Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study

Abstract

Objective To identify the incidence and risk factors of haemorrhoids and fissures during pregnancy and after childbirth.Design Prospective observational cohort study.Setting University hospital and outpatient clinics in Lithuania.Population A total of 280 pregnant women followed up until 1 month after delivery.Methods Women were examined four times through pregnancy and after delivery; those that developed peri-anal diseases were compared with those that did not.Main outcome measures Incidence, time and risk factors of haemorrhoids and fissures.Results In all, 123 (43.9%) women developed peri-anal disease: 1.6% in the first trimester, 61% during the third trimester, 34.1% after delivery and 3.3% 1 month after delivery; 114 (40.7%) women were diagnosed with haemorrhoids, seven (2.5%) with haemorrhoids and anal fissure and two (0.71%) with anal fissure. Ninety-nine (80.5%) women had vaginal delivery and 24 (19.5%) women had undergone caesarean section. Multivariate analysis identified personal history of peri-anal diseases (odds ratio [OR] 11.93; 95% confidence interval [95% CI] 2.18-65.30), constipation (OR 18.98; 95% CI 7.13-50.54), straining during delivery for more than 20 minutes (OR 29.75; 95% CI 4.00-221.23) and birthweight of newborn >3800 g (OR 17.99; 95% CI 3.29-98.49) as significant predictors of haemorrhoids and anal fissures during pregnancy and perinatal period.Conclusions Haemorrhoids and fissures are common during the last trimester of pregnancy and 1 month after delivery, with constipation, personal history of haemorrhoids or fissures, birthweight of newborn >3800 g, straining during delivery for more than 20 minutes being independently associated risk factors.

Anorectal symptoms during pregnancy and postpartum: a prospective cohort study

“…were similar to this study in several respects. They too followed a cohort of women prospectively during pregnancy (Poskus during the first and third trimester, Abramowitz in the third trimester) and postpartum . Abramowitz et al .…”

“…Poskus et al . reported a prevalence of peri‐anal problems of 43.9% from the first trimester until 1 month postpartum. In our study, a higher percentage of women with anal problems was found, with 68.5% of the women complaining of anal symptoms from the second trimester until 3 months postpartum.…”

“…The most recent study by Poskus et al . has identified the personal history of peri‐anal diseases, constipation, straining during delivery for more than 20 min and birthweight of the newborn above 3800 g as significant predictors for haemorrhoids and anal fissures prepartum and postpartum. Abramowitz et al .…”

Haemorrhoids: modern diagnosis and treatment

“…Some 40% of women will develop haemorrhoids during pregnancy, usually in the third trimester, or within the first month after delivery 50. Symptoms are believed to resolve shortly after birth, and intervention during pregnancy is therefore usually avoided.…”

Herbal laxatives and antiemetics in pregnancy

“…The most common consequences of long term constipation are hemorrhoids and anal fissures [5]. Several factors can be mentioned as potential reasons for the symptom: slower gastrointestinal (GI) transit time, higher plasma level of progesterone and mechanical obstruction [6].…”