The next step in the “hemorrhoid” problem is to distinguish whether it is a “hemorrhoid” or a “skin flap”. Patients with Crohn’s disease more commonly have a flap around the anus, which is sometimes difficult to distinguish from a hemorrhoid, so you should see your doctor for a closer examination to determine whether it is a “hemorrhoid” or a “flap”. The size, shape, and nature of the skin flaps vary. Some are large, edematous, hard and purple; others are like “elephant ears”, flat, with a wide or narrow base, soft and painless. The large dermatomes are often lesions left over from the healing of an anal fistula or fissure. Hemorrhoids are dilated masses of blood vessels and therefore are usually soft and painless. Hemorrhoids are often uncomfortable, but can become hard and painful when Crohn’s disease is active; when Crohn’s disease causes severe diarrhea, it can cause symptoms, such as bleeding. If “hemorrhoids” are identified, treatment includes sitz baths, topical medications, and diarrhea control. Because surgical excision can often lead to non-healing wounds, infection, anal stricture, and damage to the anal sphincter, hemorrhoid surgery such as external stripping and internal ligation should generally be avoided. In the absence of any anorectal Crohn’s disease, surgical excision or ligation may be performed in carefully selected patients. The problem of “anal fissures” There are two types of anal fissures in patients with Crohn’s disease, which also need to be differentiated and treated differently. The first type is the primary fissure, which is not related to Crohn’s disease and has the typical characteristics of a normal fissure: superficial ulcers, located in the median line and extending from below the dentate line to the outer edge of the anal canal. The following treatments are usually effective for it, such as sitz baths, narcotics, hormonal ointments and diarrhea control. Primary anal fissures are rare in Crohn’s disease. The second type of fissure, caused by Crohn’s disease, is characterized by deep, wide and sometimes multiple ulcers, often located laterally (not in the anterior or posterior median position), away from the median line and often associated with other perianal disease. Although these fissure lesions may appear severe, they are usually asymptomatic or mild, and most fissures caused by Crohn’s disease heal spontaneously. In the presence of active perianal Crohn’s disease, oral metronidazole, 5-aminosalicylic acid enemas or anal suppositories may be used, and immunosuppressive agents may also be considered. If anal fissures cause pain, attention should be paid to the presence of abscess or fistula formation. If the anal fissure does not heal and symptoms persist, proctitis needs to be ruled out. In cases of anal fissures caused by Crohn’s disease, anal fissure resection should not be performed. Most fissures that do not heal with medical treatment can be cured by internal sphincter lateralization if they are not combined with proctitis. If internal sphincterotomy is not performed, an abscess or fistula may eventually form. If proctitis is also present. Surgery should be avoided. A very small percentage of patients who are close to the bar will develop a special type of anal canal ulcer that is wide and penetrating and can involve most of the anal canal, even in the form of a ring, for which conventional local treatment is ineffective, and these patients often end up requiring resection of the rectum and fecal diversion.