Water that is not a life saver !

Small observations by great people may lead to great discoveries. As observation of a fall of an apple by Sir Issac Newton led to the discovery of the greatest laws of Physics. I also narrate an interesting story here. However, in this case a small observation by a small man led to a small discovery.

In the later half of 2008, over a period of few weeks, I got a spurt of patients in my office suffering from Anterior Anal Fissure.  [Anal Fissure is a condition with severe pain in the anus due to a cut caused usually by constipation. In males, 99% of fissures are on the back side (posterior) side of the anus and 1% on the front (anterior) side]. Initially I ignored it thinking it to be routine presentation but after some time, I was perplexed to note that 95% of the male patients coming to me with fissure had anterior(front) anal fissure (which were supposed to be less than 1% as per the literature). I was wondering as why this change of trend was happening. One of the patients was not getting alright even after being operated by one of my friends. I discussed it with a couple of my colleagues but even they had no idea whatsoever.

I kept on thinking for few days- in every possible direction and every possible cause- as why this could be happening and what could be the reason of this reversal of trend but to no avail. Ignorance turned into desperation was now bordering into frustration. On a routine but eventful day,  one of the similar male patient (suffering from anterior fissure and not getting relief with usual medicines) came for consultation to my clinic. Mentally prepared to listen to him for an hour, I told him  “Tell me everything in detail from the very beginning of your illness”. I was vigilantly listening as he was narrating his story. Suddenly he spoke something that made me rise in the chair and I almost jumped. He said  “I turn on the water-jet and then sit for 10-15 minutes”.  Oh my God ! was it the water-jet which was responsible for all this?

Yes, it was possible because water jet in the toilet seat from behind would hit the front wall of the anus and cause anterior (front) anal fissure. The use of water jet in toilet seats is rampant in North India and this could explain the rising trend of anterior(front)fissure in the population. This would also explain why one of the patients couldn’t get relief even after operation (because he must be using the water jet still).

I took out my out patient register and called all the patients with anterior fissure I had seen in the last few months. No wonder, all were using water jet and that too for a long time. I advised them to stop water jet immediately to which the response was spectacular.

On Feburary 1, 2009, I submitted this research to a prestigious British journal, Colorectal Disease (Colorectal Disease is published from England and is the second highest ranking colorectal journal in the world. It is the official journal of British & Ireland, European and Spanish Societies of  Coloproctolgy) and to my utter surprise, it was accepted for publication on the same day it was submitted (normally it takes 6-8 weeks for the peer review process). It subsequently got published in 2010 June issue

Pankaj Garg. Water stream in a bidet-toilet as a cause of anterior fissure-in-ano: A preliminary report. Colorectal Disease 2010 Jun;12(6):601-2

(http://www.ncbi.nlm.nih.gov/pubmed?term=19486098)

It was also covered in the leading newspapers of the region from time to time

Hindustan Times- June 9, 2009- Water jet in Toilets may cause Anal Fissures

Aaj Samaj - 5 November, 2012- Jet Spray in Toilet dangerous !

 The Tribune (National Edition)- July 8, 2009- Water jet in toilet behind rising cases of Anal Fissures

Last month, a neuroradiologist and a learned friend of mine from London, informed me that water jet is used in the instrument- Water jet Cutter- a tool capable of slicing into  metal or other materials (such as granite) using a jet of water at high velocity and pressure.  http://en.m.wikipedia.org/wiki/Water_jet_cutter