Abstract:

Aim: The exact etiology of anal fissure (AF) remains unclear but it appears that constipation and stress may instigate AF. Little is known about the role of functional bowel disorder and psychopathology in AF. The aim of this study was to investigate the comorbidity of irritable bowel syndrome (IBS) in AF and its effect on quality of life (QoL). Method: This was a cross-sectional observational study. Ninety-six AF patients (76 female; 79.2%) with a mean age of 36.54±14.98 years were recruited. The Rome 3 Criteria were applied to diagnose IBS, functional constipation (FC) and no functional gastrointestinal disorder (NoGIS). Depression, anxiety, stress level, stressful life events and QoL were evaluated. Results: Of the AF patients, 42.7% had IBS, 36.4% had FC, and 20.8% had noGIS. Furthermore, 59% had defecation disorder, characterized by obstructive defecation symptoms. Patients with IBS tended to have more anteriorly located AF (IBS: 40.5%, FC: 24.1%, NoGIS: 7.1%; p=0.053). IBS patients had a significantly higher anxiety score (p=0.021). More severe depression predicted IBS (p=0.009) and IBS predicted more severe depression score (p=0.027). Depression, pain symptom severity and IBS were the most important negative factors affecting QoL (p<0.05). Conclusion: IBS, FC and defecation disorder are frequent comorbidities in patients with AF. IBS especially and defecation disorder caused a more anxious emotional state, resulting in a decreased QoL. Depression and pain symptom severity appeared to have a greater negative effect on QoL than the other symptoms of AF itself.

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