Fecal evacuation disorders in anal fissure, hemorrhoids, and solitary rectal ulcer syndrome.

Abstract

The causative factors for hemorrhoids, anal fissure, and solitary rectal ulcer syndrome (SRUS) are poorly understood. The study was done to identify the prevalence of fecal evacuation disorders in patients with anal fissure, hemorrhoids, and SRUS using anorectal manometry (ARM). Retrospective analysis of ARM data from three centers across India was done. Baseline demographic details and symptoms pertaining to bowel movements were noted. Limited colonoscopy details pertaining to hemorrhoids, fissure-in-ano, and SRUS were noted. The patients were divided into two groups-group I (those with fissure, hemorrhoids, or solitary rectal ulcer) and group II (normal study). ARM parameters of resting anal pressure, squeeze pressure, dyssynergic defecation, and abnormal balloon expulsion were compared between the two groups. Sub-analysis was done for ARM metric differences between those with hemorrhoids, chronic fissure, and SRUS. Appropriate statistical tests were used. A p-value of < 0.05 was considered significant. There were more men in group I (87%; p-value 0.01) with a higher resting anal pressure (80 vs. 69mmHg, p-value 0.03). Functional evacuation disorders (p < 0.0001), dyssynergic defecation (77.2% vs. 46.8%, p < 0.0001) and abnormal balloon expulsion (66.7% vs. 20.3%, p < 0.0001) were significantly higher in group I. These were significantly more common in patients with anal fissure and SRUS compared to those with hemorrhoids (p-value 0.028). Functional evacuation disorders are frequently noted in patients with hemorrhoids, anal fissure, and SRUS.