To study the role of the anorectal anatomic and functional disorders in the pathogenesis of various anal diseases, the author evaluated anal pressure and cinedefecogram in 264 patients with anal diseases. These diseases fall under 3
categories(number of
cases in parentheses): hemorrhoids, (176); anal fistula, (23); anal fissure, (23). These patients visited the Department of General Surgery at the Yeungnam University Hospital (YUH) between June 1993 and May 1994. The same data were collected
from
31
controls without anal diseases.
@ES the results are follows;
@EN Constipation and straining ave strong significance in the hemorrhoids and fissure groups(p<0.05). While maximal anal resting pressure and maximal anal contraction pressure in resting and contraction have no significance in patients with anal
diseases.
In cinedefecographic examination anorectal angle(ARA) in resting and straining were 78.4±18.8°, 100.7±21.8°in control group. ARA in anal fissure group were 90.5±17.4°and 132.4±15.2°in resting and straining, which was significantly higher
than
control, and there was statistical significance in anal fissure group. the average increment of ARA in control group was 22.6±18.9°and this study was the increment of ARA below 10°. The incidence of NRPR showed mild increases in
hemorrhoids(22%)
compared with control group(16%).
The perineal distance in control goup was 6.3±2.2cm in rest, 9.6±2.6in straining and perineal descent was 3.3±2.0. there was no significant difference between groups. Perineal discent over 4cm was observed in 36% of hemorrhoids, 17% of
fistula,
56%
of fissure. The frequency showed mild increasing tendency in hemorrhoids and anal fissure compared with 25% of control group.
In female, rectocele was noted in 84% of control and 82% of the diseased. The incidence of large rectocele(size change>2cm in straining) was higher in anal fissure and hemorrhoids as 55% and 44% respectively than control 31%.
Intrarectal intussusception was noted in 29% of hemorrhoids, 26% of anal fissure, 8% of anal fistula. Relative to the 48% of control normal finding was less in anal fissure and hemorrhoids.
Common anal diseases as hemorrhoids and anal fissures have associated with constipation, straining and functional abnormality more frequently than disease free or anal fistula. But the role of anal pressure has no significance in functional
abnormalities and anal diseases. Straining may have strong relationship with anorectal functional abnormalities and anal diseases, esepecially with hemorrhoids and anal fissure which maybe the outcome of the functional abnomalities.
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