Influence of Bowel Habit and Hormonal Changes on the Development of Hemorrhoidal Disease During Pregnancy and the Postdelivery Period: A Prospective Cohort Study

Parés, David; Molinet, C.; Troya, José M.; Altimira, Laura; Lopez-Negre, Jose-Luis; Franco, Eva Martínez

doi:10.1097/dcr.0000000000001822

Cited by 7 publications

(6 citation statements)

References 38 publications

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“…It was also reported that estrogen receptors were present in the internal anal sphincter in 23.5 % of women of menstruating age, and in 11.8 % of postmenopausal women [4]. However, a newer investigation reported that there was no significant association between the changes in levels of hormones (estrogen, progesterone, and relaxin) and the development of hemorrhoidal disease [5]. In this study, there was higher incidence of hemorrhoid edema in females than that in males.…”

Section: Discussioncontrasting

confidence: 47%

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Fulvestrant, an estrogen receptor inhibitor, relieves postoperative hemorrhoid edema via up-regulation of miR- 424-5p

Meng¹,

Chen²,

Liu³

et al. 2022

Trop. J. Pharm Res

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Purpose: To investigate estrogen receptor (ER) expression in postoperative hemorrhoid edema tissues, and the likely mechanism involved in fulvestrant-mediated reduction of postoperative hemorrhoid edema.Methods: One hundred and eighty-five patients admitted to Jinshan Hospital of Fudan University, Shanghai who accepted hemorrhoidectomy were enrolled in this study. Primary cells were extracted from the anal margin tissues of patients for the determination of changes in ERα and vascular endothelial growth factor (VEGF). In vitro cellular experiments were performed in primary vascular endothelial cells to verify whether ER promoted postoperative perianal edema via the miR-424-5p estrogen receptor α gene (ESR1) axis. The cells were exposed to Fulvestrant, estradiol, and miR-424-5p mimic. Changes in expressions of ERα and VEGF were determined.Results: Fourteen patients (7.57 %), comprising 2 males (2.60 %) and 12 females (11.1 %), developedpostoperative anal margin edema. There was a significant difference in the incidence of postoperative anal edema between males and females (p < 0.05). Both immunohistochemistry and immunoblotting revealed markedly higher ERα levels in postoperative anal edema tissues than in preoperative tissues (p < 0.05). Moreover, ERα level was regulated by estradiol, and miR-424-5p targeted the estrogen receptor α gene (ESR1).Conclusion: Estradiol inhibits miR-424-5p through ERα in perianal tissues after hemorrhoid surgery. It increases VEGF and promotes perianal edema. However, fulvestrant inhibits ERα, thereby reducing VEGF expression and mitigating postoperative hemorrhoid edema, and therefore, has potential application for the management of postoperative hemorrhoid edema.

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Section: Discussioncontrasting

confidence: 47%

“…In clinics, postoperative edema is more common in females than in males. Some studies have found that abnormal estrogen expressions in hemorrhoid tissues is associated with the development of the disease [4,5]. Elevated estrogen often further results in elevated estrogen receptor (ER) [1].…”

Section: Introductionmentioning

confidence: 99%

Fulvestrant, an estrogen receptor inhibitor, relieves postoperative hemorrhoid edema via up-regulation of miR- 424-5p

Meng¹,

Chen²,

Liu³

et al. 2022

Trop. J. Pharm Res

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“…Table 2 shows a summary of the reported values for the different SS and peripartum phases ( 14 , 23 , 25 , 27 , 28 , 59-85 ). Precisely reported E2, P4, and T concentrations are presented in Supplementary Tables S1 to S6 ( 86 ).…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 depicts all methods of analysis used for the quantification of sex steroids in the assessed studies ( 14 , 23 , 25 , 27 , 28 , 59-85 ). Radioimmunoassay (RIA) was used most frequently for serum and plasma samples while enzyme-linked immunosorbent assay (ELISA) was used most frequently for saliva samples.…”

Section: Resultsmentioning

confidence: 99%

Longitudinal Course of Sex Steroids From Pregnancy to Postpartum

Đukić

Ehlert

2023

Endocrinology

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Context Sex steroids (SS) typically rise during pregnancy and decline after birth, but no consistent reference values exist for these hormonal courses. We aimed to establish an overview of SS secretion patterns during the peripartum and to better understand how SS contribute to maternal and fetal pathologies. Evidence acquisition A systematic literature search was conducted in accordance with the PRISMA guidelines using PubMed, Cochrane Library, and PsycINFO. Additionally, we conducted a supplementary manual search of references. Observational studies published in English and assessing estradiol, progesterone, and testosterone over the course of the peripartum in physically healthy female subjects were included, without restrictions on year of publication. Extracted data were analyzed descriptively and visually. Evidence synthesis SS increase progressively during pregnancy, with an extremely wide range of reported concentrations, especially in the third trimester. In fact, reported concentrations varied up to 5000-fold at comparable measurement time points. Conclusions A comprehensive understanding of the influence of SS levels on associated maternal and fetal pathologies is currently hindered by two main factors. First, reported SS levels vary widely during the peripartum period. Second, the current state of knowledge on how SS are associated with pathologies in mothers and babies is largely based on correlational studies, and causality thus remains unclear. Consequently, we recommend the development of a systematic reference framework that follows the suggestions presented in this review. This would enable the establishment of SS reference values for a healthy population, resulting in the possibility to draw conclusions about deviations and related pathologies.

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“…Current causes of hemorrhoids include chronic straining during defecation, lack of physical exercise, diarrhea, pregnancy, and inadequate fiber intake (4). There is a close link between hemorrhoids and constipation (5,6). Hard or large stools and exertion during defecation are associated with an increased prevalence of hemorrhoids.…”

Section: Introductionmentioning

confidence: 99%

Correlation Between Poor Defecation Habits and Postoperative Hemorrhoid Recurrence

Ghoorun

et al. 2022

Front. Surg.

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BackgroundThe relationship between hemorrhoid recurrence and poor defecation habits is poorly understood. This study aimed to analyze the effects of poor defecation habits on postoperative hemorrhoid recurrence.Materials and MethodWe performed a retrospective study on 1,162 consecutive patients who underwent a surgical procedure for hemorrhoids at the Sixth Affiliated Hospital of Sun Yat-Sen University from December 2016 to May 2020. All patients were followed for 12 months post-operatively. Patients were monitored for disease recurrence. Patient defecation habits were assessed using an obstructive defecation syndrome (ODS) score.ResultsPatients with a score of 0–4 had a mild defecation disorder, 5–8 a moderate defecation disorder, and 9 or more ODS. Of the 1,162 patients, 1,144 (98.45%) had a mild defecation disorder, 13 (1.12%) had a moderate defecation disorder, and 9 (0.43%) had ODS. Older patients were significantly more likely to have worse defecation habits (P < 0.001). A higher ODS score correlated with a higher maximum anal squeeze pressure (P = 0.07) and a more severe inability for the anus to relax during simulated evacuation (P = 0.002). The maximum rectum threshold was also found to be the highest in ODS patients (P = 0.010). The proportion of Procedure for prolapsing hemorrhoids (PPH) was the highest in the moderate defecation disorder group (53.85), followed by the ODS group (40.00) and the mild defecation disorder group (P = 0.023). Recurrence occurred in 5.51% of patients in the mild defecation disorder group, 38.46% of the moderate defecation disorder group, and 60% of the ODS group (P < 0.001). Multivariate analysis confirmed a higher ODS score (P < 0.001) was an independent predictor of recurrence. Furthermore, patients who occasionally exercised (P = 0.01) and patients who exercised regularly (P = 0.021) were less likely to have a recurrence.ConclusionPatients with unresolved defecation disorders are more likely to have their hemorrhoids recur and are unlikely to be satisfied with surgical management.

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Influence of Bowel Habit and Hormonal Changes on the Development of Hemorrhoidal Disease During Pregnancy and the Postdelivery Period: A Prospective Cohort Study

Cited by 7 publications

References 38 publications

Fulvestrant, an estrogen receptor inhibitor, relieves postoperative hemorrhoid edema via up-regulation of miR- 424-5p

Fulvestrant, an estrogen receptor inhibitor, relieves postoperative hemorrhoid edema via up-regulation of miR- 424-5p

Longitudinal Course of Sex Steroids From Pregnancy to Postpartum

Correlation Between Poor Defecation Habits and Postoperative Hemorrhoid Recurrence

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