ArticlePeerJ2026
Association between intestinal functional disorders and anal fistula: evidence from a retrospective case-control study.
Article in PeerJ, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
3 authors.
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Abstract
Background: Clinical observations indicate that some individuals experience bowel dysfunction, such as diarrhea or constipation, prior to the diagnosis of anal fistula (AF). These observations suggest a potential association between pre-existing intestinal dysfunction and the occurrence of AF. However, systematic clinical evidence remains limited. This study aimed to evaluate the association between pre-diagnostic bowel dysfunction and AF and to explore whether such associations differ across AF anatomical subtypes. Methods: We conducted a retrospective hospital-based case-control study including 251 patients with newly diagnosed 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). Demographic characteristics, lifestyle factors, and bowel function within 1 year before the index date were collected from medical records and supplementary interviews where applicable. Conditional logistic regression, accounting for the matched-pair design, was used to assess the association between bowel dysfunction and AF. Both crude (unadjusted) and adjusted analyses were performed. Stratified analyses were performed to explore heterogeneity across AF subtypes. Results: Pre-existing bowel dysfunction was associated with a higher likelihood of developing AF ( Conclusions: This retrospective case-control study indicates that pre-existing intestinal functional disorders, particularly chronic diarrhea, are associated with a higher likelihood of AF, with the association appearing more pronounced among low anal fistulas. No consistent subtype-specific pattern was observed overall, although diarrhea showed modest heterogeneity across anatomical classifications in exploratory analyses. Given the retrospective observational design, these findings support association rather than causation and warrant confirmation in multicenter prospective studies. Clinically, these results suggest that earlier identification and risk assessment of patients with chronic diarrhea and other intestinal functional disturbances may provide valuable insights, but further research is needed to confirm these findings.
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