Chronic Anal Fissure from Suspected Adult Sexual Abuse in a Traumatic Anal Sex Practice Patient

Abstract

The aetiopathogenesis of chronic anal fissure (CAF) is unclear and is probably multifactorial. CAF represents 10–15% of proctological consultations. This case report identifies adulthood sexual abuse as a significant risk and a potential aetiopathogenic factor of CAF. This case history was discovered while carrying out administrated interviews during authors’ clinical retrospective study on CAF.

The clinical presentation of this 49-year-old woman is predominated by chronic anal lesions (anal tears in the anoderm, anal sphincter hypertrophy), associated medical history as a high consumer of healthcare with very poor mental health, chronic traumatic anal sex practice history, and especially persistent recurrences of gastro-intestinal symptoms after surgery. Surgical history is summarized as: 7 χ spontaneous abortion; 5 χ fistulectomy and 3 χ anal abscess; 4x Bartholin’s gland; 4χ hypertrophy papilla ablation; 2χ anal manometry, 2χ fissurectomy and 1χ sphincterotomy; 2χ haemorrhoid; and 1χ hysterectomy. These symptoms initially started and the operations in particular took place after she was married.

After 26 years of sexual abuse within her marriage, the clinical diagnosis was made and was consented by this patient. A referral to a psychiatrist was evident and a long course of multidisciplinary therapy (medical, surgical, physiological and psychological approaches) seemed to be of benefit, in terms of improving the clinical symptoms. Authors suggest that physicians should suspect sexual abuse in any patient with a medical history as a high consumer of healthcare and especially when there is persistent recurrence after the lateral subcutaneous internal sphincterotomy. We recognise that the link or causality is difficult to prove and further study is probably needed to shed light on the link between sexual abuse and CAF: although in the United Kingdom, over 20.83% of the population are subject to sexual abuse. 83%.

Key Words:

• Anal fissure
• sexual abuse
• somatisation
• anal sphincterotomy

Additional information

Notes on contributors

L. Bruyninx

L. Bruyninx, B.L. André Renard Clinic Rue André Renard, 1 E-mail: [email protected]