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Anal Fissure and Thrombosed External Hemorrhoids Before and After Delivery
Abstract
Thrombosed external hemorrhoids and anal fissures are common and are responsible for severe discomfort during childbirth. However, the real incidence of these lesions is unknown. The aim of our study was to evaluate their incidence and the risk factors for these lesions during childbirth.
A prospective study with proctologic examination during the last 3 months of pregnancy and after delivery (within 2 months) was performed in 165 consecutive pregnant females.
Fifteen females (9.1 percent) with anal lesions (13 thrombosed external hemorrhoids and 2 anal fissures) were observed during pregnancy. Fifty-eight females (35.2 percent) with anal lesions (33 thrombosed external hemorrhoids and 25 anal fissures) were observed during the postpartum period. Ninety-one percent of thrombosed external hemorrhoids were observed during the first day after delivery, whereas anal fissures were distributed, with no peak, over the two months after delivery. The 2 independent risk factors for anal lesions (among obstetric, baby's, and mother's information) were dyschezia, with a 5.7 odds ratio (95 percent confidence interval, 2.7-12), and late delivery, with a 1.4 odds ratio (95 percent confidence interval, 1.05-1.9). Furthermore, many thrombosed external hemorrhoids were observed after superficial perineal tears and heavier babies (P < 0.05). Only 1 of the 33 patients with thrombosed external hemorrhoids who were observed underwent a cesarean section.
One third of females have thrombosed external hemorrhoids or anal fissures in the postpartum period. The most important risk factor is dyschezia. Traumatic delivery appears to be associated with thrombosed external hemorrhoids.
... Other risk factors related to the previous deliveries are prolonged birth (more than 12 hrs), prolonged second stage of labor (35,36) and straining duration (4,37), high weight of the newborn (4,000 g and more), spontaneous childbirth (38), and prolonged pregnancy (more than 40 weeks of pregnancy) (4,37,39). ...
... Other risk factors related to the previous deliveries are prolonged birth (more than 12 hrs), prolonged second stage of labor (35,36) and straining duration (4,37), high weight of the newborn (4,000 g and more), spontaneous childbirth (38), and prolonged pregnancy (more than 40 weeks of pregnancy) (4,37,39). ...
... Traumatic delivery appears to be associated with thrombosed external hemorrhoids (37). ...
Hemorrhoids and anal fissures occur in about 40% of pregnant women and women during postpartum period. Usually they occur during the third trimester of pregnancy and 1–2 days after giving birth. Constipation during pregnancy, perianal diseases during previous pregnancy and childbirth, instrumental delivery, straining duration of more than 20 min, and weight of the newborn more than 3,800 g are associated with hemorrhoids. Perianal diseases reduce the quality of life of both pregnant and postpartum women. In the absence of acute conditions, surgical treatment of hemorrhoids is delayed after pregnancy, childbirth, and lactation. Thrombosed internal hemorrhoids and perianal thrombosis are to be treated conservatively in most instances by prescribing adequate pain relief, oral, and topical flavonoid preparations.
... Частота геморою під час вагітності та в післяпологовому періоді, за даними різних авторів, має значні коливання (від 30% до 86% жінок). Причина частково полягає в тому, що більшість таких досліджень ґрунтується на результатах опитування в різних популяціях (вагітні, жінки в післяпологовому періоді, жінки репродуктивного віку) [1,6,8,11]. ...
... За вищезазначеними ключовими словами знайдено 2000 публікацій, з них за релевант ною інформацією обрано для аналізу 4. Крите ріями відбору були: когорта обстежених (не менш 200 осіб), проспективність спостере ження (вагітність та післяпологовий період), наявність даних щодо медичного обстеження [1,2,6,9,10]. ...
... У дослідженні [1] довели, що закреп та поло ги в терміні після 39,7 тижнів вагітності є незалежними факторами ризику розвитку геморою та анальних тріщин протягом ІІІ три местру вагітності та післяпологового періоду. ...
There are insufficient data in the literature on the actual frequency and prevalence of hemorrhoids among the general population. The incidence of hemorrhoids during pregnancy and in the postpartum period, according to various authors, varies considerably: from a third of women to 86%. The frequency of thrombosis of external hemorrhoids and cracks of the anus in the postpartum period is 25–33%. The aim is to analyze data on the frequency of hemorrhoids during pregnancy and within postpartum period, as well as data on the impact of perianal disorders on the quality of life of women; substantiate recommendations for improving the quality of life of such women. Materials and methods. The analysis of databases from medical research PubMed, MedScape, NCBI by keywords: hemorrhoids, pregnancy, postpartum period, causes, diagnosis, treatment, quality of life. 2000 publications were found, of which, according to relevant information, 4 were selected for analysis. The selection criteria were: cohort of subjects (at least 200 people), prospectiveness of observation (pregnancy and postpartum period), availability of data on medical examination. The information-analytical method and content-analysis are used. Results and conclusions. Hemorrhoids are a frequent complication during pregnancy and in the postpartum period. Perianal disease reduces the quality of life of women during pregnancy and in the postpartum period and requires improved care recommendations. Reparon Herbal, which contains herbal substances and sucralfate, according to the instructions, can be used during pregnancy and in the postpartum period to reduce the clinical manifestations of hemorrhoids, which will improve the quality of life of such women. The authors declare no conflict of interest. Key words: hemorrhoids, pregnancy, postpartum period, causes, diagnosis, treatment, quality of life.
... Существует несколько возможных причин, предрасполагающих к развитию симптомного геморроя. Исходя из анализа научной литературы, к таким факторам можно относить гормональные нарушения, повышение внутрибрюшного давления, натуживание во время дефекации на фоне запоров, длительный II период родов и связанное с ним напряжение, а также вес новорождённого более 3800 г [1][2][3]. ...
... Высокий уровень прогестерона во время беременности снижает силу мышечного каркаса венозных стенок и тонус вен [1,2]. Сочетание повышения внутрибрюшного давления с усугублением венозного застоя на фоне роста и увеличения массы плода способствует нарушению венозного кровотока и провоцирует развитие геморроидальной болезни [4,5]. ...
... -женщин в III триместре беременности до 2 месяцев послеродового периода; а K. Ferdinande и соавт. -со II триместра беременности до 3 месяцев послеродового периода [1,3,13]. L. Abramowitz и соавт. ...
Introduction. Nowadays there are no sufficient evidence based data for a scientifically approach to the treatment of hemorrhoids during pregnancy and after childbirth, as well as current data of the prevalence of hemorrhoidal thrombosis (HT) and possible risk factors. Material and methods. The study included pregnant women and puerperas who were actively diagnosed with chronic hemorrhoids (CH) and HT. The physical examination was performed four times: at the woman’s initial visit to the obstetrician-gynecologist, at 24 weeks of pregnancy, at 36 weeks of pregnancy, in the postpartum period (within 7 days after delivery). Patients suffering from HT were asked to answer a questionnaire to determine possible risk factors. Results. A study was conducted on a population of 668 women. 104 women was diagnosed with CH in the postpartum period, and 81 - during pregnancy. The median VAS score with HT was 7. Second delivery, age over 30 years old, lack of physical activity during pregnancy and vaginal delivery are possible risk factors for the development of HT. Conclusions. In the presence of a high risk of HT during pregnancy and in the postpartum period, preventive examinations by a coloproctologist are an important aspect of patient management.
... Išangės ligų dažnis nėštumo laikotarpiu ir po gimdymo nurodytas tik keliuose moksliniuose tyrimuose [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Daugelis jų atlikti moterų anketinės bei telefoninės apklausos metodu [1-5, 11, 13-19], kur išangės skausmo ir kraujavimo iš jos simptomai buvo priskirti hemorojui. ...
... Nustatyta, kad iš sergančių hemorojumi pacientų mažiau nei vienas trečdalis kreipiasi į gydytojus [39,66] [26,65]. L. Abramowitz atlikto epidemiologinio tyrimo duomenimis, dischezija nėštumo metu yra išangės įplėšos (OR 5,7 (95 % CI 2,7-12) ir išorinio hemorojaus trombozės rizikos veiksnys trečią nėštumo trimestrą (p=0,023) [71] ir po gimdymo: iš 165 tirtų moterų 56,9 %, turėjusių discheziją, diagnozuota išangės patologija, o 20,6 % buvo sveikos (OR 5,1 (95 % CI 2,5-10,3) (p<0,0001) [7]. ...
... Kitas išangės patologijos po gimdymo rizikos veiksnys -užsitęsęs antrasis gimdymo laikotarpis [15,48] bei stangų laikotarpis [7,26]. ...
Šio straipsnio tikslas – apžvelgti literatūrą, nagrinėjančią nėščiųjų hemorojaus ir išangės įplėšos paplitimą, priežastis, dažnį, rizikos veiksnius bei šių ligų įtaką moterų gyvenimo kokybei.Išangės ligos (hemorojus ir išangės įplėša) tiek nėštumo metu, tiek laikotarpiu po gimdymo yra dažna patologija, kuriai vis dar stinga tiek koloproktologų, tiek akušerių ginekologų dėmesio. Šiuo metu nėra tyrimų, kuriuose perspektyviuoju būdu nėštumo metu ir po gimdymo būtų vertinamas išangės ligų atsiradimas, nustatomi jų rizikos veiksniai. Labai svarbu ištirti ir įvertinti šių ligų paplitimą Lietuvoje ir rizikos veiksnius, jų ryšį su nėštumo ir gimdymo veiksniais, laiku šias ligas diagnozuoti ir gydyti bei atrasti priemonių, kaip jų išvengti, taip pagerinant moterų gyvenimo kokybę ne tik nėštumo ir gimdymo metu, bet ir laikotarpiu po gimdymo.Reikšminiai žodžiai: hemorojus, išangės įplėša, nėštumas, gimdymas, rizikos veiksniai, gyvenimo kokybė Hemorrhoids and anal fissures during pregnancy and after childbirth: prevalence, risk factors and impact on women’s quality of lifeDiana Bužinskienė, Gražina Drąsutienė, Tomas Poškus The aim of this study was to review the literature regarding the incidence, prevalence, risk factors of hemorrhoids and anal fissures during, before, and after pregnancy and their impact on the quality of life of women.Both hemorrhoids and anal fissures are common during and after pregnancy; however, they are frequently overlooked by both coloproctologists and gynecologists. There are no prospective cohort studies of perianal diseases during and after pregnancy with an emphasis on identifying the possible risk factors. Thus, it is important to identify the incidence and risk factors of perianal diseases in Lithuania and to find the factors of pregnancy and delivery that could be related to the occurrence or prevent the occurrence of these diseases. In this way, the possible areas of correction and intervention could be identified.Key words: hemorrhoids, anal fissure, pregnancy, delivery, risk factors, quality of life
... Инциденција хемороидне болести током трудноће и пурперијума Током другог и трећег триместра трудноће, 85% жена има потешкоће због хемороида [144]. У последња 3 месеца трудноће, тромбоза хемороида јавља се код 7,9% трудница [145]. Макартур наводи инциденцију хемороидне болести 5,3−6,9% међу првороткама [146]. ...
... Макартур наводи инциденцију хемороидне болести 5,3−6,9% међу првороткама [146]. Абрамовиц је објавио да чак 91% тромбозираних хемороида настаје првог дана после порођаја, а у 14,5% случајева они се појављују de novo после порођаја [145]. Хемороиди се често смање после порођаја, али обично неће у потпуности нестати. ...
... Симптоми су обично благи и пролазни. Квалитет живота је под утицајем бола, који варира од благе нелагодности до тешког бола који угрожава уобичајене животне активности [145,151]. Са трајањем трудноће тегобе се појачавају, чешћа су крварења, бол је константији, честа су уклештења. ...
... Sometimes internal haemorrhoids can swell and stick out of the anus. There aren't any nerves that detect pain in the rectum, but they can cause symptoms if they grow larger, including [12]: ...
... Faeces traveling through the rectum can also irritate an internal haemorrhoid. This can cause bleeding that might be noticeable on toilet tissue [12]. ...
... But since they're located on the outside of the rectal area, there might be more pain or discomfort when sitting down, doing physical activities, or having a bowel movement. They're also easier to see when they swell, and the bluish colour of the dilated veins is visible beneath the anal skin surface [12]. ...
This review discusses the implication of sugar intake in haemorrhoid and menstruation. Haemorrhoid is the clustering of veins in the rectum leading to swollen anus. This occurs due to pressure exerted on the rectum. When these veins swell, they expand outward into the membranes around the rectal and anal tissue. Most people believed that sugar is the onset of haemorrhoid. Haemorrhoid occurs as a result of pressure exerted on the rectum leading to the swelling of the veins in the rectum. Since sugar does not exert pressure on the rectum, it doesn't cause haemorrhoid but can aggravate it and increase the grade. To reduce or avoid haemorrhoid, it is advisable to visit the toilet and excrete as soon as one is pressed. The rectum should not be allowed to be filled for a long time. Menstruation is the regular monthly discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. This stops after menopause, which usually occurs between 45 and 55 years of age. It also stops during pregnancy and typically do not resume during the initial months of breastfeeding. There is a general believe that sugar Review Article Airaodion et al.; IJR2H, 2(2): 1-9, 2019; Article no.IJR2H.48212 2 intake increases menstrual flow but this review shows otherwise. High intake of sugar has not been implicated in increasing menstrual flow but cause increased severe menstrual cramps by increasing the production of prostaglandins. Prostaglandins act by contracting the uterine walls and constricting the blood vessels of the uterus which results in pain during menstruation.
... Išangės ligų dažnis nėštumo laikotarpiu ir po gimdymo nurodytas tik keliuose moksliniuose tyrimuose [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Daugelis jų atlikti moterų anketinės bei telefoninės apklausos metodu [1-5, 11, 13-19], kur išangės skausmo ir kraujavimo iš jos simptomai buvo priskirti hemorojui. ...
... Nustatyta, kad iš sergančių hemorojumi pacientų mažiau nei vienas trečdalis kreipiasi į gydytojus [39,66] [26,65]. L. Abramowitz atlikto epidemiologinio tyrimo duomenimis, dischezija nėštumo metu yra išangės įplėšos (OR 5,7 (95 % CI 2,7-12) ir išorinio hemorojaus trombozės rizikos veiksnys trečią nėštumo trimestrą (p=0,023) [71] ir po gimdymo: iš 165 tirtų moterų 56,9 %, turėjusių discheziją, diagnozuota išangės patologija, o 20,6 % buvo sveikos (OR 5,1 (95 % CI 2,5-10,3) (p<0,0001) [7]. ...
... Kitas išangės patologijos po gimdymo rizikos veiksnys -užsitęsęs antrasis gimdymo laikotarpis [15,48] bei stangų laikotarpis [7,26]. ...
Šio straipsnio tikslas – apžvelgti literatūrą, nagrinėjančią nėščiųjų hemorojaus ir išangės įplėšos paplitimą, priežastis, dažnį, rizikos veiksnius bei šių ligų įtaką moterų gyvenimo kokybei.
Išangės ligos (hemorojus ir išangės įplėša) tiek nėštumo metu, tiek laikotarpiu po gimdymo yra dažna patologija, kuriai vis dar stinga tiek koloproktologų, tiek akušerių ginekologų dėmesio. Šiuo metu nėra tyrimų, kuriuose perspektyviuoju būdu nėštumo metu ir po gimdymo būtų vertinamas išangės ligų atsiradimas, nustatomi jų rizikos veiksniai. Labai svarbu ištirti ir įvertinti šių ligų paplitimą Lietuvoje ir rizikos veiksnius, jų ryšį su nėštumo ir gimdymo veiksniais, laiku šias ligas diagnozuoti ir gydyti bei atrasti priemonių, kaip jų išvengti, taip pagerinant moterų gyvenimo kokybę ne tik nėštumo ir gimdymo metu, bet ir laikotarpiu po gimdymo.
Reikšminiai žodžiai: hemorojus, išangės įplėša, nėštumas, gimdymas, rizikos veiksniai, gyvenimo kokybė
Hemorrhoids and anal fissures during pregnancy and after childbirth: prevalence, risk factors and impact on women’s quality of life
Diana Bužinskienė, Gražina Drąsutienė, Tomas Poškus
The aim of this study was to review the literature regarding the incidence, prevalence, risk factors of hemorrhoids and anal fissures during, before, and after pregnancy and their impact on the quality of life of women.Both hemorrhoids and anal fissures are common during and after pregnancy; however, they are frequently overlooked by both coloproctologists and gynecologists. There are no prospective cohort studies of perianal diseases during and after pregnancy with an emphasis on identifying the possible risk factors. Thus, it is important to identify the incidence and risk factors of perianal diseases in Lithuania and to find the factors of pregnancy and delivery that could be related to the occurrence or prevent the occurrence of these diseases. In this way, the possible areas of correction and intervention could be identified.Key words: hemorrhoids, anal fissure, pregnancy, delivery, risk factors, quality of life
... Despite the fact that many women have anal symptoms during pregnancy and postpartum, the subject is still somewhat of a taboo [6,7]. Patients often do not mention anal symptoms because of cultural and social constraints. ...
... The literature on this subject is scarce. Several studies are dated, retrospective and based on self-diagnosis [11][12][13][14][15]. Two prospective studies, by Abramowitz et al. and Poskus et al., report that 33% of women complain of anal problems until 2 months after childbirth and 44% of women complain during pregnancy up to 1 month postpartum, respectively [6,7]. In the general population, anal symptoms occur around 15% of the time, according to two recent prospective studies [8,16]. ...
... The most recent study by Poskus et al. [6] 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. [7] identified constipation and late delivery after 39.7 weeks of pregnancy as independent risk factors for haemorrhoids and anal fissures during the third trimester and the immediate postpartum. ...
... Підраховано, що близько 50% населення в цілому відчувають симптоматичний геморой в певні моменти життя. Крім того, вагітні жінки схильні до високого ризику розвитку геморою [3][4][5]. Поширеність геморою у вагітних коливається від 25% до 35%, і до 85% вагітних жінок страждають гемороєм в третьому триместрі [6]. Іншими суб'єктами з підвищеним ризиком розвитку геморою є літні люди і люди з високим індексом маси тіла [7,8]. ...
... Подсчитано, что около 50% населения в целом испытывают симптоматический геморрой в определенные моменты жизни. Кроме того, беременные женщины подвержены высокому риску развития геморроя [3][4][5]. Распространенность геморроя у беременных колеблется от 25% до 35%, до 85% беременных женщин страдают геморроем в третьем триместре [6]. Другими субъектами с повышенным риском развития геморроя являются пожилые люди и люди с высоким индексом массы тела [7,8]. ...
Геморрой основное проктологическое заболевание, требующее комплексного лечения, которое должно включать медикаментозную системную и местную терапию, мини-инвазивные и хирургические методики. В медикаментозной местной терапии геморроя активно применяются трибенозид с лидокаином (препарат Прокто-Гливенол). Комбинация трибенозид + лидокаин (Прокто-Гливенол) представляет собой медицинский препарат для местного лечения геморроя в виде ректальных суппозиториев или ректального крема. В данном обзоре обсуждаются имеющиеся данные об использовании трибенозида + лидокаина в клинической практике с учетом результатов мини-инвазивных и хирургических методов лечения пациентов с геморроем. Проанализированы различные методы лечения пациентов с хроническим геморроем, в том числе с применением препарата Прокто-Гливенол в виде ректальных суппозиториев или ректального крема, использованы результаты литературного обзора. Показана выраженная эффективность у пациентов комбинации трибенозид + лидокаин в облегчении симптомов, вызванных геморроем, ее безопасность оценивалась в клинических наблюдениях на пациентах любого пола, либо в сравнении с двумя его отдельными компонентами (трибенозидом или лидокаином), либо в сравнении со стероидами при лечении. В том числе оценивалась эффективность и переносимость комбинации трибенозид + лидокаин у женщин с геморроем в результате беременности или родов. Имеется достаточно убедительных доказательств для рекомендации использования этой комбинированной терапии препаратом Прокто-Гливенол в виде ректальных суппозиториев или ректального крема как быстрого, эффективного ибезопасного варианта местного лечения хронического геморроя.
Chronic combined hemorrhoids is the main proctologic disease requiring the use of complex treatment, which should include systemic and local therapy, minimally invasive and surgical techniques. In the local drug therapy of hemorrhoids, tribenoside with lidocaine (Procto-Glyvenol) is actively used. The combination tribenoside + lidocaine (Procto-Glyvenol) is the medication for topical treatment of hemorrhoids in the form of suppositories or rectal cream. In this review, the available data on the use of tribenoside + lidocaine in clinical practice are discussed, taking into account the results of minimally invasive and surgical methods of treating patients with hemorrhoids. Various methods of treating patients with chronic hemorrhoids were analysed, including the use of Procto-Glyvenol in the form of suppositories or rectal cream; the results of the literature review were used. A pronounced efficacy of the combination of tribenoside + lidocaine in relieving symptoms caused by hemorrhoids was showed; its safety was evaluated in clinical observations in patients of both sexes, either in comparison with its two separate components (tribenoside + lidocaine), or in comparison with steroids. In particular, the efficacy and tolerability of the tribenoside + lidocaine combination in women with hemorrhoids as a result of pregnancy or childbirth was assessed. There is sufficient convincing evidence to recommend the use of this combination therapy with Procto- Glyvenol in the form of suppositories or rectal cream as a fast, effective and safe option for topical treatment of chronic hemorrhoids.
Геморой - основне проктологічне захворювання, що вимагає застосування комплексного лікування, яке повинно включати медикаментозну системну і місцеву терапію, міні-інвазивні і хірургічні методики. У медикаментозній місцевій терапії геморою активно застосовуються трибенозид з лідокаїном (препарат Прокто-Глівенол). Комбінація трибенозид + лідокаїн (Прокто-Глівенол) являє собою лікарський засіб для місцевого лікування геморою, у вигляді ректальних супозиторіїв або ректального крему. У цьому огляді обговорюються наявні дані про використання трибенозиду + лідокаїну в клінічній практиці з урахуванням результатів міні-інвазивних і хірургічних методів лікування пацієнтів з гемороєм. Проаналізовано різні методи лікування пацієнтів з хронічним гемороєм, в тому числі із застосуванням препарату Прокто-Глівенол у вигляді ректальних супозиторіїв або ректального крему, використані результати літературного огляду. Продемонстрована виражена ефективність у пацієнтів комбінації трибенозид + лідокаїн в полегшенні симптомів, викликаних гемороєм, і безпеку застосування оцінювали в клінічних спостереженнях на пацієнтах будь-якої статі, в порівнянні з двома його окремими компонентами (трибенозид або лідокаїн), або в порівнянні з терапією стероїдами при лікуванні. В тому числі, оцінювалася ефективність і переносимість комбінації трибенозид + лідокаїн у жінок з гемороєм спричиненим вагітнiстю або пологами. Достатньо переконливих даних для рекомендації використання комбінованої терапії препаратом Прокто-Глівенол, супозиторії ректальні або крем ректальний, як швидкого, ефективного та безпечного варіанту місцевого лікування хронічного геморою.
... Hemoroider har en prevalens på 4,4 %, forekommer oftest i aldersgruppen 45-65 år og er uvanlig før 20 års alder (2). Tilstanden er vanlig hos gravide kvinner (3). ...
... Vanligvis anbefales konservativ behandling for hemoroider grad I, kombinasjon av konservativ behandling og strikkligering for grad II/III og ulike former for kirurgisk behandling for grad III og IV (4). 2 10 kPa (normalt 9,6-13,7), pCO 2 3,8 kPa (normalt 4,3-5,7), baseoverskudd -6,9 mmol (normalt -3 -+3) og laktat 7,7 mmol (normalt 0,5-2,5). Orienterende blodprøver viste hemoglobin 12,9 g/dl (11,(7)(8)(9)(10)(11)(12)(13)(14)(15)3), C-reaktivt protein (CRP) 120 mg/l (< 5), leukocytter 5,5 · 10 9 /l (4,0-11,0 · 10 9 /l), kreatinin 122 μmol/l (45-90), kreatinkinase (CK) 304 U/l (35-210). Urinstiks var negativ. ...
... An anal fissure is an ulcer arising in the squamous epithelium just distal to the mucocutaneous junction [1]. Systematic screening showed anal fissures in 15% of 259 women 2 months after delivery [2]. Anal fissures usually manifest suddenly, with intense anal pain triggered by defaecation, and may be accompanied by anal bleeding and itching. ...
... Haemorrhoidal disease is a common chronic disorder [6]. Pregnant women are particularly at risk, with external thrombosis being reported in 9% and 20% of women during pregnancy and after delivery, respectively [2]. Most cases of haemorrhoidal disease occur between the ages of 45 and 65, but the entire population is at risk [7]. ...
Aim
Current questionnaires designed to evaluate the haemorrhoidal disease burden ignore symptoms such as bleeding, pain and itching. A specific questionnaire is needed to evaluate the global impact of anal disorders on patients’ daily lives.
Method
We developed a questionnaire (HEMO‐FISS‐QoL) to assess the symptom burden of anal disorders and administered it to 256 patients (mean age, 46.2 years; men, 60.4%) with haemorrhoidal disease (67.2%), anal fissure (29.3%) or both (3.5%). Psychometric properties were evaluated by testing the acceptability, construct validity and reliability of the questionnaire. Principal components and multitrait analyses were used to identify dimensions and to assess construct validity. Backward Cronbach alpha curves and a graded response model were used to reduce the number of items and modalities. External validity was evaluated against the SF‐12 and Psychological Global Well‐Being Index (PGWBI), using Spearman's correlation coefficient.
Results
Principal component analysis defined four dimensions: Physical disorders, Psychology, Defecation, and Sexuality. The number of questions was reduced from 38 to 23. The HEMO‐FISS‐QoL scores correlated well with those of the SF‐12 and PGWBI (p<0.001). Cronbach's coefficients (all >0.7) reflected good internal reliability of the different dimensions. The total score increased with the severity of the anal disorders and with their consequences (days off work and personal spending related to the disease).
Conclusion
The HEMO‐FISS‐QoL questionnaire reliably evaluates the global impact of haemorrhoids and anal fissures on patients’ daily lives. This simple tool may prove useful for treatment evaluation in clinical trials and daily practice.
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... During pregnancy or after giving birth some women develop symptomatic haemorrhoids, particularly during the third trimester and puerperium. Pregnancy and vaginal birth predispose women to develop symptomatic haemorrhoids for one or more of the following reasons: hormonal changes, increased intra-abdominal pressure, straining during defecation due to constipation, prolonged straining during the second stage of labour for more than 20 min, and giving birth to a baby with a weight over 3800 g [1][2][3]. The high levels of progesterone during pregnancy decrease the strength of the muscles venous walls and reduce the venous tone [1,2] any combination of increased intra-abdominal pressure, increased venous congestion from the weight of the fetus, and obstruction of venous returns contributes to the development of pathological changes and incidence of haemorrhoids [4,5]. ...
... Pregnancy and vaginal birth predispose women to develop symptomatic haemorrhoids for one or more of the following reasons: hormonal changes, increased intra-abdominal pressure, straining during defecation due to constipation, prolonged straining during the second stage of labour for more than 20 min, and giving birth to a baby with a weight over 3800 g [1][2][3]. The high levels of progesterone during pregnancy decrease the strength of the muscles venous walls and reduce the venous tone [1,2] any combination of increased intra-abdominal pressure, increased venous congestion from the weight of the fetus, and obstruction of venous returns contributes to the development of pathological changes and incidence of haemorrhoids [4,5]. ...
Objective
To investigate the prevalence and severity of haemorrhoids after birth among first-time mothers in relation to management during the second stage of labour and to describe the women's experiences with haemorrhoids.
Method
A mixed method explanatory sequential design was used.
Nulliparous women were allocated to an intervention group for whom the second-stage of labour practice followed the MIMA model (Midwives management during second stage of labour) or to a control group for whom standard-care practice was followed. Data were collected three weeks and 1.5 years after birth.
Result
A total of 496 (82.1%) women responded to the questionnaire three weeks after birth, 120 (70%) responded to the questionnaire 1.5 years after the birth. The women in the intervention group had fewer symptoms from haemorrhoids three weeks after birth compared to the women in the control group (adj. OR 0.6 95% CI 0.4–0.9). Half of the women in the intervention and control group (50.8%) who reported problems with haemorrhoids three weeks after birth still experienced problems after 1.5 years. The majority of all women did not seek medical care due to their symptoms. The women who described that they experienced haemorrhoids as a problem after birth felt neglected by the healthcare system.
Conclusion
A substantial percentage of women had symptoms from haemorrhoids after birth. Many of these women felt that their problems were neglected. Women who experienced a slow birth of the baby’s head and spontaneous pushing suffered less from haemorrhoids 3 weeks after birth.
... Congruent with the current study Abramowitz et al. (2002) [17] in a prospective study of 165 women in the last three months of pregnancy and the first 10 weeks postpartum, only two women had anal fissure before delivery, but 25 women had anal fissure afterwards. Also, Sagap and Remzi (2006) [18] added that a less commonly cause of anal fissure is prolonged-repeated diarrhea in their study about controversies in the treatment of common anal problems. ...
... Congruent with the current study Abramowitz et al. (2002) [17] in a prospective study of 165 women in the last three months of pregnancy and the first 10 weeks postpartum, only two women had anal fissure before delivery, but 25 women had anal fissure afterwards. Also, Sagap and Remzi (2006) [18] added that a less commonly cause of anal fissure is prolonged-repeated diarrhea in their study about controversies in the treatment of common anal problems. ...
Objective: Anal fissure is a common problem through the world, it causes considerable morbidity. The aim of the study was to evaluate the effect of designed nursing guidelines on acute anal fissure treatment outcomes.Methods: Research design: Quasi-experimental design. Setting: General Surgery Wards and Outpatient Clinics of General Surgery at Assiut University Hospital. Sample: A purposive sample of 60 male and female adult patients diagnosed of having acute anal fissure. Patients were equally divided on random basis into two equal groups (study and control) 30 patients for each. Tools: Tool I-Patient assessment sheet. Tool II-Numeric Pain Rating Scale. Tool III-Bates-Jensen Wound Assessment Tool.Results: No statistically significant difference was found between the study and the control groups as regard demographic data. There was a statistically significant improvement in the pain level and wound healing among the study group (1.63 ± 2.08 and 11.93 ± 4.5 respectively) than in the control group (2.87 ± 2.33 and 14.43 ± 4.29 respectively). Also, there was a high statistically significant improvement in the level of knowledge of the study group than their level before applying the guidelines (p < .001).Conclusions: Designed nursing guidelines had a statistically significant effect on improving patients' knowledge, pain level, and wound healing among the study group patients than among the control group ones with acute anal fissure. Recommendations: Patients teaching should be an integral part of the nurses' duty in all hospitals. Further studies on larger sample from different geographical areas in Egypt to generalize the results.
... Patients living with HIV (human immunodeficiency virus) are already urged to undertake regular screening for anal issues [15]. Women who are pregnant or have just given birth are also encouraged to do so [16]. Given the frequency of gastrointestinal symptoms in these individuals, it is important to do regular screenings for either constipation or diarrhea. ...
Background:In clinical practice, anal problems are often underappreciated. Patients often hide their atypical symptom presentation, according to research, which delays diagnosis and therapy. The management by primary care physicians is inadequately characterized.The aim of the present research was to understand the issues of anal diseases that people suffer from and their problems in accepting the examination of anal diseases. Methods:This research work involved following a cross-sectional approach of study and therefore included collecting first-hand data. This was accomplished through the conduction of the survey and data that are considered through the conduction of the survey are quantitative in nature. This would help in determining the acceptance of patients for examination of anal disease. The method that would be employed for considering the size of the sample is stratified random sampling. The survey involved conducting a survey of patients with anal disease. Results: Of 884 participants included in the current study, 578 accept to be examined for anal disease (65.4%). Half of study participants agreed that anal disease has increased in the recent times (n= 438, 49.5%). Most of study participants believed that eating habits have a role in the development of anal disease (n= 657, 74.3%). In addition, about a third of study participants suffered from chronic anal disease (n= 281, 31.8%). More than half of study participants believe in the need of clinical examination and importance of treatment (n= 455, 51.4%). Anal pain was the most frequent issue experienced by study participants (n= 338, 38.2%). Conclusion:The studys findings revealed that half of the people in this survey who were asked their opinion on the prevalence of anal illness agreed that it had grown in recent years. The majority of the people in this research thought that their diet had a contribution in the onset of their illness. Moreover, 66 percent of those surveyed agree that clinical examinations should not make them feel uncomfortable. A majority of research participants reported experiencing anal discomfort.
... Additionally frequent in the postpartum period are hemorrhoids. As per reports, anal fissures, findings also suggested external hemorrhoid, or both are evident in 33% of these participants at this time (5) . Although a number of risk factors have been identified, it is unclear how pregnancy-related perianal disorders are caused biologically or by what mechanism (6) . ...
Objective: Estimate to the prevalence of hemorrhoids Signs and Symptoms among pregnancies in maternity teaching hospitals in Mosul city. Material: Descriptive study was conducted in maternity teaching hospital 20to30 September 2022. A purposive sample that consists of (64) patients , chosen according to the criteria. Their age ranges between (15-44) years. A questionnaire was developed for purposive of study & included 3 parts is consist of part one demographic data and part three is composed of (7) items. The overall questions included (28) items. Results: The age groups is between(20-24) years and constituted Prevalence (29.7%), In addition the age groups is between (25-29) years and constituted (29.7%) Most of samples were females constitute of Prevalence (60%) of the total samples. In regard with residence city Prevalence (76.6%) .In regard with levels of education elementary Prevalence (20.3%) .In regard with occupation housewife Prevalence (65.6%) high percentage. Conclusion: This study concluded that the Age, Residence, occupation a variables are the most socio-demographic variables that were associated prevalence of hemorrhoids Signs and Symptoms among pregnancies and the level of education variable.High percent from total sample were in residence city it constitute of Prevalence (76,6%). With regard to the occupation housewife were living urban areas and constitutes Prevalence (65,6%) and there are many high associations among some variables prevalence of hemorrhoids Signs and Symptoms among pregnancies and the age significant.
... Additionally frequent in the postpartum period are hemorrhoids. As per reports, anal fissures, findings also suggested external hemorrhoid, or both are evident in 33% of these participants at this time (5) . Although a number of risk factors have been identified, it is unclear how pregnancy-related perianal disorders are caused biologically or by what mechanism (6) . ...
Objective: Estimate to the prevalence of hemorrhoids Signs and Symptoms among pregnancies in maternity teaching hospitals in Mosul city. Material: Descriptive study was conducted in maternity teaching hospital 20to30 September 2022 . A purposive sample that consists of (64) patients , chosen according to the criteria . Their age ranges between (15-44) years. A questionnaire was developed for purposive of study & included 3 parts is consist of part one demographic data and part three is composed of (7) items . The overall questions included (28) items. Results: The age groups is between(20-24) years and constituted Prevalence (29.7%), In addition the age groups is between (25-29) years and constituted (29.7%) Most of samples were females constitute of Prevalence (60%) of the total samples. In regard with residence city Prevalence (76.6%) .In regard with levels of education elementary Prevalence (20.3%) .In regard with occupation housewife Prevalence (65.6%) high percentage. Conclusion: This study concluded that the Age, Residence, occupation a variables are the most socio- demographic variables that were associated prevalence of hemorrhoids Signs and Symptoms among pregnancies and the level of education variable.High percent from total sample were in residence city it constitute of Prevalence (76,6%). With regard to the occupation housewife were living urban areas and constitutes Prevalence (65,6%) and there are many high associations among some variables prevalence of hemorrhoids Signs and Symptoms among pregnancies and the age significant. Keywords: Prevalence, Hemorrhoids, Pregnancies.
... Because, studies have reported that 33-44% of women experience discomfort due to anal region lesions in the first months after birth. [18] For this reason, frequent breastfeeding by sitting may make anal region lesions chronic. ...
Objective: The aim of this study is to examine the effect of obstetric factors on the medical treatment success of anal fissure in women. Material and Method: A total of 324 women, who were diagnosed with anal fissure, who applied to the General Surgery outpatient clinic between 2015 and 2020, were included in the study. The patients were divided into two groups; group I (medical treatment was successful) and group II (medical treatment failed-surgery performed). Both groups were compared in terms of age, body mass index (BMI), number of births, delivery type, birth weight, breastfeeding rate, constipation, diarrhea, smoking and anal fissure symptoms. Results: Medical treatment was applied to all of the 324 patients we included in our study, and it was observed that 45.7% of them had successful medical treatment and 54.3% had undergone surgical treatment (lateral internal sphincterotomy) because of unsuccessful medical treatment. It was found that age, BMI, number of births, number of vaginal births, breastfeeding rate, constipation rates were higher in those who failed medical treatment (p<0.05). The number of cesarean sections, birth weight, diarrhea and smoking were found to be similar between the two groups (p>0.05). While gas incontinence was observed in 44.1% of those who underwent surgical treatment, this rate was found to be 1.4% in those who benefited from medical treatment. Conclusion: In our study, it was found that while maternal age, number of births, vaginal delivery and breastfeeding rates had a negative effect on the success of anal fissure medical treatment, cesarean delivery and baby birth weight were not effective. Öz Abstract Hacı Bolat1, Bülent Çakmak2 Amaç: Bu çalışmanın amacı, kadınlarda görülen anal fissürün medikal tedavi başarısında obstetrik faktörlerin etkisinin incelenmesidir. Gereç ve Yöntem: Çalışmaya2015-2020 yılları arasında Genel Cerrahi polilliniğine anal bölge rahatsızlığı nedeni ile başvurup anal fissür tanısı almış 324 kadın dahil edildi. Hastalar iki gruba ayırıldı; grup I (medikal tedavi başarılı) ve grup II (medikal tedavi başarısız-cerrahi yapılan). Her iki grup yaş, vücut kitle indeksi (VKİ), doğum sayısı, doğum şekli, bebek doğum ağırlığı, emzirme oranı, kabızlık, ishal, sigara içme ve anal fissür semptomları açısından karşılaştırıldı. Bulgular: Çalışmamıza aldığımız 324 hastanın tümüne medikal tedavi uygulanmış olup bunlardan %45,7'sinde medikal tedavi başarılıyken, %54,3'ünde ise medikal tedavi başarısız olduğundan dolayı cerrahi tedavi (lateral internal sfinkterotomi) uygulandığı gözlendi. Medikal tedavi başarısız olanlarda yaş, VKİ, doğum sayısı, vajinal doğum sayısı, emzirme oranı, kabızlık oranlarının daha fazla olduğu tespit edildi (p<0,05). Sezaryen sayısı, bebek doğum ağırlığı, ishal ve sigara kullanımının iki grup arasında benzer olduğu bulundu (p>0,05). Cerrahi tedavi uygulananlarda %44,1 gaz inkontinansı görülürken medikal tedaviden yarar görenlerde bu oran %1,4 saptandı. Sonuç: Çalışmamızda gebelik sürecinde oluşan anal fissür medikal tedavi başarısında obstetrik etkenlerden maternal yaş, doğum sayısı, vajinal doğum ve emzirmenin olumsuz yönde etki ettiği görülürken sezaryenle doğum ve bebek doğum kilosunun etkili olmadığı saptandı.
... Around 8% of pregnant females will experience EHT, especially during the 2nd and 3rd trimesters. Risk factors are vaginal delivery, constipation, high birth weight, traumatic and /or instrumental delivery (30)(31)(32). Prevention and conservative management (fibers, stool softeners, sitz baths and topical creams) are considered the initial treatment, reserving surgical management for postpartum period. There has been reluctance in performing surgical excision, especially under general anesthesia, due to technical difficulties encountered with patient positioning as well as fear of inducing premature labor (31). ...
Background
External hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease. This condition causes extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line thus leading to congestion and swelling. The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades.
Methods
This mini-review focuses on the most relevant studies found in literature evaluating conservative and surgical management of EHT. Special conditions such as pregnancy and EHT in elderly patients have been considered.
Results
Traditionally, symptoms duration represents the discriminant in the choice between medical and surgical treatment. Several Coloproctological Societies considered conservative treatment as the first-line approach to EHT and a variety of options have been proposed: wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection and topical application of 0.2% glyceryl trinitrate. Meanwhile, different surgical treatments are recommended when EHT fails to respond to conservative management or when symptoms onset falls within the last 48–72 h: drainage with radial incision, conventional excision, excision under local anesthesia and stapled technique.
Conclusion
The management and treatment of EHT is still controversial since no specific guidelines have been published. Both medical and surgical treatment have been proven effective but randomized clinical trials and structured consensus-based guidelines are warranted.
... The main reported symptoms caused by hemorrhoids are burning, itching, perianal pain and bleeding [2]. This condition is especially prevalent in pregnancy, mainly during the third trimester and the postpartum period [3,4]. A few clinical studies reported the incidence of hemorrhoids, varying from around 15% to 41%, or even reaching 85% in some of the populations with the tendency to be more common with increased age and parity [3,[5][6][7][8]. ...
Abstract Background To compare specific dietary and behavioral recommendations for hemorrhoids prevention during pregnancy. Methods This was a randomized, single-blind, multicenter trial conducted in three different clinical centers. Patients were randomly allocated into two groups in a ratio of 1:1. Intervention consisted of specific dietary and behavioral counseling. The primary outcome of this study was the rate of hemorrhoids at the time of discharge from the obstetrics unit. Categorical variables were compared by the Chi-Squared or Fisher exact tests, as appropriate. Continuous variables were compared using either the Student's t-test or the Mann–Whitney U test. Binary logistic regression model was used to identify independent predictors of hemorrhoids after delivery. This analysis was performed on factors with a p-value
... 2 The risk of developing hemorrhoids during pregnancy is even higher because of the vascular structure changes with hormonal irregularity, increased intra-abdominal pressure, and constipation. 3 The prevalence of hemorrhoids persisting after delivery in pregnant women is between 25% and 35%, and these percentages rise up to 85% in the third trimester. 4 The severity of hemorrhoids is classified into 4 clinical grades according to Goligher classification. ...
... Severe complications and sequelae are rare [4]: moderate pain or transient heaviness (9% to 70%), minimal rectal bleeding (2% to 10%) and rare seepage [4] [9] [10]. Several cases of serious infectious complications have been reported and 3 cases of impotence, preceded by hemospermia or hematuria, have been reported after injection into the prostatic zone. ...
Hemorrhoids are a clinical and anatomical subject that has not been completely investigated [1]. This benign condition is expressed by intermittent functional manifestations as rectorrhagies and prolapse. while the medical treatments seek to relieve symptoms, the instrumental ones are intended to reposition and hold the hemorrhoids in an anatomically correct position and to reduce their vascularity [1]. Indeed, sclerotherapy seems an effective and safe method in fact. Aim of the Study: To report the results of a moroccan series of patients treated with sclerosing injections, emphasizing short-and long-term efficacy as well as the rate of complications. Methods: This is a descriptive retrospective study of the 148 patients with symptomatic internal hemorrhoids who have been treated with sclerotherapy in the gastroenterology department of the university medical center of Fez over a period of 17 years [2001-2018]. Results: The average age of our patients is 47.1 years [19-86]. We notified a large male predominance with a sex ratio M/F 2.58. Rectorrhagies and prolapse were the most frequent reasons for consultation; they were respectively notified in 96% (n = 143) and 83% of patients (n = 123). Anemia was found in 45 cases (30.4%), of which 29 cases required transfusion. Proctologic examination found internal hemorrhoids grade 2 in 83% (n = 124) and grade 1 in 16.2% (n = 24) of patients. Initial success was found in 119 cases (80.4%) after an average of 2.25 sessions (1-4). Nine patients (8, 11%) had minor complications dominated by minimal rectorrhagies in 8 cases, resolved spontaneously. In 29 cases (19.5%), the sessions were interrupted following a failure of the technique in 12 cases (41.3%), in 11 cases after change of the stage of hemorrhoids of stage II to III, in 4 cases following the appearance of an anal fissure contraindicating the How to cite this paper: Abid 37 Open Journal of Gastroenterology procedure, and in 2 cases due to severe pain post sclerosis. Among these 29 cases, 13 patients were referred for surgery, while in 16 patients we opted for an instrumental treatment by ligature. The initial evolution was specified with a average follow-up of 3 months (1-13 months). The recurrence rate was 22.3% (N: 33 cases) after an average follow-up of 9.5 months (1-48 months). In the long term (over one year) and in the short term, the recidivism rate was 6% (n = 9 cases) and 16.2% (n = 24) respectively. Among recurrent patients, the sclerosis protocol was repeated in 20 patients (60.6%) with a success rate of 85%; for the remaining 13 patients, we opted for elastic ligation in 4 patients, and for surgery in 6 patients, while 3 patients were lost to follow-up. Conclusion: Since the end of the XIX century, sclerosis has been an instrumental technique, simple, inexpensive, and effective for the treatment of symptomatic internal hemorrhoids of grades 1 and 2, allowing good results in the long run, with minimal risk of complications.
... Con la trombectomía simple se han reportado tasas de retrombosis hasta del 33 % medidas a 24 meses (13)(14)(15)(16). La trombectomía con incisión amplia en la piel con fleboextracción reduciría a menos del 3 % de la retrombosis, reduciría el dolor posoperatorio, acortaría el tiempo de cicatrización, generaría un pronto retorno a las actividades diarias y el manejo se hace de una manera ágil y a bajo costo. ...
Objetivo:
Evaluar los resultados de la trombectomía más fleboextracción como alternativa en el manejo de la enfermedad hemorroidal externa trombosada.
Materiales:
Estudio observacional, cuantitativo, retrospectivo, transversal y descriptivo de los pacientes que consultaron y se sometieron a la trombectomía más fleboextracción como técnica alternativa en el manejo de la enfermedad hemorroidal externa trombosada en el servicio de coloproctología del Hospital Militar Central desde el primero de enero de 2014 hasta el 31 de diciembre de 2016.
Resultados:
Se encontró que 197 pacientes consultaron por hemorroides externas trombosadas, el 71 % eran hombres y el promedio de edad para el grupo de manejo conservador fue de 48,5 años, frente al promedio del grupo de manejo quirúrgico, que fue de 43,2 años. El seguimiento promedio posterior al inicio del tratamiento médico o quirúrgico fue de 16 meses. En el grupo de manejo quirúrgico, la tasa de recurrencia fue del 7,2 % y el intervalo de recurrencia fue 29,2 meses.
Conclusiones:
Los pacientes a quienes se les practicó la técnica de trombectomía más fleboextracción presentaron una menor tasa de retrombosis hemorroidal, menor tasa de dolor y sangrado posoperatorio. La trombectomía hemorroidal con fleboextracción es una técnica bien tolerada en el consultorio, que se puede realizar sin anestesia, a diferencia del estándar de manejo actual con hemorroidectomía externa en elipse, que requiere anestesia local, regional o general, y una sala de procedimientos quirúrgicos que deja un defecto mayor en la piel por el tejido resecado, un mayor tiempo de cicatrización y de dolor posoperatorio.
... Because, studies have reported that 33-44% of women experience discomfort due to anal region lesions in the first months after birth. [18] For this reason, frequent breastfeeding by sitting may make anal region lesions chronic. ...
Objective: The aim of this study is to examine the effect of obstetric factors on the medical treatment success of anal fissure in women.
Material and methods: A total of 324 women, who were diagnosed with anal fissure, who applied to the General Surgery outpatient clinic between 2015 and 2020, were included in the study. The patients were divided into two groups; group I (medical treatment was successful) and group II (medical treatment failed - surgery performed). Both groups were compared in terms of age, body mass index (BMI), number of births, delivery type, birth weight, breastfeeding rate, constipation, diarrhea, smoking and anal fissure symptoms.
Results: Medical treatment was applied to all of the 324 patients we included in our study, and it was observed that 45.7% of them had successful medical treatment and 54.3% had undergone surgical treatment (lateral internal sphincterotomy) because of unsuccessful medical treatment. It was found that age, BMI, number of births, number of vaginal births, breastfeeding rate, constipation rates were higher in those who failed medical treatment (p 0.05). While gas incontinence was observed in 44.1% of those who underwent surgical treatment, this rate was found to be 1.4% in those who benefited from medical treatment.
Conclusion: In our study, it was found that while maternal age, number of births, vaginal delivery and breastfeeding rates had a negative effect on the success of anal fissure medical treatment, cesarean delivery and baby birth weight were not effective.
... Many studies also postulate a relationship between pregnancy and AVT [9][10][11], while others cannot confirm this [5,12]. Abramowitz et al. showed constipation as a risk factor, but only observed pregnant women or women shortly after delivery [13]. In the study of Jongen et al., 12.6% of the women were in the second or third trimester of pregnancy [1]. ...
PurposeThe recurrence rates of excision, incision, and conservative treatments following anal vein thrombosis (AVT) are unclear. We compared the efficacy of treatment methods using Kaplan–Meier statistics. Our null hypothesis H0 is that incision of AVT gives as good results as surgical excision in terms of recurrence-free outcome.Methods
One hundred fifty patients treated in a single hospital in northern Germany from 2013 to 2017 were interviewed and their data analysed.ResultsWhile recurrence-free outcome was about 22% following conservative treatment and 21% for incisional treatment, only surgical excision enabled recurrence-free outcome (86%) 4 years following surgery. While conservative and incisional therapy did not differ statistically, excision was significantly better than both of those treatments (p < 0.001).Conclusions
Our null hypothesis H0 that incision of AVT gives as good results as surgical excision in terms of recurrence free outcome was rejected. Incision of AVT should be abandoned, as it is painful, useless, and associated with a high recurrence rate as a conservative treatment in four of five patients. Surgical excision is the only method that enables significant recurrence-free outcome and should be used as the treatment of choice.
... Many studies also postulate a relationship between pregnancy and AVT [9][10][11], while others cannot confirm this [5,12]. Abramowitz et al. showed constipation as a risk factor, but only observed pregnant women or women shortly after delivery [13]. In the study of Jongen et al., 12.6% of the women were in the second or third trimester of pregnancy [1]. ...
PurposeThe recurrence rates of excision, incision, and conservative treatments following anal vein thrombosis (AVT) are unclear. We compared the efficacy of treatment methods using Kaplan–Meier statistics. Our null hypothesis H0 is that incision of AVT gives as good results as surgical excision in terms of recurrence-free outcome.Methods
One hundred fifty patients treated in a single hospital in northern Germany from 2013 to 2017 were interviewed and their data analysed.ResultsWhile recurrence-free outcome was about 22% following conservative treatment and 21% for incisional treatment, only surgical excision enabled recurrence-free outcome (86%) 4 years following surgery. While conservative and incisional therapy did not differ statistically, excision was significantly better than both of those treatments (p < 0.001).Conclusions
Our null hypothesis H0 that incision of AVT gives as good results as surgical excision in terms of recurrence free outcome was rejected. Incision of AVT should be abandoned, as it is painful, useless, and associated with a high recurrence rate as a conservative treatment in four of five patients. Surgical excision is the only method that enables significant recurrence-free outcome and should be used as the treatment of choice.
... Women's Health (2008) 4(5) future science group future science group Hemorrhoids are more common in women than in men and often develop for the first time during straining with childbirth [60]. Overall, 48-63% of patients with grade 3 or 4 hemorrhoids (requiring manual reduction), report soiling of underwear [61,62]. ...
... Many studies also postulate a relationship between pregnancy and AVT [9][10][11], while others cannot confirm this [5,12]. Abramowitz et al. showed constipation as a risk factor, but only observed pregnant women or women shortly after delivery [13]. In the study of Jongen et al., 12.6% of the women were in the second or third trimester of pregnancy [1]. ...
Purpose. The recurrence rates of excision, incision, and conservative treatments following anal vein thrombosis (AVT) are unclear. We compared the efficacy of treatment methods using Kaplan–Meier statistics. Our null hypothesis H0 is that incision of AVT gives as good results as surgical excision in terms of recurrence-free outcome.
Methods. One hundred fifty patients treated in a single hospital in northern Germany from 2013 to 2017 were interviewed and their data
analysed.
Results. While recurrence-free outcome was about 22% following conservative treatment and 21% for incisional treatment, only surgical excision enabled recurrencefree outcome (86%) 4 years following
surgery. While conservative and incisional therapy did not differ statistically, excision was significantly better than both of those
treatments (p< 0.001).
Conclusions. Our null hypothesis H0 that incision of AVT gives as good results as surgical excision in terms of recurrence free outcome was rejected. Incision of AVT should be abandoned, as it is painful, useless, and associated with a high recurrence rate as a conservative treatment in four of five patients. Surgical excision is the only method
that enables significant recurrence-free outcome and should be used as the treatment of choice.
... Protocological conditions such as those associated with haemorrhoids and anal fissures are common in pregnancy. 14 Approximately 25-35% of pregnant women experience haemorrhoids 15,16 and in some series this has even been reported to be as high as 75-85%. 17 The aetiology in pregnancy is related to increasing circulating volume, the effects of progesterone on smooth muscle in the walls of the veins and increased intra-abdominal pressure resulting from the gravid uterus, causing compression of the superior rectal veins. ...
Rectal bleeding is a common symptom experienced by pregnant women. Although the majority of cases are attributable to benign conditions such as haemorrhoids and anal fissures, other more serious diagnoses such as inflammatory bowel disease and malignancy should not be overlooked. Most investigations are safe during pregnancy and these should not be withheld as significant implications on both foetal and maternal morbidity may result. In these cases, a multidisciplinary team approach is essential. This review explores the differential diagnosis, investigation and management of rectal bleeding during pregnancy.
... Variance of the inferior rectal artery noted on post-mortem studies further supports the theory of ischemia as causative etiology [16]. Post-partum status is also associated with higher rates of AF, as is anoreceptive intercourse and prior anorectal surgery [6,17]. Atypical features such as off midline or multiple fissures may suggest secondary pathology like HIV, Crohn's disease or neoplastic causes [4,6,[18][19][20]. ...
IntroductionAnal fissure is the most common cause of severe anorectal pain in adults, contributing significantly to coloproctology workloads. There are a wide variety of management options available, including topical nitrites, calcium channel blockers, botulinum toxin injection and sphincterotomy. The aim of this study was to review current options for the treatment of chronic anal fissure.MethodsA comprehensive search identifying randomized controlled trials comparing treatment options for anal fissure published between January 2000 and February 2020 was performed. The primary outcome assessed was healing at 8 weeks post commencing treatment. Secondary outcomes included recurrence, intolerance of treatment and complications.ResultsA total of 2822 studies were identified. After removal of duplicates and non-relevant studies, we identified nine randomized controlled trials which met pre-defined criteria. There was a total of 775 patients. At 8 weeks, healing rates were 95.13% in those treated with sphincterotomy, 66.7% in the botulinum toxin group, 63.8% in the nitrate group, 52.3% for topical diltiazem and 50% for topical minoxidil. Recurrence was highest amongst those treated with botulinum toxin injection (41.7%) and lowest for sphincterotomy (6.9%). Although the absolute number is low, there was a risk of permanent incontinence with sphincterotomy.Conclusion
This review of the randomized control data demonstrates that healing was significantly higher amongst those treated with sphincterotomy versus more conservative modalities. Topical nitrites had similar outcomes to botulinum toxin injection but were poorly tolerated in comparison to other treatments. The benefit of sphincterotomy was at a cost of increased complications, notably permanent incontinence.
... The incontinence grade ranges from 1.3% to 2.9%. In DK Das's study with 50 patients, one patient developed fecal soiling (lasted for 2 weeks) and 2 patients developed temporary flatus incontinence [10] . In our study 8 patients had experienced incontinence which is of mild grade and temporary. ...
... Pregnancy and spontaneous vaginal delivery are wellestablished predisposing factors for the development of HD in females due to the increased intra-abdominal pressure from uterine growth, the hormonal changes, and constipation (38% of the pregnant females). Clinical reports demonstrated that HD is mostly prevalent in the last trimester of pregnancy and in the first month after delivery, with about 25-35% of the pregnant females suffering from this disease [127,128]. In particular, thrombosed external hemorrhoids (TEH) are more frequent during the last trimester of pregnancy and immediately after delivery (7.8% and 20%, respectively). ...
Hemorrhoidal disease (HD) is the most common proctological disease in the Western countries. However, its real prevalence is underestimated due to the frequent self-medication.
The aim of this consensus statement is to provide evidence-based data to allow an individualized and appropriate management and treatment of HD. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL, and EMBASE.
These guidelines are inclusive and not prescriptive.
The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by American College of Chest Physicians. The recommendations were graded A, B, and C.
... The prevalence of HD during pregnancy can reach 85% during the third trimester [107,108]. Treating constipation by increasing fluid and fiber intake and taking a warm sitz bath 3 times a day may be helpful in improving symptoms from HD. In a prospective comparative study, relief of HD symptoms was achieved in all 284 patients in the warm sitz bath group but only in 179/211 patients in the control group [109]. ...
Hemorrhoidal disease (HD) is a frequent health problem with considerable repercussions on patients' quality of life. However, much of the clinical practice related to HD is based on knowledge without scientific evidence and supported largely by empirical experience of the physician who deals with this pathology. As in other countries, the goal of this consensus is to establish statements supported by solid scientific evidence and whose purpose will be to standardize and guide the diagnosis and management of HD both in the general population and in some particular groups of patients.
Copyright © 2019 by S. Karger AG, Basel.
... La ragade anale colpisce principalmente il soggetto giovane ed è rara dopo i 65 anni [21] . Se l'incidenza è equivalente in entrambi i sessi, è relativamente frequente nel periodo post-partum, riguardando il 15% delle donne [22] . ...
La patologia emorroidaria è la principale causa di visita in proctologia. Quando diventano complicate, le emorroidi esterne causano trombosi e le emorroidi interne sono responsabili di sanguinamenti e/o di prolasso. I principali trattamenti strumentali sono la fotocoagulazione a infrarossi e la legatura elastica. Chirurgicamente, l’emorroidectomia è più efficace a lungo termine, ma espone a sequele più lunghe e più dolorose. L’intervento di Longo o la legatura sotto controllo Doppler con o senza mucopessi hanno indicazioni più limitate e un tasso di fallimento e di recidiva più importante. La ragade anale è la seconda causa principale di consultazione in proctologia. La diagnosi è spesso clinicamente evidente. Il trattamento medico, in particolar modo con la regolarizzazione del transito, è la prima linea solitamente raccomandata. Tuttavia, la chirurgia è il trattamento a lungo termine più efficace. Si basa su due principi che possono essere associati: ridurre il tono dello sfintere ed eseguire l’escissione della ragade anale. La sfinterotomia laterale interna è la tecnica standard nella letteratura internazionale, ma espone al rischio di incontinenza irreversibile. In Francia, è, quindi, preferita la fissurectomia, che, tuttavia, è più a rischio di recidiva. La fistola anale è la più frequente delle suppurazioni anoperineali. Il trattamento della fistola anale è sempre chirurgico. Solo la gestione dell’ascesso è urgente. Gli obiettivi sono di drenare la suppurazione, di evitare la recidiva e di preservare l’apparato dello sfintere. La fistulotomia è la tecnica più efficace, ma espone a rischi di incontinenza, in determinate situazioni. Le tecniche di risparmio sfinterico si sviluppano per preservare la continenza, ma sono all’origine di un alto tasso di insuccesso. La malattia di Crohn, il seno pilonidale e la malattia di Verneuil sono responsabili della maggior parte delle altre suppurazioni perineali.
... Severe complications and sequelae are rare [4]: moderate pain or transient heaviness (9% to 70%), minimal rectal bleeding (2% to 10%) and rare seepage [4] [9] [10]. Several cases of serious infectious complications have been reported and 3 cases of impotence, preceded by hemospermia or hematuria, have been reported after injection into the prostatic zone. ...
... In fact, hemorrhoids are present in 85% of woman during the second and third trimesters of pregnancy (Gojnic et al. 2005) with a thrombosed hemorrhoid rate of 7.9% in the last 3 months (Abramowitz et al. 2002). ...
... Les thromboses hémorroïdaires externes ne sont pas rares et surviennent la plupart du temps dans les 24 heures suivant l'accouchement [10]. Le traitement est la thrombectomie simple en anesthésie locale. ...
... Les thromboses hémorroïdaires externes ne sont pas rares et surviennent la plupart du temps dans les 24 heures suivant l'accouchement [10]. Le traitement est la thrombectomie simple en anesthésie locale. ...
... It has been reported that 33% of these patients are suffering from thrombosed external hemorrhoids, or anal fissures during this period. 4 Although various risk factors have been described, the exact mechanism and biological rationale behind pregnancy-related perianal problems are not clear. 5 Functional constipation is another common issue during pregnancy, with an incidence ranging between 11% and 38%. 2 Unfortunately, there is not enough data to adequately evaluate the effectiveness and safety of pharmacological and non-pharmacological treatment modalities for constipation in pregnancy. ...
Purpose
To identify the effect of pregnancy on the development of external hemorrhoids and constipation.
Subjects and methods
This pilot study involved 61 primigravid women without a history of perianal diseases. Each patient was examined and filled a questionnaire between the 11th and 14th gestational week prior to prenatal screening tests. Patients were re-examined and questioned in relation to perianal symptoms and hemorrhoidal changes again in the 24th and 37th gestational weeks.
Results
A total of 5, 8, and 11 women had symptomatic external hemorrhoids with or without perianal complications in the 11–14th, 24th, and 37th gestational weeks, respectively. Meanwhile, 27, 25, and 29 women complained about constipation in the 11–14th, 24th, and 37th gestational weeks, respectively. Only 4 (6.6%) patients experienced painful hemorrhoids. The overall morbidity rate was 18% (11 cases). We found a statistically significant relationship between external hemorrhoids/perianal complications and gestation-induced constipation through logistic regression analysis (p < 0.001).
Conclusion
Various risk factors and biological explanations exist for the high frequency of hemorrhoids during pregnancy. Because participants were primigravid women without a history of perianal complaints, findings suggest a direct effect of pregnancy itself on the development of external hemorrhoids/perianal symptoms.
Pregnant women and their partners often ask healthcare professionals whether sex is safe during pregnancy, and what consequences may result from sexual activity. Many clinicians can also be unsure of the answers to these type of questions, leading to both patient and clinician resorting to the internet for advice, which can be inaccurate and anxiety-inducing. Here, the authors provide clinicians with an insight into the information offered by 'Dr Google' so that they can reassure and advise their patients as necessary. Aimed at obstetricians and other physicians caring for pregnant women, this book reviews the implications of sex during pregnancy such as those complicated by medical conditions, those at risk of preterm birth and multiple pregnancies. Other chapters cover physiological changes during pregnancy that may affect sexual function and intimacy, as well as the differing guidelines provided by various global obstetric societies.
Patients with severe, acute anal pain require appropriate and prompt diagnosis as well as targeted treatment in combination with pain therapy. In addition to the medical history including digital examination, only simple procedures, such as proctoscopy or rectoscopy are commonly available. However, pain often limits the diagnostic workup. Early and adequate pain management should be implemented. Computed tomography or magnetic resonance imaging is often of no value in acute situations. In special cases, examination under anesthesia (EUA) may be very helpful.
Background:
Haemorrhoidal disease in women during pregnancy is common in clinical practice. However, there are scarce prospective data on its real prevalence and women's demographics.
Objective:
The aim was to determine the prevalence of haemorrhoidal disease during pregnancy and to assess its impact on quality of life. Additionally, to identify the relationship between patients' characteristics, bowel habits, hormonal changes, and the presence of symptomatic haemorrhoids.
Design:
Prospective longitudinal cohort study.
Setting:
This study was conducted in Obstetrics Department for pregnancy follow-up.
Patients:
A cohort of pregnant women.
Intervention:
The study was designed to follow up a homogeneous cohort of women for 15 months. Visits took place in the first and third trimesters of pregnancy, and 3 and 6 months after delivery. Women's demographics (age, past medical history, bowel habit, Bristol stool scale) and serum determination of pregnancy-related hormones (estrogen, progesterone, and relaxin) were determined.
Main outcome measures:
The primary outcome was the development of hemorrhoidal disease.
Results:
Overall, 109 women (mean age, 31.2 ± 5.4 years) were included in the study. The prevalence of symptoms and physical findings of haemorrhoidal disease was present in 11% in the first trimester, 23% in the third trimester, 36.2% at 1 month post-delivery, and 16.9% at 3 months post-delivery. A previous medical history of haemorrhoidal disease was significantly associated with diagnosis of haemorrhoids in the first trimester (p<0.0001) and third trimester (p=0.005). Symptoms of constipation were associated with this clinical disorder in the first trimester (p=0.011) and third trimester of pregnancy (p=0.022), respectively. No association was found between hormonal changes and development of haemorrhoidal disease.
Limitations:
a larger sample would provide more information.
Conclusions:
Prevalence of women with haemorrhoidal disease increased during pregnancy and post-delivery. A previous history of haemorrhoidal disease and constipation were significantly associated with diagnosis of symptomatic haemorrhoidal disease. See Video Abstract at http://links.lww.com/DCR/B504.
Fecal incontinence is a common problem in women, which often enforces life changes owing to embarrassment and social stigma. It is frequently not reported or diagnosed. Age, obstetric trauma, pelvic surgery, chronic diarrhea, obesity and other medical conditions, such as diabetes and stroke, increase the risk of fecal incontinence. Preventive strategies include avoiding diarrheal triggers, discouraging the routine use of episiotomies, early recognition and management of obstetric injuries and possibly pelvic floor muscle exercises after childbirth. Treatment options are available and should be discussed with the patient. These, in order of progression, are education and medications for diarrhea or constipation, supportive care, biofeedback training and surgery.
Background:
Hemorrhoids are a common anal disorder and are more frequent in women than in men. Urinary incontinence (UI) also occurs more frequently in women than in men. Although both diseases share similar risk factors, research on the association between the two diseases is lacking. This study aimed to investigate the relationship between hemorrhoids and UI in adult Korean women.
Methods:
This study was based on the data of the 2008-2009 Korean National Health and Nutrition Examination Survey. Logistic regression test was performed to determine the relationship between hemorrhoids and UI after adjusting for age, body mass index (BMI), smoking, heavy drinking, physical activity, education level, income, diabetes mellitus, and hypertension.
Results:
Analysis of the data of 8,139 adult women revealed that the prevalence of hemorrhoids, which were self-reported and diagnosed by a physician, was 17.5% and 7.9%, respectively. Both types of hemorrhoids were more prevalent in older women with spouses, those with a large waist circumference, and those with a high BMI. The prevalence of UI was significantly high in the hemorrhoid group, regardless of whether it was self-reported or diagnosed by a physician. Multiple logistic regression analyses revealed a significant association between the prevalence of UI and hemorrhoids, both of which were found to peak at 19-39 years of age.
Conclusions:
Our findings demonstrate that hemorrhoids are significantly correlated with UI in adult Korean women. When treating adult women with hemorrhoids, it is, therefore, necessary to consider other pelvic floor diseases such as UI.
La maladie hémorroïdaire a une prise en charge spécifique lorsqu’elle survient au cours de la grossesse, au cours d’une maladie inflammatoire chronique intestinale (MICI), si un traitement antiagrégant ou anticoagulant est en cours ou en cas d’antécédent d’irradiation pelvienne. Le traitement médical reste globalement inchangé (laxatifs, fibres…). Une attention particulière doit être portée sur la prescription des anti-inflammatoires non stéroïdiens et des antalgiques. Le traitement instrumental est contre-indiqué en cas de grossesse, MICI active, notamment avec une suppuration anopérinéale ainsi que chez un patient sous anticoagulant ou antiagrégant autre que l’aspirine. Le traitement chirurgical est envisageable sous aspirine, en cas de complication sévère résistante au traitement médical en cas de grossesse et en cas de MICI quiescente sans atteinte anorectale ni de suppuration. L’anticoagulation augmente le risque hémorragique postopératoire. Une radiothérapie pelvienne limite fortement la prise en charge thérapeutique.
Background
Anal abscess is an important complication of anal fissure (AF), whereas interleukin‐6R (IL‐6R) has been implicated in the development of abscess. In this study, we aimed to explore the possible molecular mechanisms underlying the regulatory effects of miRNAs on IL‐6R and other inflammatory factors related to the induction of anal abscess in AF.
Methods
Bioinformatics analysis, luciferase assay, real‐time polymerase chain reaction, and Western blot analysis were performed to identify the possible regulatory relationships between IL‐6R and miR‐124/miR‐125a by comparing the differentiated expression of miR‐125a, miR‐124, tumor necrosis factor‐α (TNF‐α), interferon‐γ (IFN‐γ), and IL‐4 among different groups of AF patients.
Results
IL‐6R messenger RNA (mRNA) was identified as a target gene of miR‐124 because the luciferase activity in cells cotransfected with wild‐type IL‐6R and miR‐124 mimics was significantly reduced. In addition, the expression of IL‐6R mRNA and protein was significantly inhibited in the presence of miR‐124 or an IL‐6R inhibitor, confirming the presence of a negative regulatory relationship between miR‐124 and IL‐6R. Moreover, miR‐124 and inflammatory factors were differentially expressed in AF patients carrying different genotypes of rs531564 polymorphism.
Conclusions
miR‐124 and inflammatory factors TNF‐α, IFN‐γ, and IL‐4 may be used as indicators of anal abscess development in AF patients. In addition, miR‐124 polymorphism rs531564 is involved with the pathogenesis of anal abscess in AF patients, and the presence of rs531564 may increase the incidence of anal abscess via upregulating the expression of IL‐6R, TNF‐α, IFN‐γ, and IL‐4.
Anale Schmerzen sind in den meisten Fällen heftig und erfordern neben der Diagnostik eine rasche und suffiziente Behandlung. Dabei ist die Schmerztherapie an erster Stelle zu nennen. Neben der Erhebung der Anamnese, der Inspektion des Befunds inklusive digitaler Untersuchung sind in den meisten Fällen nur noch einfache Maßnahmen wie z. B. eine Prokto- bzw. Rektoskopie nötig. Schnittbilduntersuchungen haben keinen Stellenwert, in besonderen Fällen kann eine Untersuchung in Narkose notwendig werden.
Gastrointestinal disorders constitute one of the most frequent complaints of pregnancy. An understanding of the mode of presentation and the incidence of the various gastrointestinal disorders will optimize care in obstetric patients. Disorders of the esophagus, stomach, duodenum, ilium, jejunum, colon, rectum, and appendix are individually discussed with reference to physiologic changes in pregnancy, infectious diseases, autoimmune disease, and ulcer formation.
Pregnancy is associated with a wide variety of physiologic changes in virtually all the organ systems of the body. Some of these changes, such as the hyperventilation of pregnancy with its resulting respiratory alkalosis, are clinically silent, whereas others, such as heart-burn and hemorrhoids, cause significant distress. The effects of pregnancy on the hepatobiliary system have been the subject of much scrutiny and many publications, whereas disturbances of the hollow viscera have been infrequently reviewed. In this report, we will discuss the major pathophysiologic changes that occur along the length of the hollow viscera of the gastrointestinal tract during pregnancy.
The pregnant patient afflicted with a variety of colorectal conditions merits special consideration for reasons related to the safety and timeliness of operation while preserving fetal viability and fertility. The literature is scanty with respect to hemorrhoids, fissures, and colorectal and anal carcinoma. Therefore, the patient has to have a forthright discussion with her physician(s) about the pros and cons of operative and nonoperative approaches, which can result in either therapeutic abortion and timely surgery versus preserving the fetus and taking on the unknown factor of whether delay in treatment will cause an adverse outcome. This underscores the need for a frank discussion with the patient with regard to anticipated outcomes. In benign conditions, there is more latitude to adopt a conservative approach, as the patient's ability to tolerate the symptoms of her condition would dictate the need for definitive operative therapy. In the patient with malignancy, delaying surgical or radiation therapy carries an unknown risk to the patient. Here, the patient's personal views regarding abortion and future fertility dictate the timing of definitive treatment.
Haemorrhoidal disease is the consequence of distal displacement of the anal cushions, which are normal structures with an important role in continence. The causes of haemorrhoidal disease are unknown; constipation and abnormal bowel habit are commonly blamed despite largely contrary evidence. The most consistently demonstrated physiological abnormality is an increased maximum resting anal pressure. Most evidence points to this being a secondary phenomenon rather than the cause of haemorrhoidal disease. Among the many unexplored areas are the function of the longitudinal muscle in relation to haemorrhoidal disease, the description and pharmacological responsiveness of the anal subepithelial muscle, and the clinical role of specific pharmacological agents that might reverse some of the observed physiological changes.
Hémorroïdes et grossesses
- Jm Garrigues
- Rouillon
Analyse de l’incidence et des facteurs éthiopathogéniques des thromboses hémorroïdaires du post-partum [abstract]
- Jm Rouillon
- P Blanc
- Garrigues
Grossesse et pa-thologie anale: etude prospective
- Terris E G Pradel
- F Juilliard
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