Relationship between anal symptoms and anal findings

Abstract

Background: The frequencies and types of anal symptoms were compared with the frequencies and types of benign anal diseases (BAD). Methods: Patients transferred from GPs, physicians or gynaecologists for anal and/or abdominal complaints/signs were enrolled and asked to complete a questionnaire about their symptoms. Proctologic assessment was performed in the knee-chest position. Definitions of BAD were tested in a two year pilot study. Findings were entered into a PC immediately after the assessment of each individual. Results: Eight hundred seven individuals, 539 (66.8%) with and 268 without BAD were analysed. Almost one third (31.2%) of patients with BAD had more than one BAD. Concomitant anal findings such as skin tags were more frequently seen in patients with than without BAD (<0.01). After haemorrhoids (401 patients), pruritus ani (317 patients) was the second most frequently found BAD. The distribution of stages in 317 pruritus ani patients was: mild (91), moderate (178), severe (29), and chronic (19). Anal symptoms in patients with BAD included: bleeding (58.6%), itch (53.7%), pain (33.7%), burning (32.9%), and soreness (26.6%). Anal lesions could be predicted according to patients' answers in the questionnaire: haemorrhoids by anal bleeding (p=0.032), weeping (p=0.017), and non-existence of anal pain (p=0.005); anal fissures by anal pain (p=0.001) and anal bleeding (p=0.006); pruritus ani by anal pain (p=0.001), itching (p=0.001), and soreness (p=0.006). Conclusions:The knee-chest position may allow for the accumulation of more detailed information about BAD than the left lateral Sims' position, thus enabling physicians to make more reliable anal diagnoses and provide better differentiated therapies.

Do we at all need surgery to treat thrombosed external hemorrhoids? Results of a prospective cohort study

“…Therefore, recurrences with our patients seem rather unlikely but anal inflammation is supposable announced by itching (18.8%), pricking (10.4%), and a sore anus (8.3%). 24,25,28 Patient attitudes against our treatment policy did not influence therapeutic results since the majority of patients characterized it as "valuable to test" or "understandable" (61.1%). These patients had no better results than those who …”

Dermatologische Proktologie

“…In einer kürzlich publizierten Studie wurden über 800 Patienten mit analen und/oder gastrointestinalen Beschwerden befragt und untersucht [7]. Ein Pruritus bestand bei über der Hälfte der Patienten mit benignen analen Erkrankungen.…”

Patients&rsquo; views of medical positioning for proctologic examination

“…2 Moreover concomitant anal findings were shown to play a role in the pathogenesis of benign anal diseases when patients with and without concomitant anal findings and benign anal diseases were compared (P  0.01). …”

“…4 Others found that the lithotomy position seems to be less tolerated. 5 Whilst diagnoses might depend on positioning, 1,2 doctors argue that the patient's sense of shame is violated in other than the left lateral Sims' position. 4,5 In fact doctors might be biased regarding positioning of patients for proctological examination and some may even conceal their own preferences.…”

“…1,2 The left lateral Sims' position is said to be well tolerated, especially by aged or debilitated patients. 3 Certainly it is more comfortable than the knee-chest position.…”