Published: 2019-09-26

Assessment of thyroid profile in patients with fissure in ano in the South Indian population

Madhumitha Prabhakaran, Bharath Narayanasami, Arcot Rekha


Background: Hard faeces result in local trauma to the rectal mucosa which secondarily activates internal anal sphincter hypertonia. This will compress end arteries of the anus and cause ischemia of the posterior commissure and eventually anal fissures. A precipitating history of constipation is found in approximately 20% of patients with anal fissures. Constipation is one of the classic signs of hypothyroidism.

Methods: Patients who presented to the surgical OPD of Saveetha Medical College and Hospital, Thandalam, India during the months of March and April of 2019 with lower abdominal complaints were screened for fissure in ano. The thyroid profile of these patients was analysed.

Results: 38.2% of patients with lower gastrointestinal complaints and 3.6% of the total number of patients presenting to the surgical OPD were attributed to an anal fissure. The incidence of hypothyroidism in patients with an anal fissure is 32%. Since the incidence of hypothyroidism in our study is higher than the prevalence of hypothyroidism in the general population as documented by multiple studies in the past, we can conclude that there is a significant association between hypothyroidism and development of anal fissures.

Conclusions: By analysing the thyroid profile in patients with anal fissures, we found an association between the two entities. This information can be used to predict and prevent anal fissures in hypothyroid patients.


Hypothyroidism, Fissure in ano, Anal fissure, Constipation, Thyroid profile, Lower gastrointestinal complaints

Full Text:



McCallion K, Gardiner KR. Progress in the understanding and treatment of chronic anal fissure. Postgraduate Med J. 2001;77(914):753-8.

Klosterhalfen B, Vogel P, Rixen H, Mittermayer C. Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Disease Colon Rectum. 1989;32(1):43-52.

Prohm P, Bonner C. Is manometry essential for surgery of chronic fissure-in-ano?. Disease Colon Rectum. 1995;38(7):735-8.

Minguez M, Tomas-Ridocci M, Garcia A, Benages A. Pressure of the anal canal in patients with hemorrhoids or with anal fissure. Effect of the topical application of an anesthetic gel. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva. 1992;81(2):103-7.

Yaylali O, Kirac S, Yilmaz M, Akin F, Yuksel D, Demirkan N, et al. Does hypothyroidism affect gastrointestinal motility?. Gastroenterol Res Practice. 2009;2009:529802.

Unnikrishnan AG, Kalra S, Sahay RK, Bantwal G, John M, Tewari N. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J Endocrinol Metab. 2013;17(4):647.

Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab. 2011;15(S2):78.

Sanjeet B. Hypothyroidism in India: more to be done. Lancet Diab Endocrinol. 2014;2(10):778.

Velayutham K, Selvan SS, Unnikrishnan AG. Prevalence of thyroid dysfunction among young females in a South Indian population. Indian J Endocrinol Metab. 2015;19(6):781.