Do obstetric factors have an effect on success of medical treatment of anal fissure seen in women?

Abstract

Objective: The aim of this study is to examine the effect of obstetric factors on the medical treatment success of anal fissure in women. Material and methods: A total of 324 women, who were diagnosed with anal fissure, who applied to the General Surgery outpatient clinic between 2015 and 2020, were included in the study. The patients were divided into two groups; group I (medical treatment was successful) and group II (medical treatment failed - surgery performed). Both groups were compared in terms of age, body mass index (BMI), number of births, delivery type, birth weight, breastfeeding rate, constipation, diarrhea, smoking and anal fissure symptoms. Results: Medical treatment was applied to all of the 324 patients we included in our study, and it was observed that 45.7% of them had successful medical treatment and 54.3% had undergone surgical treatment (lateral internal sphincterotomy) because of unsuccessful medical treatment. It was found that age, BMI, number of births, number of vaginal births, breastfeeding rate, constipation rates were higher in those who failed medical treatment (p <0.05). The number of cesarean sections, birth weight, diarrhea and smoking were found to be similar between the two groups (p> 0.05). While gas incontinence was observed in 44.1% of those who underwent surgical treatment, this rate was found to be 1.4% in those who benefited from medical treatment. Conclusion: In our study, it was found that while maternal age, number of births, vaginal delivery and breastfeeding rates had a negative effect on the success of anal fissure medical treatment, cesarean delivery and baby birth weight were not effective.

Keywords

• Anal fissure
• pregnancy
• delivery
• obstetrics
• medical therapy

Kadınlarda görülen anal fissürün medikal tedavi başarısında obstetrik faktörlerin etkisi var mıdır?

Abstract

Amaç: Bu çalışmanın amacı, kadınlarda görülen anal fissürün medical tedavi başarısında obstetrik faktörlerin etkisinin incelenmesidir. Gereç ve yöntemler: Çalışmaya2015-2020 yılları arasında Genel Cerrahi polilliniğine anal bölge rahatsızlığı nedeni ile başvurup anal fissür tanısı almış 324 kadın dahil edildi. Hastalar iki gruba ayırıldı; grup I (medikal tedavi başarılı) ve grup II (medikal tedavi başarısız - cerrahi yapılan). Her iki grup yaş, vücut kitle indeksi (VKİ), doğum sayısı, doğum şekli, bebek doğum ağırlığı, emzirme oranı, kabızlık, ishal, sigara içme ve anal fissür semptomları açısından karşılaştırıldı. Bulgular: Çalışmamıza aldığımız 324 hastanın tümüne medikal tedavi uygulanmış olup bunlardan %45,7’sinde medikal tedavi başarılıyken, %54,3’ünde ise medikal tedavi başarısız olduğundan dolayı cerrahi tedavi (lateral internal sfinkterotomi) uygulandığı gözlendi. Medikal tedavi başarısız olanlarda yaş, VKİ, doğum sayısı, vajinal doğum sayısı, emzirme oranı, kabızlık oranlarının daha fazla olduğu tespit edildi (p<0,05). Sezaryen sayısı, bebek doğum ağırlığı, ishal ve sigara kullanımının iki grup arasında benzer olduğu bulundu (p>0,05). Cerrahi tedavi uygulananlarda %44,1 gaz inkontinansı görülürken medikal tedaviden yarar görenlerde bu oran %1,4 saptandı. Sonuç: Çalışmamızda gebelik sürecinde oluşan anal fissure medikal tedavi başarısında obstetrik etkenlerden maternal yaş, doğum sayısı, vajinal doğum ve emzirmenin olumsuz yönde etki ettiği görülürken sezaryenle doğum ve bebek doğum kilosunun etkili olmadığı saptandı.

Keywords

• Anal fissür
• gebelik
• doğum
• obstetrik
• medical tedavi

References

1. 1. Adamová Z, Slováček R, Bár T, Sankot J VP. Anal fissure. Cas Lek Ces. 2015;154:11–3.
2. 2. Nelson R. A Systematic Review of Medical Therapy for Anal Fissure. Diseases of the Colon and Rectum. Dis Colon Rectum; 2004;47:422–31.
3. 3. Hananel N, Gordon PH. Re-examination of clinical manifestations and response to therapy of fissure-in-ano. Dis Colon Rectum. 1997;40(2):229–33.
4. 4. Ferdinande K, Dorreman Y, Roelens K, Ceelen W, De Looze D. Anorectal symptoms during pregnancy and postpartum: a prospective cohort study. Color Dis. 2018;20(12):1109–16. 5. Freymond JM, Chautems R, Santa V Della, Wolter L. Proctological emergencies in pregnant women. Rev Med Suisse. 2018;14(614):1394–6.
5. 6. Poskus T, Buzinskiene D, Drasutiene G, Samalavicius NE, Barkus A, Barisauskiene A, et al. Haemorrhoids and anal fissures during pregnancy and after childbirth: A prospective cohort study. BJOG An Int J Obstet Gynaecol. 2014;121(13):1666–71.
6. 7. Emile SH, Elgendy H, Elfeki H, Magdy A, Abdelmawla AA, Abdelnaby M, et al. Does the duration of symptoms of anal fissure impact its response to conservative treatment? A prospective cohort study. Int J Surg. 2017;44:64–70.
7. 8. Altomare DF, Binda GA, Canuti S, Landolfi V, Trompetto M, Villani RD. The management of patients with primary chronic anal fissure: A position paper. Techniques in Coloproctology. Tech Coloproctol; 2011;15:135–41.
8. 9. Poh A. Innovations in chronic anal fissure treatment: A systematic review. World J Gastrointest Surg. 2010;2(7):231.

9. 10. Meyer I, Richter HE. Impact of fecal incontinence and its treatment on quality of life in women.Women’s Health. Future Medicine Ltd.; 2015;11:225–38.
10. 11. Abramowitz L, Batallan A. Epidemiology of anal lesions (fissure and thrombosed external hemorroid) during pregnancy and post-partum.Gynecologie Obstetrique et Fertilite. Elsevier Masson SAS; 2003;31:546–9.
11. 12. Faridi A, Willis S, Schelzig P, Siggelkow W, Schumpelick V, Rath W. Anal sphincter injury during vaginal delivery - An argument for cesarean section on request? In: Journal of Perinatal Medicine. J Perinat Med; 2002;379–87.
12. 13. Poskus T, Buzinskienė D, Drasutiene G, Samalavicius N, Barkus A, Barisauskiene A, et al. Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study. BJOG An Int J Obstet Gynaecol. 2014;121(13):1666–71.
13. 14. Murad-Regadas SM, Regadas FSP, Filho FSPR, Borges LB, da Silva Vilarinho A, Veras LB, et al. Pubovisceral muscle and anal sphincter defects in women with fecal or urinary incontinence after vaginal delivery. Tech Coloproctol. 2021;23(2):117–28.
14. 15. Beaty JS, Shashidharan M. Anal Fissure. Clinics in Colon and Rectal Surgery. Thieme Medical Publishers, Inc. 2016;29:30–7.
15. 16. Klosterhalfen B, Vogel P, Rixen H, Mittermayer C. Topography of the inferior rectal artery. Dis Colon Rectum. 1989;32(1):43–52.
16. 17. Abramowitz L, Batallan A. Epidemiology of anal lesions (fissure and thrombosed external hemorroid) during pregnancy and post-partum. Gynecologie Obstetrique et Fertilite. Elsevier Masson SAS; 2003;31:546–9.
17. 18. Abramowitz L, Sobhani I, Benifla JL, Vuagnat A, Daraï E, Mignon M, et al. Anal fissure and thrombosed external hemorrhoids before and after delivery. Dis Colon Rectum. 2002;45(5):650–5.
18. 19. Jamshidi R. Anorectal Complaints: Hemorrhoids, Fissures, Abscesses, Fistulae. Clin Colon Rectal Surg. 2018; 31(2):117–20.
19. 20. Jahnny B, Ashurst JV. Anal Fissures. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2020.
20. 21. Beaty JS, Shashidharan M. Anal Fissure. Clinics in Colon and Rectal Surgery. Thieme Medical Publishers, Inc.; 2016;29:30–7.
21. 22. Constipation in children and young people: diagnosis and management. Constipation in children and young people: diagnosis and management. National Institute for Health and Care Excellence (UK); 2017
22. 23. Felt-Bersma RJF, Bartelsman JF. Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseases. Best Pract Res Clin Gastroenterol.2009; 23(4):575–92.
23. 24. Nelson RL. Anal fissure (chronic). BMJ clinical evidence. BMJ Publishing Group; 2014;2014.