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Quality of life in patients with chronic anal fissure
Authors:N. Griffin,A. G. Acheson,P. Tung&dagger  ,C. Sheard&dagger  ,C. Glazebrook&dagger  , J. H. Scholefield
Affiliation:Departments of Surgery;and Behavioural Sciences, Queens Medical Centre, Nottingham, UK
Abstract:Objective Little is known about the quality of life in patients with the distressing symptoms of chronic anal fissure. This was a prospective study assessing the physical and mental health of fissure patients before and after topical treatment. Patients and methods New patients attending the fissure clinic were recruited prospectively into the study over a 2‐month period. On first appointment, patients were given 2 questionnaires to complete: the Short‐Form 36 Health Survey (SF‐36) and a general questionnaire recording patients' demographic details, previous treatment, site and duration of fissure and symptoms on a visual analogue scale (VAS). Following an 8‐week course of topical treatment, patients repeated the SF‐36 and symptoms were again recorded on a VAS. Healing of fissure was noted. Results Fifty‐four patients entered the study, of which 39 returned for follow‐up; 16 male, 23 female; mean age 38.6 years (range 17–80 years). Median duration of fissure was 6 months (3 months – 10 years). Higher VAS ratings for fissure pain were associated with worse scores for all aspects of health‐related quality of life, including mental health (P < 0.001), bodily pain (P < 0.001), vitality (P < 0.006) and social functioning (P < 0.001). Compared to age and gender matched norms for the SF‐36, fissure patients had more bodily pain (P < 0.001, Wilcoxon) and poorer health perceptions (P < 0.02, Wilcoxon). Gender did not affect any of the SF‐36 subscales. However, females did report significantly more bleeding (P = 0.05). On follow‐up, healing was complete in 27 patients (69%). Symptoms of pain, bleeding and irritation were all significantly reduced in this group. Repeating the SF‐36 showed an improvement in bodily pain, role‐physical functioning and vitality (P < 0.05). Conclusion Successful nonsurgical treatment of chronic anal fissure leads to symptomatic improvement and beneficially affects health‐related quality of life.
Keywords:Anal fissure    quality of life    glyceryl trinitrate    diltiazem
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