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The epidemiology and treatment of anal fissures in a population-based cohort.

Mapel DW, Schum M, Von Worley A - BMC Gastroenterol (2014)

Bottom Line: The incidence also varied by sex, and was significantly higher among females 12-24 years, and among males 55-64 years (P < 0.001).Constipation, obesity, and hypothyroidism are associated comorbidities.Surgical interventions for AF including botulinum toxin and lateral internal sphincterotomy are uncommon.

View Article: PubMed Central - HTML - PubMed

Affiliation: Lovelace Clinic Foundation, 2309 Renard Place SE, Albuquerque NM 87106, New Mexico, USA. dmapel@comcast.net.

ABSTRACT

Background: Anal fissure (AF) is regarded as a common problem, but there are no published epidemiologic data, nor information on current treatment. The purpose of this study was to examine the incidence, associated comorbidities, and treatment of AF in a population-based cohort.

Methods: We conducted a retrospective analysis of all persons who were enrolled in one large regional managed care system and treated for AF during calendar years 2005-2011. All persons aged 6 years or older who had a clinic, hospitalization, or surgical procedure associated with AF were identified from utilization data. To identify comorbidities associated with AF, each case was matched by age and gender to 3 controls.

Results: There were 1,243 AF cases, including 721 (58%) females and 522 (42%) males; 150 (12%) of the cases occurred in children aged 6-17 years. The overall annual incidence was 0.11% (1.1 cases per 1000 person-years), but ranged widely by age [0.05% in patients 6-17 years to 0.18% in patients 25-34 years]. The incidence also varied by sex, and was significantly higher among females 12-24 years, and among males 55-64 years (P < 0.001). Comorbidities associated with AF included chronic constipation (prevalence 14.2% vs 3.6%), hypothyroidism (14.7% vs 10.4%), obesity (13.0% vs 7.7%), and solid tumors without metastasis (5.2% vs 3.7%) (P < 0.001 for all comparisons). A total of 448 were dispensed a topical prescription medication, 31 had botulinum toxin injection, and only 13 had lateral internal sphincterotomy.

Conclusions: AF is a common clinical problem, and the incidence varies substantially by age and sex. Constipation, obesity, and hypothyroidism are associated comorbidities. Most patients are prescribed topical treatments, although it appears that many prescriptions are never filled. Surgical interventions for AF including botulinum toxin and lateral internal sphincterotomy are uncommon.

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Related in: MedlinePlus

Incidence of anal fissure (cases per 1000 persons per year) by sex and age group.
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Figure 1: Incidence of anal fissure (cases per 1000 persons per year) by sex and age group.

Mentions: A total of 1243 persons met all study inclusion criteria (Table 1). More women (N = 721, 58% of cohort) were diagnosed with AF than men. This health system enrolls a higher proportion of women overall (55.8% during the study period), and after calculation of the incidence of AF by person-years at risk, the overall difference in AF by sex did not reach statistical significance (p = 0.08) (Table 2). However, there were several important differences between men and women by age strata (Figure 1 and Table 2). Women from 12–24 had significantly higher incidence of AF than males at those age, while men age 55–64 had significantly higher AF incidence than women. Accordingly, the mean age among women with AF was 40.9 years and among men was 46.6 years (p < 0.001).


The epidemiology and treatment of anal fissures in a population-based cohort.

Mapel DW, Schum M, Von Worley A - BMC Gastroenterol (2014)

Incidence of anal fissure (cases per 1000 persons per year) by sex and age group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4109752&req=5

Figure 1: Incidence of anal fissure (cases per 1000 persons per year) by sex and age group.
Mentions: A total of 1243 persons met all study inclusion criteria (Table 1). More women (N = 721, 58% of cohort) were diagnosed with AF than men. This health system enrolls a higher proportion of women overall (55.8% during the study period), and after calculation of the incidence of AF by person-years at risk, the overall difference in AF by sex did not reach statistical significance (p = 0.08) (Table 2). However, there were several important differences between men and women by age strata (Figure 1 and Table 2). Women from 12–24 had significantly higher incidence of AF than males at those age, while men age 55–64 had significantly higher AF incidence than women. Accordingly, the mean age among women with AF was 40.9 years and among men was 46.6 years (p < 0.001).

Bottom Line: The incidence also varied by sex, and was significantly higher among females 12-24 years, and among males 55-64 years (P < 0.001).Constipation, obesity, and hypothyroidism are associated comorbidities.Surgical interventions for AF including botulinum toxin and lateral internal sphincterotomy are uncommon.

View Article: PubMed Central - HTML - PubMed

Affiliation: Lovelace Clinic Foundation, 2309 Renard Place SE, Albuquerque NM 87106, New Mexico, USA. dmapel@comcast.net.

ABSTRACT

Background: Anal fissure (AF) is regarded as a common problem, but there are no published epidemiologic data, nor information on current treatment. The purpose of this study was to examine the incidence, associated comorbidities, and treatment of AF in a population-based cohort.

Methods: We conducted a retrospective analysis of all persons who were enrolled in one large regional managed care system and treated for AF during calendar years 2005-2011. All persons aged 6 years or older who had a clinic, hospitalization, or surgical procedure associated with AF were identified from utilization data. To identify comorbidities associated with AF, each case was matched by age and gender to 3 controls.

Results: There were 1,243 AF cases, including 721 (58%) females and 522 (42%) males; 150 (12%) of the cases occurred in children aged 6-17 years. The overall annual incidence was 0.11% (1.1 cases per 1000 person-years), but ranged widely by age [0.05% in patients 6-17 years to 0.18% in patients 25-34 years]. The incidence also varied by sex, and was significantly higher among females 12-24 years, and among males 55-64 years (P < 0.001). Comorbidities associated with AF included chronic constipation (prevalence 14.2% vs 3.6%), hypothyroidism (14.7% vs 10.4%), obesity (13.0% vs 7.7%), and solid tumors without metastasis (5.2% vs 3.7%) (P < 0.001 for all comparisons). A total of 448 were dispensed a topical prescription medication, 31 had botulinum toxin injection, and only 13 had lateral internal sphincterotomy.

Conclusions: AF is a common clinical problem, and the incidence varies substantially by age and sex. Constipation, obesity, and hypothyroidism are associated comorbidities. Most patients are prescribed topical treatments, although it appears that many prescriptions are never filled. Surgical interventions for AF including botulinum toxin and lateral internal sphincterotomy are uncommon.

Show MeSH
Related in: MedlinePlus