Rectal bleeding in pregnant women

Abstract

The article presents a review of scientific literature on the main causes of rectal bleeding in pregnant women. Anatomical, biochemical and hormonal changes during pregnancy often lead to the progression of typical benign diseases (chronic hemorrhoids, anal fissure, etc.), radical surgical treatment of which can be carried out in the puerperal period. However, Crohn’s disease, ulcerative colitis or malignant colorectal polyps can be triggered by pregnancy and affect its course – this requires immediate examination and drug therapy. Pregnancy causes many physiological changes that affect the interpretation of routine biochemical and hematological examination methods. It is known that pregnancy requires increased iron content, the pregnancy courses often with anemia. The erythrocytes sedimentation rate varies significantly depending on the severity of anemia and the pregnancy term. Therefore, it is necessary to carefully analyze the main clinical manifestations of various intraluminal diseases that can potentially cause rectal bleeding in pregnant women.This article also describes the directions of diagnostic search and treatment strategy of rectal bleeding during pregnancy. Chronic hemorrhoids often accompany pregnancy in the third trimester. Some researchers indicate that up to 75% of pregnant women have complaints which are typical for chronic hemorrhoids. An anal fissure in lateral positions should cause suspicion of Crohn’s disease, tuberculosis, syphilis, human immunodeficiency virus, acquired immunodeficiency syndrome, dermatological diseases (most often psoriasis) and anal carcinoma.Bleeding in sexually acquired proctitis is usually mild and is often accompanied by minor purulent discharge. Rectal bleeding can be a sign of both ulcerative colitis and Crohn’s proctitis or sigmoiditis, but it is more typical for ulcerative colitis. Other associated clinical features are diarrhea, abdominal pain, urge to defecate, and specific extraintestinal manifestations (peripheral arthropathy, sacroiliitis, ankylosing spondylitis, conjunctivitis, iridocyclitis, episcleritis, aphthous skin ulcers, erythema nodosum, or pyoderma gangrenosum). If the bleeding is caused by a benign polyp, endoscopic polypectomy solves the bleeding problem.Therefore, rectal bleeding in pregnant women is diagnosed quite often. In most cases, it is caused by benign diseases of the rectum (chronic hemorrhoids or anal fissure), which are amenable to conservative therapy and usually do not threaten the life and health of a woman or a child. However, there is a rate of pregnant women whose rectal bleeding is caused by colorectal diseases, which require a comprehensive approach to diagnosis and treatment. In these women, the benefit and risk should be determined when choosing a diagnostic and treatment algorithm.