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Intestinal Dysfunction as a Risk Factor for Anal Fistula: Evidence from a Retrospective Case-Control Analysis

gastroenterology-and-hepatology
public-health
surgery-and-surgical-specialties

Abstract

Background. Clinical observations indicate that some patients experience bowel dysfunction, including diarrhea or constipation, before the diagnosis of a nal f istula (AF). This observation suggests a potential role of bowel dysfunction as a precursor to AF. However, systematic evidence supporting this association remains limited. This study aimed to investigate whether preexisting bowel dysfunction is associated with an increased subsequent risk of AF. It also sought to evaluate the differential impact of bowel dysfunction across various AF subtypes.

Methods. A retrospective case-control study was conducted, comprising 251 patients newly diagnosed with AF between July 2024 and July 2025. During the same period, 251 age- and sex-matched individuals without AF were selected as controls (1:1 matching, age ±3 years). Data were collected on demographic characteristics, lifestyle factors, bowel function within 1 year before diagnosis . Logistic regression was applied to evaluate the association between bowel dysfunction and AF. Stratified analyses were subsequently performed to examine variations across AF subtypes.

Results. Preexisting bowel dysfunction was significantly associated with higher AF risk (P < 0.05). Diarrhea was identified as an independent risk factor (OR ≈ 2.2), whereas constipation showed no statistically significant association with AF. Additional independent risk factors included smoking, alcohol consumption, prolonged sedentary or standing occupations, and high BMI . Subtype analysis revealed no statistically significant differences in the distribution of either constipation or diarrhea were observed across various fistula subtypes or tract patterns.

Conclusions. Bowel dysfunction represents a significant risk factor for AF, with chronic diarrhea playing a particularly prominent role, especially in the cases of low- level AF. While bowel dysfunction appears to influence the initial onset of AF, it does not appear to dictate the subsequent anatomical subtype. These findings underscore the clinical importance of early screening and proactive management of individuals with chronic diarrhea and other bowel dysfunction, as such interventions may help lower the risk of developing AF.

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