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Observational Study
. 2017 Aug 3;18(1):78.
doi: 10.1186/s12875-017-0649-6.

Prevalence of anal symptoms in general practice: a prospective study

Géraldine Tournu  1 , Laurent Abramowitz  2 , Camille Couffignal  3   4   5 , Frédéric Juguet  6 , Agnès Sénéjoux  7 , Stéphane Berger  8 , Anne-Laure Wiart  9 , Marc Bernard  10 , Françoise Provost  11 , Hélène Pillant-Le Moult  12 , Dominique Bouchard  13 , Jean-Pierre Aubert  14 ; GREP study group; MG-PREVAPROCT study group
Affiliations
Observational Study

Prevalence of anal symptoms in general practice: a prospective study

Géraldine Tournu et al. BMC Fam Pract. .

Erratum in

Abstract

Background: Anal disorders are largely underestimated in general practice. Studies have shown patients conceal anal symptoms leading to late diagnosis and treatment. Management by general practitioners is poorly described. The aim of this study is to assess the prevalence of anal symptoms and their management in general practice.

Methods: In this prospective, observational, national study set in France, all adult patients consulting their general practitioner during 2 days of consultation were included. Anal symptoms, whether spontaneously revealed or not, were systematically collected and assessed. For symptomatic patients, the obstacles to anal examination were evaluated. The general practitioner's diagnosis was collected and a proctologist visit was systematically proposed in case of anal symptoms. If the proctologist was consulted, his or her diagnosis was collected.

Results: From October 2014 to April 2015, 1061 patients were included by 57 general practitioners. The prevalence of anal symptoms was 15.6% (95% CI: 14-18). However, 85% of these patients did not spontaneously share their symptoms with their doctors, despite a discomfort rating of 3 out of 10 (range 1-5). Although 65% of patients agreed to an anal examination, it was not proposed in 45% of cases with anal symptoms. Performing the examination was associated with a significantly higher diagnosis rate of 76% versus 20% (p < 0.001). Proctologist and general practitioner diagnoses were consistent in 14 out of 17 cases.

Conclusions: Patients' concealed anal symptoms are significant in general practice despite the impact on quality of life. Anal examination is seldom done. Improved training of general practitioners is required to break the taboo.

Keywords: Anal; Epidemiology; Examination; General practice; Haemorrhoids; Proctology.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the National Committee for Data Protection and Liberties (CNIL-CCTIRS France) and the Institutional review board of Paris X section (Paris X CPP), which approved all participating sites. A verbal consent to participate in the study was obtained from all patients, general practionners and proctologists, which was approved by the ethics committee.

Competing interests

LA is a consultant for Bayer, Sanofi, Abbvie, Allergan, MEDAPharma and Coloplast. This study was financed by a grant of BAYER laboratories.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient flow-chart
Fig. 2
Fig. 2
Proportion of diagnoses depending on clinical examination
Fig. 3
Fig. 3
Level of discomfort due to the anal symptom, when it was spontaneously declared or revealed after questioning
See this image and copyright information in PMC

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