Physical activity decreases the likelihood of peripheral neuropathy in persons with diabetes.

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 []. The disease is often diagnosed in young adulthood and is associated with significant morbidity due to its intestinal and extra-intestinal manifestations []. The etiology of CD is multifactorial, involving genetic predisposition, environmental triggers, immune dysregulation, and gut microbiota alterations [].Perianal involvement in CD occurs in approximately 20–40% of patients, presenting as abscesses, strictures, and fistulas [–]. PCD is recognized as one of the most debilitating manifestations of CD []. It is often refractory to standard medical therapy, requires combined medical-surgical approaches, and carries a high risk of recurrence [, ]. The introduction of biologic therapies, particularly anti-TNF agents, and advanced proctological techniques have significantly improved treatment outcomes, although clinical management remains challenging []. PCD is associated with increased hospitalization rates, multiple surgical procedures, greater use for immunosuppressive therapy, and reduced quality of life (QoL) [, ].Beyond physical symptoms, PCD can cause significant psychosocial distress, sexual dysfunction, and impairment in daily activities [, ]. 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 [–].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 [, , ]. 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 [, ]. This study aimed to fill this knowledge gap by evaluating QoL, fecal incontinence, and sexual function in patients with CD with and without PCD, while identifying potential risk factors that contribute to poorer outcomes. 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.