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ANAL PROBLEMS DURING PREGNANCY AND POSTPARTUM: A PROSPECTIVE COHORT STUDY
Yaliva Dorreman2, Kymentie Ferdinande1, Kristien Roelens2, Wim Ceelen3, Steven Weyers2, Hans Van Vlierberghe1, Danny De Looze*1
1Gastroenterology, University Hospital Gent, Gent, Belgium; 2Gynaecology, University Hospital Gent, Gent, Belgium; 3Digestive surgery, University Hospital Gent, Gent, Belgium
Introduction: Many 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.
Aims: 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.
Methods: This 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. Descriptive 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.
Results: Sixty-eight percent of the women developed anal symptoms during the whole study period. Anal symptoms occurred 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. Most prevalent diagnoses were: hemorrhoidal thrombosis (immediate postpartum), hemorrhoidal prolapse (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.
Conclusions: Two thirds of pregnant women deal with anal symptoms during pregnancy 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 in pregnant women is recommended.
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