Questioning the presence of anal symptoms in patients applying to the family medicine outpatient clinic
Abstract
Introduction: Patients usually hide anal region diseases due to the sensitivity of the anal area. Questioning and successfully managing anal region disease symptoms in primary care will prevent late diagnosis of underlying diseases. This study aims to investigate the presence of anal symptoms in patients admitted to family medicine outpatient clinics for any reason.
Methods: Our research is a descriptive study. A questionnaire form was created by scanning the literature, was applied by 5 different research assistants to patients aged 18 and over who applied to the family medicine outpatient clinic. It is aimed to reach the maximum number of individuals with the improbable sample.
Results: 64.8% of the 165 participants included in the study are female, and 35.2% are male, with a mean age of 35,69 ± 14,53 (Min:18, Max:75). Anal symptoms were detected in 46 patients (27.9%) after questioning. The most frequently reported symptoms were constipation with a rate of 14.5% (n=24), rectal pain at a rate of 7.9% (n=13), rectal bleeding at a rate of 7.3% (n=12), rectal swelling at a rate of 5.5% (n=9) and rectal itching at a rate of 3.6% (n=6). 81.8% of these patients reported that they could share with their doctor when they have symptoms of moderate severity and above. 86.1% (n=142) said they would accept digital rectal examinations if necessary.
Conclusion: It is crucial to determine the prevalence of anal symptoms in the general population. Although these symptoms affect the quality of life by causing severe pain and discomfort, they are rarely shared by patients. Routine questioning and examination of anal area symptoms enable more effective disease management. The majority of cases can be diagnosed after examination in primary care. Therefore, the first step is essential for the early diagnosis and treatment of these diseases.
Keywords: Rectal Disease, Family Medicine, Digital Rectal Examination
References
- 1. Pigot F, Siproudhis L, Bigard MA, Staumont G. Ano-rectal complaints in general practitioner visits: consumer point of view. Gastroentérologie Clinique et Biologique. 2006;30:1371–4. https://doi.org/10.1016/S0399-8320(06)73557-6
- 2. Abramowitz L, Benabderrahmane M, Pospait D, Philip J,Laouenan C. The prevalence of proctological symptoms amongst patients who see general practitioners in France. Eur J Gen Pract. 2014;20:301–6. https://doi.org/10.3109/13814788.2014.899578
- 3. Hennigan TW, Franks PJ, Hocken DB, Allen-Mersh TG. Rectal examination in general practice. BMJ Med. 1990;301:478–80. https://doi.org/10.1136/bmj.301.6750.478
- 4. Brown HW, Dyer KY, Rogers RG. Management of Fecal Incontinence. Obstet Gynecology. 2020;136:811-22. https://doi.org/10.1097/AOG.0000000000004054
- 5. Foxx-Orenstein AE, Umar SB and Crowell MD. Common anoreactal disorders. Gastroenterol Hepatol (N Y). 2014;10(5):294-301. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4076876/
- 6. Karataş A. [Approach to gastrointestinal system problems in primary care and family medicine] (in Turkish) Nobel Publishing House, Ankara; 2021:50-53.
- 7. Abramowitz L, Sobhani I, Ganansia R, Vuagnat A, Benifla JL, Darai E, et al. Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study. Dis Colon Rectum. 2000;43:590–8. https://doi.org/10.1007/BF02235567
- 8. Jahnny B, Ashurst JV. Anal Fissures. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
- 9. Morlat P. Prise en charge médicale des personnes vivant avec le VIH. Recommandations du groupe d’expert .France;2013.
- 10. Ministry of Health [Internet]. Available at: https://hsgm.saglik.gov.tr/tr/kanser-tarama-standartlari/listesi/kolorektal-kanser-tarama-program%C4%B1-ulusal-standartlar%C4%B1.html (Access Date: July 24, 2023)
- 11. Gutzeit O, Levy G, Lowenstein L. Postpartum female sexual function: Risk factors for postpartum sexual dysfunction. Sexual Med. 2020;8(1):8–13. https://doi.org/10.1016/j.esxm.2019.10.005
- 12. Rasijeff AMP, García-Zermeño K, Di Tanna GL, Remes-Troche J, Knowles CH, Scott MS. Systematic review and meta-analysis of anal motor and rectal sensory dysfunction in male and female patients undergoing anorectal manometry for symptoms of faecal incontinence. Colorectal Dis. 2022;24(5):562-76. https://doi.org/10.1111/codi.16047
- 13. Truong A, Zaghian K, Fleshner P. Anorectal Crohn's Disease. Surg Clin North Am. 2019;99(6):1151-62.
- 14. Siproudhis L, Pigot F, Godeberge P, Damon H, Soudan D, Bigard MA. Defecation Disorders: a French Population Survey. Dis Colon Rectum. 2006;49:219–27. https://doi.org/10.1007/s10350-005-0249-8
- 15. Nelson RL, Abcarian H, Davis FG, Persky V. Prevalence of benign anorectal disease in a randomly selected population. Dis Colon Rectum. 1995;38:341–4. https://doi.org/10.1007/BF02054218
- 16. Tournu G, Abramowitz L, Cougffignal C, Juguet F, Senejoux A, Berger S, et al. Prevalence of anal symptoms in general practice: a prospective study. BMC Fam Pract. 2017;18:78. https://doi.org/10.1186/s12875-017-0649-6
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Abstract
Giriş: Anal bölge hastalıkları konunun hassasiyeti nedeniyle hastalar tarafından genellikle saklanmaktadır. Anal bölge hastalık semptomlarının birinci basamakta sorgulanması ve başarılı yönetimi altta yatan hastalıkların geç teşhis edilmesini önleyecektir. Bu araştırmanın amacı herhangi bir nedenle birinci basamağa başvuran hastaların anal semptomlarının varlığını araştırmaktır.
Yöntem: Araştırmamız tanımlayıcı tipte bir çalışmadır. Polikliniğe başvuran 18 ve üzeri yaş hastalara 5 farklı Araştırma Görevlisi tarafından literatür taranarak oluşturulan bir anket formu uygulanmıştır. Olasılıksız örneklem ile maksimum bireye ulaşılması hedeflenmiştir.
Bulgular: Araştırmaya dahil edilen 165 katılımcının %64,8'i kadın, %35,2'si erkek olup, yaş ortalaması 35,69±14,53’tür (Min:18, Max:75). Sorgulama sonrası 46 hastada (%27,9) anal semptom saptandı. En çok bildirilen semptomlar %14,5 oranında (n=24) kabızlık, %7,9 oranında makatta ağrı (n=13), %7,3’ü (n=12) oranında makatta kanama, %5,5 oranında (n=9) anal şişlik ve %3,6 oranında (n=6) makatta kaşıntı idi. Bu hastaların %81,8’i orta şiddet ve üstünde bir rahatsızlık derecesinde semptomları olduğunda doktorlarıyla paylaşabileceğini belirtmiştir. %86,1’i(n=142) ise gerektiğinde anal muayeneyi kabul edeceğini söylemiştir.
Sonuç: Genel popülasyonda anal semptom prevalansının saptanması önem taşımaktadır. Bu semptomlar ciddi ağrı ve rahatsızlığa sebep olarak yaşam kalitesini etkilese de hastalar tarafından nadiren paylaşılmaktadır. Rutin anal bölge semptomlarının sorgulanması ve muayene, yönetimin daha etkili şekilde yapılmasını sağlar. Vakaların büyük çoğunluğu birinci basamakta muayene sonrası tanı alabilir. Dolayısıyla bu hastalıkların erken tanı ve tedavisi için birinci basamak önem kazanmaktadır.
Anahtar Kelimeler: Rektal Hastalık, Aile Hekimliği, Dijital Rektal Muayene
References
- 1. Pigot F, Siproudhis L, Bigard MA, Staumont G. Ano-rectal complaints in general practitioner visits: consumer point of view. Gastroentérologie Clinique et Biologique. 2006;30:1371–4. https://doi.org/10.1016/S0399-8320(06)73557-6
- 2. Abramowitz L, Benabderrahmane M, Pospait D, Philip J,Laouenan C. The prevalence of proctological symptoms amongst patients who see general practitioners in France. Eur J Gen Pract. 2014;20:301–6. https://doi.org/10.3109/13814788.2014.899578
- 3. Hennigan TW, Franks PJ, Hocken DB, Allen-Mersh TG. Rectal examination in general practice. BMJ Med. 1990;301:478–80. https://doi.org/10.1136/bmj.301.6750.478
- 4. Brown HW, Dyer KY, Rogers RG. Management of Fecal Incontinence. Obstet Gynecology. 2020;136:811-22. https://doi.org/10.1097/AOG.0000000000004054
- 5. Foxx-Orenstein AE, Umar SB and Crowell MD. Common anoreactal disorders. Gastroenterol Hepatol (N Y). 2014;10(5):294-301. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4076876/
- 6. Karataş A. [Approach to gastrointestinal system problems in primary care and family medicine] (in Turkish) Nobel Publishing House, Ankara; 2021:50-53.
- 7. Abramowitz L, Sobhani I, Ganansia R, Vuagnat A, Benifla JL, Darai E, et al. Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study. Dis Colon Rectum. 2000;43:590–8. https://doi.org/10.1007/BF02235567
- 8. Jahnny B, Ashurst JV. Anal Fissures. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
- 9. Morlat P. Prise en charge médicale des personnes vivant avec le VIH. Recommandations du groupe d’expert .France;2013.
- 10. Ministry of Health [Internet]. Available at: https://hsgm.saglik.gov.tr/tr/kanser-tarama-standartlari/listesi/kolorektal-kanser-tarama-program%C4%B1-ulusal-standartlar%C4%B1.html (Access Date: July 24, 2023)
- 11. Gutzeit O, Levy G, Lowenstein L. Postpartum female sexual function: Risk factors for postpartum sexual dysfunction. Sexual Med. 2020;8(1):8–13. https://doi.org/10.1016/j.esxm.2019.10.005
- 12. Rasijeff AMP, García-Zermeño K, Di Tanna GL, Remes-Troche J, Knowles CH, Scott MS. Systematic review and meta-analysis of anal motor and rectal sensory dysfunction in male and female patients undergoing anorectal manometry for symptoms of faecal incontinence. Colorectal Dis. 2022;24(5):562-76. https://doi.org/10.1111/codi.16047
- 13. Truong A, Zaghian K, Fleshner P. Anorectal Crohn's Disease. Surg Clin North Am. 2019;99(6):1151-62.
- 14. Siproudhis L, Pigot F, Godeberge P, Damon H, Soudan D, Bigard MA. Defecation Disorders: a French Population Survey. Dis Colon Rectum. 2006;49:219–27. https://doi.org/10.1007/s10350-005-0249-8
- 15. Nelson RL, Abcarian H, Davis FG, Persky V. Prevalence of benign anorectal disease in a randomly selected population. Dis Colon Rectum. 1995;38:341–4. https://doi.org/10.1007/BF02054218
- 16. Tournu G, Abramowitz L, Cougffignal C, Juguet F, Senejoux A, Berger S, et al. Prevalence of anal symptoms in general practice: a prospective study. BMC Fam Pract. 2017;18:78. https://doi.org/10.1186/s12875-017-0649-6
- 17. Van Dyne EA, Henley SJ, Saraiya M, Thomas CC, Markowitz LE, Benard VB. Trends in Human Papillomavirus-Associated Cancers - United States, 1999-2015. MMWR (Morbidity and Mortality Weekly Report). 2018;67(33):918–24. http://dx.doi.org/10.15585/mmwr.mm6733a2
Details
| Primary Language | English |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | Original Research |
| Authors | |
| Publication Date | July 28, 2023 |
| Submission Date | March 25, 2023 |
| Acceptance Date | June 10, 2023 |
| Published in Issue | Year 2023Volume: 8 Issue: 4 |
