Document Detail

Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable.
MedLine Citation:
PMID:  15812586     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Chronic anal fissure is said to be associated with internal sphincter hypertonia. However, an unknown proportion of fissures may be associated with normal or even low resting pressures and may subsequently be resistant to pharmacological treatments or at risk from surgical treatments, both of which aim to reduce sphincter hypertonia. This study investigated the ability of surgeons to detect low or normal pressure fissures by digital rectal examination. METHODS: Patients with chronic anal fissure were assessed prospectively. The results of anal manometry performed on these patients were compared with digital rectal assessment of sphincter tone undertaken by a surgeon blinded to the manometry results. RESULTS: Forty consecutive patients (21 male) with chronic anal fissure were studied. Twenty-two (55 percent) had normal maximum resting pressure and a further 3 (8 percent) had low pressures on anal manometry. On clinical assessment, only five (13 percent) patients were evaluated as having no anal hypertonia. Clinical assessment of anal tone correctly identified 14 of 15 patients with high manometric maximum resting pressure (sensitivity, 93 percent), yet detected only 4 of 25 patients with normal or low pressures (specificity, 16 percent). The positive predictive value of clinical assessment of anal tone was 40 percent and the negative predictive value, 80 percent. CONCLUSIONS: The incidence of patients with chronic anal fissure without high manometric maximum resting pressure is higher than previously reported. The ability of surgeons to identify this group clinically was poor. It is reasonable to treat all patients primarily medically, and then selectively investigate by manometry those patients who fail medical therapy before considering lateral sphincterotomy.
Oliver M Jones; Thanesan Ramalingam; Ian Lindsey; Chris Cunningham; Bruce D George; Neil J McC Mortensen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  48     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-04-06     Completed Date:  2005-05-12     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  349-52     Citation Subset:  IM    
Department of Colorectal Surgery, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom.
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MeSH Terms
Anal Canal / physiopathology*
Chronic Disease
Fissure in Ano / physiopathology*
Muscle Hypertonia / physiopathology
Physical Examination*
Prospective Studies
Reproducibility of Results
Statistics, Nonparametric

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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