This article examines the complex relationship between disease perception, negative emotions, and their impact on postoperative recovery in patients with perianal diseases. These conditions not only cause physical discomfort, but also carry a significant emotional burden, often exacerbated by social stigma. Psychological factors, including stress, anxiety, and depression, activate neuroendocrine pathways, such as the hypothalamic–pituitary–adrenal axis, disrupting the gut microbiota and leading to dysbiosis. This disruption can delay wound healing, prolong hospital stay, and intensify pain. Drawing on the findings of Hou et al , our article highlights the critical role of illness perception and negative emotions in shaping recovery outcomes. It advocates for a holistic approach that integrates psychological support and gut microbiota modulation, to enhance healing and improve overall patient outcomes.