Prospective Study on the Quality of Life in Patients
with Anorectal Disease
Amrutha.S.Kumar1, M.Sekar
Babu2 , Vijey Aanandhi
M2*
1Department of Pharmacy Practice, School of
Pharmaceutical Sciences, Vels University (VISTAS),
Chennai, Tamil Nadu, India.
2Department of Pharmaceutical Chemistry,
School of Pharmaceutical Sciences, Vels University
(VISTAS), Chennai, Tamil Nadu, India.
Corresponding Author E-mail: hodpchemistry@velsuniv.ac.in
ABSTRACT:
Objectives: To assess the impairment of health related
quality of life in patients with Anorectal disease by
evolving a Questionnaire. To evaluate the impact in the quality of life in
patients with Anorectal disease. Methodology: This method involves prospective analysis of quality
of life in men and women with anorectal disease. The
study is carried out by the collection and documentation of general information
of the patient regarding the disease.SF-12 Questionnaire: The SF-12
Health Survey includes 12 questions from the SF-36 Health Survey (Version 1).
These include: 2 questions concerning physical functioning; 2 questions on role
limitations because of physical health problems; 1 question on bodily pain; 1
question on general health perceptions; 1 question on vitality
(energy/fatigue); 1 question on social functioning; 2 questions on role
limitations because of emotional problems; and 2 questions on general mental
health (psychological distress and psychological well-being). Results: The study was conducted among 100 patients .There is an extremely
significant (P<0.0001**) values were obtained when compared between pre
counseling and post counseling phases of knowledge, attitude and perception
scores. Conclusion: Hemorrhoids is a
common anorectal disease condition seen in almost all the age group except for
neonates. Seen from my study that quality of life of patients with hemorrhoids
could be improved to some extend with good education regarding the disease.
KEYWORDS: Hemorrhoids, Quality of life, Anorectal
disease
INTRODUCTION:
Hemorrhoids are a common condition where the venous
drainage of rectum and anal canal become dilated. Fissure in anus is a
condition where there may be tear in the anal canal.1 More than men women are mostly affected
with hemorrhoids usually at the age of 50 years and older will develop during
the lifetime.2 Hemorrhoids classified into internal hemorrhoids and
external hemorrhoids. External hemorrhoids located in the anus around the skin
and the Internal hemorrhoids may
protrude or prolapsed through the anus.3
External hemorrhoids located in the anus around the
skin and the Internal hemorrhoids may
protrude or prolapsed through the anus.3 The exact pathophysiology of hemorrhoids still unknown. For many
years of the theory research the varicose veins, that hemorrhoids were caused
by varicose veins in the anal canal. In patients with portal hypertension and
varicose there is no chance of sudden incidence of hemorrhoids.4 The
straining during bowel movements, coughing or lifting the heavy weight etc
there will be a back pressure on the anal venules and
tense the tender swelling appears lateral to the anal margin.5 The
common symptom of internal hemorrhoids blood on the stool is bright red , or on
the toilet paper or on the toilet after the bowel movement. In external
hemorrhoids may form blood clot and the blood clot in the vein, the condition
called thrombosis. Thrombosed external hemorrhoids
cause bleeding, painfull swelling or hard lump around
the anus. The itching and irritation and pain are the worse condition.6
The medical history should include some factors like duration of disease,
nature of the symptom, bowel habit, co morbid condition, medication like non
steroidal anti-inflammatory drug (NSAIDs), Anti-coagulant.7 There
are variety of treatments are available for hemorrhoids disease, as
non-surgical and surgical. The non-surgical approaches are successful in 80-99
% of patients with hemorrhoid issues. The goal of the non-surgical treatments
is:
·
Decrease hemorrhoid vascularity
·
Reduced redundant tissue
·
Promote hemorrhoid fixation to the rectal wall to improve
prolapsed 8
The treatment include Rubber band ligation, Sclerotheraphy, Infrared coagulation, Meta-analyses, Cryo-surgery and lord’s procedure, stapled haemorrhoidopexy
(SH), Milligan-Morgan Haemoridectomy (MMH),The acute
complication in hemorrhoid disease in
the Internal hemorrhoids the reason for the venous drainage cause is still
unknown and it result in the venous thrombosis and more or less tense swell is
edema. The External hemorrhoids with thrombosis results in the sudden pain in
the perianal skin swelling9.The grade
system described by Goligher Grade I: No prolapse, vascular cushions in the anal canal visualized by
endoscopy. ▪ Grade II: Prolapse during
defecation, but spontaneous reduction. ▪ Grade III: Prolapse
during defecation, which need manually reduction. ▪ Grade IV: Persistent prolapse irrespective attempt to reduce the prolapse13.Hemorrhoids
are the part of our anatomy like eye, ear, nose, toes, we born with 6
hemorrhoids three within the
anus(internal hemorrhoid) and the three outside of the anal(external
hemorrhoids)14.The conservative management for avoidance of
constipation and hard stool, most fiber agent are bulking agent which softening
the stools by absorbing water12 Quality of life (QOL) is generally
done for the individuals and societies for their well being. Education plays a
key role in improving the quality of life of patients with the particular
disease.
MATERIALS AND METHODS:
The study was carried out in
a 6months period in a tertiary care hospital
STUDY INSTRUMENT:
SF12 Questionnaire. People were first selected
for the study and following were the inclusion and exclusion criteria. In-patients diagnosed with Benign Anorectal disease willing to participate in completing the
simple questionnaire Patients of age
less than18.In the exclusion criteria Pediatric patients with Anal
disease , Patients with psychiatry complications, Patients with morbid
disorders, Pregnant patients, Patients of age above 25, Patients with Malignant
Anorectal disease, Patients with traumatic conditions
METHOD:
This method involves prospective analysis of quality
of life in men and women with Anorectal disease. The
study is carried out by the collection and documentation of general information
of the patient including personal history. The family background, clinical
findings, investigations and medical illness associated with Anorectal disease. Further quality of life is documented
using specific questionnaire designed to assess the impact of Anorectal disease and their complications. Data collected
from the questionnaire was then tabulated and scored in their respective
charts.
STATISTICAL ANALYSIS:
The obtained data were carefully tabulated,
scored and categorized in accordance to their respective categories. Data
analysis was further done using Statistical analysis was done by calculating
the mean and standard deviation @ student t test. The collected data will be
analyzed using graph pad prism software.
SF12
QUESTIONNAIRE VALUATION:
The sf12 questionnaire health survey
includes question like, 2 questions concerning physical functioning; 2
questions on role limitations because of physical health problems; 1 question
on bodily pain; 1 question on general health perceptions question on vitality
(energy/fatigue); 1 question on social functioning; 2 questions on role
limitations because of emotional problems; and 2 questions on general mental
health psychological distress and psychological well-being. Finally, the documented questionnaire is evaluated for the final
outcome. The study was conducted
after obtaining informed consent from the patient. This study was approved by
the Ethics committee IEC/DOPV/ 2015/23
RESULTS:
The out of 100 patients,42 patients were male and 58
patients are female. In the age group 23% were in the age group of less than
18,and 35% were in the age group of 18-25 and 40% were in the age group of more
than 25. So in this study, indicated that more number of people in the age
group is affected in the range of more than 25. The table bmi
value ae classified into 3 group less than 18, 18-25,more
than 25 more increase in the range of more than 25.out of 100 patients
married(68%) and unmarried(32%) patients study also done, and the married are
mostly affected by the anorectal disease. The co
morbidities ration the diabetes mellitus patients are more prone to the
disease. The results for the pre counseling value for pcs
(physical component score) mean-39.7 and SD-21.0 and mcs(mental
component score) mean 33.5 and SD -5.15,
Post counseling value pcs mean-50.4 and SD- 6.173, mcs mean-42.7 and SD-4.153. Pre counseling value for pcs 39.7 and the post counseling value is 50.4 and the pre
counseling value for mcs is 33.5 and the post
counseling value is 42.7. The value for pcs and mcs for pre counseling for pcs
39.7 and the mcs pre counseling value us 33.5 and the
p value is significant <0.005*. The
value for pcs and mcs after
post counseling, the pcs for post counseling is 50.4 and
mcs for post counseling is 42.7 and the p value is
significant <0.0001**
Table 1 Gender Wise,age and bmi distribution:
Gender |
No. Of patients |
Percentage |
Male |
42 |
42% |
Female |
58 |
58% |
Age |
|
|
Less than 18 |
25 |
25% |
18-25 |
35 |
35% |
Above 25 |
40 |
40% |
BMI |
|
|
Less than 18 |
25 |
25% |
18-25 |
35 |
35% |
More than 25 |
40 |
40% |
Table 2 Distribution based on
Marital status and disease
Marital status |
No.of patients |
Percentage |
Un married |
32 |
32% |
Married |
68 |
68% |
Disease |
|
|
Diabetes mellitus |
49 |
49% |
Thyroid |
25 |
25% |
Hypertension |
26 |
26% |
Table 3 precounselling for PCSandMCS
precounselling |
mean |
sd |
|
PCS |
54% |
39.7 |
21.01 |
MCS |
46% |
33.5 |
5.15 |
Table
4 post counselling for PCS and MCS
post counselling |
mean |
s.d |
|
PCS |
54% |
50.4 |
6.173 |
MCS |
46% |
42.7 |
4.153 |
Table 5 for PCS pre and pro counselling
Mean pcs
before counselling |
mean pcs
after counselling |
39.7 |
50.4 |
Table 6
for MCS pre andpost counselling
Mean mcs
before counselling |
mean mcs
after counselling |
33.5 |
42.7 |
Table 7 for pre counselling PCSandMCS
Pre counselling mean pcs |
pre counselling mean mcs |
p value |
39.7 |
33.5 |
<0.005* |
Table 8
for post counselling PCSandMCS
Post counselling mean pcs |
post counselling mean mcs |
p value |
50.4 |
42.7 |
<0.0001** |
DISCUSSION:
This study was designed to find out the
quality of life among hemorrhoids patients and to create awareness about the anorectal disease. In this study ,total 100 patients are
included who were all suffering from the anorectal
disease. It is an interventional study conducted in the Anorectal
disease patients. By using Performa, the patients demographics, patient medical
history, lab investigation and other report were monitored. Assessment is done
by using SF-12 Questionnaire, which consists of 12 question about the physical
and mental component summaries respectively. Patient counseling was provided at
the initial level and the patient knowledge about hemorrhoids, cause, risk,
management, treatment and life style modification were assessed during the Pre
counseling phase and Post counseling
phase. Out of 100 patients, 42 patients were male and 58 patients are female In
the age group 25 % were in the age group of less than 18, and 35% were in the
age of 18-25 group, and 40% were in the age group of more than 25.So in this
study, indicated that more number of people in the age group is affected in the
range of more than 25. The table bmi are classified
into 3 age group less than 18, 18-25, more than 25 more increase in the bmi value is in the range of more than 25. Out of 100
patients, 32 patients (32%) are unmarried and 68 patients (68%) are married,
the study shows that married people are more affected from the anorectal disease. Out of 100 patients. 45 patients are
diabetes mellitus, 20 patients were thyroid, 21 patients are hypertension,
14 patients are no co morbid. The pre
counseling values for the pcs and mcs,
pcs mean-39.7 SD-21.0, mcs
mean-33.5 SD-5.15. The post counseling values for pcs
and mcs. Post counseling value for pcs mean-50.4 and SD-6.173 Post counseling value for mcs mean-42.7 and SD-4.153. The value for pcs in pre -counseling 39.7 and the post counseling pcs is 50.4. The value show the pre and post counseling of mcs, in the pre counseling the value of mcs
is 33.5 and the post counseling mcs is 42.7. The
value for pcs andmcs for
pre counseling for pcs pre counseling value is 39.7 and the mcs pre counseling value is 33.5 and the p value is
significant <0.005*.The value of pcs and mcs after post counseling, the pcs
value for post counseling is 50.4 and the mcs value
for the post counseling is 42.7 and the p value is significant <0.0001**,.
In this study female are more affected than the male due to changes in the life
style modification, in the pregnancy time, diet changes Mahesh.c.Misra
et al(2005) conducted a study on the Drug Treatment of Hemorrhoids and the study
concluded that in ancient times drugs are developed for treating the anorectal disease condition. Today in the modern condition
also the drugs are developed comparing to the ancient time10 De
Miguel M, et al 2005 conducted a study on the surgical treatment of hemorrhoids
and the study concluded that surgery is
most effect in the symptomatic grade III-IV. The study showed no respond by the outpatient treatment. The study also discussed in
detail regarding the surgery practice and other technique11
CONCLUSION:
The quality of life patients
with the anorectal disease shown that quality of life
have been effective for the patient undergone for the survey from the current
study it was concluded that the females above 25 years of age with a BMI of
above 25, married and patients with diabetes were more prone and had
hemorrhoids . Furthermore studies are required to support this data.
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Received on 18.08.2016
Modified on 19.09.2016
Accepted on 20.10.2016 ©
RJPT All right reserved
Research J. Pharm. and Tech. 2017; 10(1): 145-148.
DOI: 10.5958/0974-360X.2017.00032.4