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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 5-7

Incidence of fissure-in-ano among night duty workers


1 Department of Shalyatantra, MGACH and RC, Wardha, Maharashtra, India
2 Rognidan Department, Shree Ayurved Mahavidyalaya, Nagpur, India

Date of Web Publication27-Aug-2019

Correspondence Address:
Dr. Kiran B Khandare
Department of Shalyatantra, MGACH and RC, Salod, Wardha, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_10_19

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  Abstract 

Background: Anal fissure is commonly seen in today’s era. The incidence of fissure is 10% of the total cases attending proctology clinics. Lifestyle has an important impact on anorectal diseases along with improper dietary habits. Aims: To analyse whether there is any relation between night awakening and fissure-in-ano or not, this study was undertaken. Materials and Methods: A total of 100 subjects who were working at night since at least 6 months were selected. A prepared questionnaire was given to the subjects and they were asked to fill it genuinely. Subjects who were having fissure-in-ano were observed and noted. Different groups were formed on the basis of the days of night duty of the employees per week, type of night duty, and dietary habits of the individuals, and assessment was carried out. Observation: Sixty-two subjects were found to have some of the complaints listed in the questionnaire. They were examined. Among those 62 subjects, 43 subjects were diagnosed with fissure-in-ano. Conclusion: The study revealed that 8.68% is the incidence of fissure-in-ano in night duty workers, which is found to be significant.

Keywords: Anal fissure, anorectal, incidence, questionnaire


How to cite this article:
Khandare KB, Umate VS, Shrivastav PP. Incidence of fissure-in-ano among night duty workers. J Indian Sys Medicine 2019;7:5-7

How to cite this URL:
Khandare KB, Umate VS, Shrivastav PP. Incidence of fissure-in-ano among night duty workers. J Indian Sys Medicine [serial online] 2019 [cited 2019 Sep 19];7:5-7. Available from: http://www.joinsysmed.com/text.asp?2019/7/1/5/265513


  Introduction Top


An anal fissure is a longitudinal split in the anoderm of the distal anal canal, which extends from the anal verge proximally toward, but not beyond, the dentate line.[1] Spasm of the anal sphincter has been noted in association with anal fissure. It causes severe pain and bleeding with bowel movements, and is associated with spasm of the internal anal sphincter, which may lead to reduction of blood flow and delayed healing. In the modern science, fissure-in-ano has been classified into two groups, namely acute and chronic. Most anal fissures are minor and thought to heal spontaneously, but those that are still symptomatic after 4–6 weeks are often referred to as chronic fissure.[2]

In Ayurvedic texts, this disease is clinically correlated with Parikartika (fissure-in-ano). The factors responsible to cause Parikartika are found in various texts as Vamana (vomiting), Virechana vyapada (complication of purgation), Basti karma vyapada (complication of medicated enema), Upadrava of Atisara (complication of diarrhea), Grahani (irritable bowel syndrome), and Arsha (hemorrhoids).[3]

Fissure-in-ano was first recognized as a disease in 1934, it is a common condition affecting a sizeable majority of population, including all age groups, but is particularly seen in young and healthy adults.[4] The incidence of fissure is 10% of all the total cases attending proctology clinics.[5] Lifestyle has an important impact on fissure-in-ano along with improper dietary habits. Despite extensive investigation of this disease, the exact etiology of anal fissure remains unclear. So to check whether there is any relation between night awakening and fissure-in-ano or not, this study was carried out.


  Materials and Methods Top


Type of study: Observational study.

Duration of study: 6 Months

Sample size: 100 Participants

Type of sampling: Random

Data procuring sources:

  • Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod (Hirapur)


  • Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe)


  • ATM centers at Wardha


  • Clinical sources: The individuals working at night

    Methods

  • A total of 100 subjects who were working at night (for minimum 8h at night) since a minimum of 6 months were approached.


  • Questionnaires were distributed among them.


  • Different groups were formed on the basis of the points mentioned in questionnaire.


  • The number of participants having complaints related to fissure-in-ano was observed and noted.


  • Assessment of fissure-in-ano was carried out on the basis of the physical examination.


  • Data were collected and analyzed.


  • Inclusion Criteria

    Employees working since at least 6 months on night duty, irrespective of age, sex, and religion were included in this study.

    Exclusion Criteria

    The participants were excluded if they had any major diseases such as tuberculosis, ulcerative colitis, Crohn’s disease, and anal carcinoma.


      Observation and Results Top


    1. Distribution of patients according to occupational status:


    2. In this study, it was observed that the occupational status of maximum number of patients surveyed was staff nurse (64%) followed by security guard (21%) followed by others. The details are given in [Table 1].
      Table 1: Distribution of patients according to occupational status


      Click here to view


    3. Distribution of patients according to their age (years):


    4. In this study, it was observed that the maximum number of patients surveyed were from the age group 21–30 years (61%) followed by age group 31–40 years (29%) followed by others. The details are given in [Table 2].
      Table 2: Distribution of patients according to their age (years)

      Click here to view


    5. Distribution of patients according to their gender:


    6. In this study, it was observed that 64% patients are female and 36% patients are male. Distribution of patients according to their gender is given in [Graph 1].




    7. Distribution of patients according to total duration of night duty (years):


    8. In this study, it was observed that the maximum number of patients surveyed were performing night duty since 5 years (63%) followed by 6–10 years (25%) followed by others. The details are given in [Table 3].
      Table 3: Distribution of patients according to total duration of
      night duty (years)


      Click here to view


    9. Distribution of patients according to incidence of fissure-in-ano:


    10. In this survey, it was observed that the incidence of fissure-in-ano is 43% [Table 4].
      Table 4: Distribution of patients according to incidence

      Click here to view


    11. Distribution of patients according to drinking habit:


    12. In this study, it was observed that the maximum number of patients (80%) were drinking tea. The details are given in [Table 5].
      Table 5: Distribution of patients according to drinking habit

      Click here to view


    13. Distribution of patients according to dinner during night duty:


    14. Distribution of patients according to dinner during night duty is given in [Graph 2].





      Discussion Top


    In this study, a total of 100 subjects working at night duty (minimum 8h at night) for more than 6 months, irrespective of sex and religion, were approached. They were distributed with the questionnaire.

    Different groups were formed on the basis of the parameters mentioned in the questionnaire: occupation, age, sex, total duration of night duty, incidence, timing of diet, and drinking habit during night duty.

    In the study, 36 subjects were males and 64 were females. As the study center was hospital area, most of the participants were staff nurses. Total 62 of the 100 subjects were having symptoms of fissure-in-ano. Among those 62 subjects, 43 were diagnosed with fissure-in-ano after anorectal examination. For those 43 subjects, z value was 8.68 (>1.96). However, the incidence of fissure-in-ano among night duty workers was found to be significant.


      Methods to Prevent the Incidence of Fissure-in-ano in Night Duty Employees Top


    The workers should be facilitated with a light dinner break at early night. They should avoid drinking tea at midnight as it contains theophylline, which (presumably via the kidneys) causes extracellular dehydration, a secondary increase in intestinal fluid absorption, and hence causes constipation,[6] which may lead to fissure in ano.


      Conclusion Top


    The study reveals that working on night duty, irrespective of age, sex, and religion, is responsible for causing fissure-in-ano. Night duty workers take food even after midnight, which may cause digestive disturbances and irregular bowel habits that lead to fissure-in-ano. The workers have a habit of drinking tea at midnight to remain awake, which also adds to the reason to cause fissure-in-ano. After looking at the significance of this study, it can be concluded that dues of night duty should be reduced to maintain health of the employees. This small study has paved a big avenue in the incidence of fissure-in-ano.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.

     
      References Top

    1.
    Williams NS, Bulstrode CJK, O’Connell PR Bailey and Love’s Short Practice of Surgery. 25th ed. CRC Press: New York2008; 258.  Back to cited text no. 1
        
    2.
    Mapel DW, Schum M, Worley AV The epidemiology and treatment of anal fissures in a population based cohort. BMC Gastroenterol 2014;129:14.  Back to cited text no. 2
        
    3.
    Shastri A Sushrut Samhita, vol-II. 11th ed. Chaukhambha sanskrita sanstahan publication, Varanasi:Chikitsa sthan1997; 34/16:151.  Back to cited text no. 3
        
    4.
    Rehman S, Hassan R, Zarin M Location of anal fissure in 127 patients. Pakistan journal of surgery 2009;25:270.  Back to cited text no. 4
        
    5.
    Pescatori M, Interisano A Annual report of the Italian coloproctology units. Tech Coloproctol 1995;3:29-30.  Back to cited text no. 5
        
    6.
    Hojgaard L, Arffmamm S Tea consumption: a cause of constipation? Br Med J 1981;282:864.  Back to cited text no. 6
        



     
     
        Tables

      [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



     

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