionalcitationids=\"CR25 CR26 CR27\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Given the young age at which Crohn\u0026rsquo;s disease often presents, and the potential psychosocial and relational impact of both the disease and its treatments, sexual health should remain a routine consideration in patient care, even if patients do not spontaneously raise the issue.\u003c/p\u003e \u003cp\u003eBeyond perianal disease activity, we identified two additional independent predictors of poor QoL: age greater than 40 years and the absence of chronic maintenance medical therapy. The association with older age may reflect cumulative disease burden, the presence of comorbidities, or differences in coping strategies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The link between lack of maintenance therapy and reduced QoL is noteworthy, particularly as the majority of patients on maintenance treatment in our cohort were receiving biologic agents, most commonly anti-TNF drugs. These treatments have been shown in multiple studies to improve both objective disease control and patient-reported outcomes [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Our findings therefore reinforce current recommendations favoring early and sustained use of effective medical therapy for PCD, particularly in cases with high risk of recurrence.\u003c/p\u003e \u003cp\u003eThe clinical implications of these findings are significant. First, they underline the importance of actively screening for perianal disease activity during routine follow-up visits, rather than relying solely on patient self-report, given the potential reluctance to discuss sensitive symptoms. Second, they suggest that prompt and aggressive treatment of active PCD may yield meaningful improvements in patient quality of life. Third, they highlight the need to address broader aspects of patient well-being, including sexual health and continence, even when these are not volunteered by the patient.\u003c/p\u003e \u003cp\u003eNonetheless, certain limitations must be acknowledged. The single-center design and recruitment from a tertiary referral hospital may limit generalizability, as such populations may include patients with more complex or severe disease. Furthermore, the reliance on self-reported measures introduces the possibility of recall or social desirability bias. Additionally, the relatively small sample size for sexual function questionnaires, particularly among men, limits the ability to detect subtle differences.\u003c/p\u003e \u003cp\u003eFuture research should include larger, multicenter, prospective studies to confirm our findings and explore the longitudinal relationship between PCD activity and quality of life. Investigations into interventions aimed specifically at improving continence and sexual function in this population are also warranted. Finally, given that some patients with non-active PCD in our study reported QoL comparable to those without perianal disease, further exploration of the factors that enable such resilience may help inform supportive care strategies.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this cross-sectional study of patients with Crohn’s disease, active perianal disease was independently associated with a substantial reduction in health-related quality of life, while non-active perianal disease did not significantly impair patient-reported outcomes. Older age and the absence of chronic maintenance medical therapy emerged as additional predictors of poorer quality of life. Although differences in fecal continence and sexual function between groups were not statistically significant, trends toward worse outcomes in active perianal disease highlight the importance of further investigation.\u003c/p\u003e \u003cp\u003eThese findings underscore the central role of disease activity control in optimizing quality of life for patients with perianal Crohn’s disease and support the integration of targeted perianal assessment and treatment strategies into routine clinical care.\u003c/p\u003e \u003cp\u003eClinicians should routinely inquire about perianal symptoms, continence, and sexual health, even in asymptomatic or remissive patients, to identify issues that may otherwise go unreported. Multidisciplinary care, involving gastroenterologists, colorectal surgeons, specialized nurses, and mental health professionals, is likely to yield the most comprehensive improvement in outcomes.\u003c/p\u003e "},{"header":"Declarations","content":" \u003cp\u003eThe authors declare that they have no conflicts of interest related to the subject matter of this article. No external funding or financial support was received from any organizations, institutions, or companies in the preparation, writing, or publication of this manuscript\u003c/p\u003e \u003cp\u003e This study was approved by the Institutional Review Board of Shaare Zedek Medical Center (Approval number: 0094-22-SZMC). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY.S. and B.L. contributed equally to the conception and design of the study, data acquisition, data analysis, and drafting of the manuscript. O.C. contributed to study conception, supervised the research, and critically revised the manuscript. C.Y. and G.R. contributed to data collection, database management, and preliminary analyses. M.T. contributed to study design, clinical interpretation of the data, and manuscript revision. B.S.A. contributed to clinical oversight, interpretation of results, and critical revision of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChrobak-Bień, J., Gawor, A., Paplaczyk, M., Małecka-Panas, E., \u0026amp; Gąsiorowska, A. (2017). Analysis of factors affecting the quality of life of those suffering from Crohn's disease. \u003cem\u003ePolski przeglad chirurgiczny\u003c/em\u003e, \u003cem\u003e89\u003c/em\u003e(4), 16\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMart\u0026iacute;nez S\u0026aacute;nchez, E. 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Kimmy Caplan and Nissim Leon (New York: Routledge, 2024). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4324/9781003315643\u003c/span\u003e\u003cspan address=\"10.4324/9781003315643\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Demographic and clinical characteristics in study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient characteristics\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en = 150\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerianal disease\u003c/p\u003e \u003cp\u003en = 47\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon perianal disease\u003c/p\u003e \u003cp\u003en = 103\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e, mean ± SD\u003c/p\u003e \u003cp\u003eAge \u0026lt; = 40, n (%)\u003c/p\u003e \u003cp\u003e Age \u0026gt; 40, n (%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.0 ± 8.66\u003c/p\u003e \u003cp\u003e133(88.7)\u003c/p\u003e \u003cp\u003e17(11.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.36 ± 7.93\u003c/p\u003e \u003cp\u003e41(87.2)\u003c/p\u003e \u003cp\u003e6(12.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.29 ± 9\u003c/p\u003e \u003cp\u003e92(89.3)\u003c/p\u003e \u003cp\u003e11(10.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYear of disease\u003c/b\u003e, mean ± SD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.33 ± 6.48\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53 ± 6.42\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.79 ± 6.47\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e, n (%)\u003c/p\u003e \u003cp\u003emale\u003c/p\u003e \u003cp\u003e female\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(14)\u003c/p\u003e \u003cp\u003e129(86)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(23.4)\u003c/p\u003e \u003cp\u003e36(76.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(9.7)\u003c/p\u003e \u003cp\u003e93(90.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.025*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocation of Disease\u003c/b\u003e, n (%)\u003c/p\u003e \u003cp\u003eIleal\u003c/p\u003e \u003cp\u003eColonic\u003c/p\u003e \u003cp\u003eIleocolonic\u003c/p\u003e \u003cp\u003eUpper GI\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86(57.3)\u003c/p\u003e \u003cp\u003e13(8.7)\u003c/p\u003e \u003cp\u003e50(33.3)\u003c/p\u003e \u003cp\u003e7(4.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(53.2)\u003c/p\u003e \u003cp\u003e4(8.5)\u003c/p\u003e \u003cp\u003e18(38.3)\u003c/p\u003e \u003cp\u003e3(6.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61(59.8)\u003c/p\u003e \u003cp\u003e9(8.8)\u003c/p\u003e \u003cp\u003e32(31.4)\u003c/p\u003e \u003cp\u003e4(3.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e0.405\u003c/p\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhenotype\u003c/b\u003e, n (%)\u003c/p\u003e \u003cp\u003eNon- stricturing non-penetrating\u003c/p\u003e \u003cp\u003eStricturing\u003c/p\u003e \u003cp\u003ePenetrating\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87(58)\u003c/p\u003e \u003cp\u003e32(21.3)\u003c/p\u003e \u003cp\u003e31(20.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(38.3)\u003c/p\u003e \u003cp\u003e13(27.7)\u003c/p\u003e \u003cp\u003e16(34)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69(67)\u003c/p\u003e \u003cp\u003e19(18.4)\u003c/p\u003e \u003cp\u003e15(14.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEIM\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96(64)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(63.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66(64.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily history of IBD\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80(53.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(44.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59(57.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChronic Treatment\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124(82.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(85.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84(81.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny Surgery\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44(29.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(31.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(28.15)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePregnancy\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47(31.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en = 36\u003c/b\u003e\u003c/p\u003e \u003cp\u003e15(41.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en = 93\u003c/b\u003e\u003c/p\u003e \u003cp\u003e32(34.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.442\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSD, standard deviation; EIM, extra-intestinal manifestation; IBD, Inflammatory bowel disease * p \u0026lt; 0.005\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"±\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"±\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"±\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuestionnaire scores of Crohn's patients according to study groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestionnaire\u003c/p\u003e \u003cp\u003emean ± SD\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO Perianal disease (n)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eActive Perianal disease (n)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-Active Perianal disease (n)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSIBDQ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e31.73 ± 12.423(103)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e41.43 ± 13.38(21)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e26.81 ± 10.53(26)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWexner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.46 ± 4.12 (95)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e5.16 ± 4.75 (19)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e2.57 ± 3.01(23)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFSFI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e24.10 ± 8.72(47)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e25.64 ± 4.71(5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e19.52 ± 9.21(9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.352\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIIEF\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e19.57 ± 3.86(7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e17.5 ± 7.77 (2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c4\"\u003e \u003cp\u003e17 ± 10.44(3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eSIBDQ, Short Inflammatory Bowel Disease Questionnaire: Wexner: Fecal continence Wexner score; FSFI: Female Sexual Function Index; IIEF: International Index of Erectile Function; * p \u0026lt; 0.005\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSIBDQ questionnaire scores according to study variable groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003e(150)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSIBDQ\u003c/p\u003e \u003cp\u003emean ± SD\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eANCOVA\u003c/p\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerianal disease\u003c/b\u003e\u003c/p\u003e \u003cp\u003eNo Perianal disease\u003c/p\u003e \u003cp\u003eActive Perianal disease\u003c/p\u003e \u003cp\u003eNon-Active Perianal disease\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003cp\u003e26\u003c/p\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.73 ± 12.423\u003c/p\u003e \u003cp\u003e41.43 ± 13.38\u003c/p\u003e \u003cp\u003e26.81 ± 10.53\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt; 0.001*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAge \u0026lt; = 40\u003c/p\u003e \u003cp\u003eAge \u0026gt; 40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.33 ± 12.57\u003c/p\u003e \u003cp\u003e39.29 ± 13.33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.024*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChronic Treatment\u003c/b\u003e\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.20 ± 12.738\u003c/p\u003e \u003cp\u003e37.15 ± 12.556\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.039*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eSIBDQ, Short Inflammatory Bowel Disease Questionnaire * p \u0026lt; 0.005\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Perianal Crohn’s disease, Quality of life, Fecal incontinence, Sexual function, Patient-reported outcomes","lastPublishedDoi":"10.21203/rs.3.rs-8591206/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8591206/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo evaluate the impact of perianal Crohn\u0026rsquo;s disease (PCD) activity on quality of life (QoL), fecal continence, and sexual function in patients with Crohn\u0026rsquo;s disease (CD), and to identify factors associated with impaired patient-reported outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional analytical study was conducted, from an existing CD patient database at Shaare Zedek Medical Center who diagnosed with and without perianal disease and were seen in IBD clinic between June 2023 to August 2024.The patients agreed to participate and answered validated questionnaires that assessed QoL (SIBDQ), fecal incontinence (WEXNER), and sexual function (IIEF for men, FSFI for women). A total of 150 CD patients were recruited, including 47 with PCD (active and non-active) and 103 without PCD.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePatients with active PCD had significantly lower QoL compared to those with non-active PCD and without PCD (p\u0026thinsp;=\u0026thinsp;0.001). Two major risk factors for decreased QoL were identified: age over 40 (p\u0026thinsp;=\u0026thinsp;0.024) and only conservative treatment (without chronic medication) (p\u0026thinsp;=\u0026thinsp;0.031). Although no significant difference was found in fecal incontinence between groups, 64.2% of PCD patients reported some degree of incontinence. Sexual function scores were lower in PCD patients, particularly women, though the difference was not statistically significant.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eActive PCD significantly reduces QoL in CD patients, with older age and absence of chronic treatment contributing to poorer outcomes. These findings highlight the need for optimized treatment strategies to improve patient well-being. Further research should explore additional clinical and psychological aspects affecting CD patients with perianal involvement.\u003c/p\u003e","manuscriptTitle":"The Effect of Perianal Disease on Quality of Life, Fecal Incontinence, and Sexual Function in Crohn’s disease patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 10:46:09","doi":"10.21203/rs.3.rs-8591206/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-26T17:13:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-26T13:25:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97134285599169589395207031156441593180","date":"2026-01-19T08:48:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-16T21:33:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-13T20:35:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-13T14:11:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"Digestive Diseases and Sciences","date":"2026-01-13T10:57:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b58ceeff-267b-45cd-9649-041b9cec0219","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T15:59:56+00:00","versionOfRecord":{"articleIdentity":"rs-8591206","link":"https://doi.org/10.1007/s10620-026-09766-0","journal":{"identity":"digestive-diseases-and-sciences","isVorOnly":false,"title":"Digestive Diseases and Sciences"},"publishedOn":"2026-02-16 15:56:52","publishedOnDateReadable":"February 16th, 2026"},"versionCreatedAt":"2026-01-20 10:46:09","video":"","vorDoi":"10.1007/s10620-026-09766-0","vorDoiUrl":"https://doi.org/10.1007/s10620-026-09766-0","workflowStages":[]},"version":"v1","identity":"rs-8591206","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8591206","identity":"rs-8591206","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}