title: Chronic anal fissure: common aetiopathogenesis, with special attention to sexual abuse.
abstract: BACKGROUND
  Chronic anal fissures represent 15% of proctologic consultations, although their aetiopathogenesis is unclear and multifactorial. This study aims to identify the aetiopathogenesis, risk factor of recurrence after lateral subcutaneous internal anal sphincterotomy and existing correlation with sexual abuse, as sexual abuse accounts for over 21% of anal fissures.
  
  
  METHODS
  We retrospectively studied 80 cases of surgical (n = 54) and medical (n = 26) patients known with chronic anal fissure over eight months. We built an original questionnaire referring to the NorVold Abuse Questionnaire. Sixty cases were interviewed with only twenty filling the questionnaire themselves.
  
  
  RESULTS
  Among the aetiological factors observed, as reported by these patients, we underlined chronic constipation 51 (64%), postoperative haemorrhoidectomy 15 (19%), sexual abuse 15 (19%), vaginal delivery and hysterectomy 10 (13%), traumatic anal sex 10 (13%), digital anal examination 4 (5%), anti-inflammatory non-steroid suppository 3 (4%), asthma with chronic cough 3 (4%). The recurrence rate reached 39% (31 cases, 13/26 (50%) in the medical group, against 18/54 (33%) in the surgical group. The 4/15 (27%) of sexual abuse happened in adulthood and 6/15 (40%) never disclosed this information.
  
  
  CONCLUSIONS
  Sexual abuse is a significant aetiological factor of chronic anal fissures and it is to be suspected in cases of recurrence after anal sphincterotomy. For such cases, a multidisciplinary treatment is crucial to improve the prognosis of the disease. We recognise that the causality is difficult to prove and we cannot confirm that every sexually abused person could inevitably develop chronic anal fissure.
authors.affiliation: Department of Abdominal Surgery, Andre-Renard Clinic, Herstal, University of Liège, faculty of medicine, Belgium.
authors.forename: M J
authors.initials: MJ
authors.lastname: Nzimbala
authors.forename: L
authors.initials: L
authors.lastname: Bruyninx
authors.forename: A
authors.initials: A
authors.lastname: Pans
authors.forename: P
authors.initials: P
authors.lastname: Martin
authors.forename: F
authors.initials: F
authors.lastname: Herman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002650:Child Abuse, Sexual; D002908:Chronic Disease; D003248:Constipation / Q000209:etiology; D005260:Female; D005401:Fissure in Ano / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult