The management of perirectal disease in association with IBD requires an individual approach to the patient with combined medical and surgical therapy where appropriate. No matter what therapy is used, the main goal is to alleviate symptoms and cure the problem where possible. Before undertaking management it is crucial to delineate the extent not only of the local disease but the total extent of the problem in the gastrointestinal tract. This will obviously influence the way in which the local disease is managed. What has been presented is a practical, common-sense approach to the management of what is often an extremely difficult problem.