PWE-001 Anal problems during pregnancy and postpartum: a prospective cohort study

Abstract

IntroductionMany pregnant women have anal symptoms during pregnancy and postpartum. The most common proctological problems reported are haemorrhoids, anal fissures and anal incontinence. Literature about this problem is scarce.The aim of this study is to determine the prevalence of anal problems and constipation during the second and third trimester of pregnancy, in the immediate postpartum and up to three months after childbirth. We also want to identify the risk factors for the development of anal symptoms.MethodThis is a prospective cohort study. Women between their 19th and 25th week of pregnancy are included. High-risk pregnancy and non-Dutch speaking are exclusion criteria. Ninety-four women were followed with a symptom questionnaire in the second and third trimester, in the immediate postpartum (within 3 days) and three months postpartum. Descreptive data were obtained from the patient files. A specific proctological diagnosis was presumed on the basis of combined symptoms (rectal bleeding, anal pain and swelling). Constipation was defined by the Rome III criteria. Statistical analysis was performed with SPSS and risk factors were identified using multivariate analysis with binary logistic regression.ResultsSixty-eight percent of the women developed anal symptoms during the whole study period. Anal symptoms occured in 50% of the women during pregnancy, in 56,2% in the immediate postpartum and in 62,9% during the three months postpartum. The most prevalent symptom was anal pain. Constipation was reported by 60,7% during the whole study period. The most prevalent diagnoses were: hemorrhoidal thrombosis (immediate postpartum), hemorrhoidal prolaps (3rd trimester and immediate postpartum) and anal fissure (not episode-related). Anal incontinence was only reported in 2% during the postpartum. Multivariate analysis identified constipation and a history of anal problems as significant risk factors for the development of anal complaints pre-and postpartum.ConclusionTwo thirds of pregnant womed deal with anal symptoms during pregnancy and/or postpartum, especially hemorrhoidal complications and anal fissure. This high prevalence emphasises the clinical importance of this problem. The most important risk factor is constipation. Therefore, prevention of constipation pre-and postpartum is recommended.Disclosure of InterestNone Declared

Veiksnių, Galinčių Didinti Hemorojinių Mazgų Išsivystymo Riziką, Paplitimas Tarp Kauno Klinikinės Ligoninės Pacientų, Operuotų Dėl Hemorojaus

“…Atlikta įvairių studijų, kuriose tirti hemoroidinių mazgų rizikos veiksniai, tačiau nemaža dalis tyrimų rezultatų prieštaringi. Abejonių nekelia teigiamas maistinių skaidulų poveikis hemorojaus prevencijai, tačiau tokių veiksnių, kaip amžiaus, lyties, paveldėjimo, nutukimo, tuštinimosi sutrikimų (viduriavimo ar vidurių užkietėjimo), nėštumo bei gimdymo ir kitų, įtaka hemorojinių mazgų atsiradimui išlieka neaiški (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Siekiant geriau ją suprasti ir taikyti efektyvesnę hemorojaus prevenciją, pirmiausia svarbu išsiaiškinti, kurie iš šių veiksnių ir kiek plačiai paplitę tarp sergančiųjų hemorojumi.…”

“…nėščiųjų susiduria su išangės simptomais nėštumo metu po gimdymo, dažniausiai su hemorojaus komplikacijomis, o 60,7 proc. moterų nėštumo ir 3 mėnesių po gimdymo laikotarpiu vargina vidurių užkietėjimas (11). Pasak Gojnic ir bendraautorių, 85 proc.…”