Prevalence of anal symptoms in general practice: a prospective study.

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.

[Anal incontinence]. / Incontinence anale.

Anal incontinence. Anal incontinence is a frequent and handicapping symptom, and causes are multiple. Mild anal incontinence can be successfully treated medically and with rehabilitation in more than 50%. Serious anal incontinence requires specialized centers to have complementary investigations and conservative or surgical treatments. Prevention of anal incontinence is the best treatment by limiting injuries on the anal sphincter (delivery, anal surgery).

Incontinence anale. L'incontinence anale est un symptôme fréquent et handicapant pour les patients dont les causes sont multifactorielles. Les incontinences modérées sont améliorées par un traitement médical et une rééducation périnéale dans plus de 50 % des cas. Les incontinences plus sévères nécessitent une prise en charge en centre spécialisé de pelvi-périnéologie pour la réalisation d'examens complémentaires et l'instauration de traitements médicaux conservateurs ou chirurgicaux. La prévention de l'apparition d'une incontinence anale en limitant les gestes délétères sur la continence anale (accouchements, chirurgie…) reste le meilleur des traitements.