title: Posterior perineal support as treatment for anal fissures--preliminary results with a new toilet seat device.
abstract: BACKGROUND
  Anal fissures can cause morbidity in an otherwise healthy young patient. The process of evacuation results in stretching and descent of the anoderm and perineum especially posteriorly. Posterior perineal support may provide counter pressure at the posterior aspect of the pelvic floor, balancing the pressure exerted by the faeces on the anal wall, thus improving evacuation and reducing the trauma associated with it, and reducing symptoms of anal fissures. Symptoms of constipation may also be reduced secondarily. We report the preliminary results with a novel, simple and noninvasive method of treatment provided by a toilet seat device.
  
  
  METHODS
  A prospective study was performed in 32 patients. The study was designed mainly to investigate the patients' subjective perceptions of their symptoms related to anal fissures and constipation. Questionnaires were provided to patients before, during and after treatment.
  
  
  RESULTS
  The study revealed statistically significant improvement in pain, bleeding, symptoms of constipation and abdominal discomfort after 3 months usage of the device. The odds of patients perceiving an improvement in symptoms were also significantly increased after 3 months of treatment compared to 2 weeks of treatment.
  
  
  CONCLUSIONS
  This preliminary study revealed that a posterior perineal support device can bring about significant improvement in the symptoms of patients with anal fissures. There may also be secondary benefits of a reduction in the symptoms of constipation. Although not conclusive, these results should serve as a springboard for further research into this area.
authors.affiliation: Mt Elizabeth Medical Centre, Seow-Choen Colorectal Centre Pte Ltd, Singapore.
authors.forename: Kok-Yang
authors.initials: KY
authors.lastname: Tan
authors.forename: Francis
authors.initials: F
authors.lastname: Seow-Choen
authors.forename: Chew Heng
authors.initials: CH
authors.lastname: Hai
authors.forename: Gan Kok
authors.initials: GK
authors.lastname: Thye
mesh_terms: D000328:Adult; D003248:Constipation / Q000503:physiopathology / Q000517:prevention & control; D003672:Defecation; D004867:Equipment Design; D005260:Female; D005401:Fissure in Ano / Q000503:physiopathology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction; D017773:Pelvic Floor / Q000503:physiopathology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014038:Toilet Facilities / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult