PREVALENCE AND POSSIBLE RISK FACTORS OF HEMORRHOIDAL THROMBOSIS IN PREGNANCY AND POSTPARTUM PERIOD

Abstract

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.

Keywords

hemorrhoids / hemorrhoids during pregnancy / hemorrhoidal thrombosis / hemorrhoids after childbirth / thrombosis of external hemorrhoids

References

[1] Abramowitz L., Sobhani I., Benifla J.L., Vuagnat A., Darai E., Mignon M. et al. Anal fissure and thrombosed external hemorrhoids before and after delivery. Diseases of the colon and rectum. 2002; 45(5): 650-5.

[2] Barleben A., Mills S. Anorectal anatomy and physiology. The Surgical clinics of North America. 2010; 90(1):1-15. DOI: 10.1016/j.suc.2009.09.001

[3] Poskus T., Buzinskiene D., Drasutiene G., Samalavicius N.E., Barkus A., Barisauskiene A. et al. Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study. BJOG: Intern. J. Obstet. Gynaecol. 2014;121(13): 1666-71.

[4] Avsar A.F., Keskin H.L. Haemorrhoids during pregnancy. J. Obstet. Gynaecol. 2010; 30(3): 231-7.

[5] Quijano C.E, Abalos E. Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium. Cochrane Database of Systematic Reviews. 2005(3): Cd004077.

[6] Howell E.A. Lack of patient preparation for the postpartum period and patients’ satisfaction with their obstetric clinicians. Obstet. Gynecol. 2010; 115(2 Pt. 1): 284-9.

[7] Schytt E., Lindmark G., Waldenstrom U. Physical symptoms after childbirth: prevalence and association with self-related health. BJOG: Intern. J. Obstet. Gynaecol. 2005; 112(2): 210-7.

[8] Borders N. After the afterbirth: a critical review of postpartum health relative to method of delivery. J. Midwifery Women’s Health. 2006; 51(4): 242-8.

[9] Woolhouse H., Perlen S., Gartland D., Brown S.J. Physical health and recovery in the first 18 months postpartum: does cesarean section reduce long-term morbidity? Birth (Berkeley, Calif). 2012; 39(3): 221-9.

[10] Медкова Ю.С., Маркарьян Д.Р., Чурина Ю.А., Тулина И.А., Александров Л.С., Царьков П.В., Ищенко А.И. Выбор метода лечения геморроидального тромбоза у беременных и родильниц: данные пилотного проспективного исследования. Вопросы гинекологии, акушерства и перинатологии. 2019; 18(2): 94-100.

[11] Росстат. Краткие итоги выборочного обследования «Семья и рождаемость». https://www.gks.ru/free_doc/2010/family.htm

[12] Mac Arthur C., Lewis M., Knox E.G. Health after childbirth. Br. J. Obstet. Gynaecol. 1991; 98:1193-204.

[13] Ferdinande K., Dorreman Y., Roelens K., Ceelen W., De Looze D. Anorectal symptoms during pregnancy and postpartum: a prospective cohort study. Colorectal Dis. 2018; 20(12): 1109-16. doi: 10.1111/codi.14324

[14] Rouillon J.M., Blanc P., Garrigues J.M., Viala J.L., Michel H. Analyse de l’incidence et des facteursétio pathogéniques des thromboses hémorroïdaires du post-partum. Gastroenterol. Clin. Biol. 1991;15: A300.

[15] Bols E.M., Hendriks E.J., Berghmans B.C., Baeten C.G., Nijhuis J.G., De Bie R.A. A systematic review of etiological factors for postpartum fecal incontinence. Acta Obstet. Gynecol. Scand. 2010; 89: 302-14.

[16] Simmons S.C. Ano-rectal disorders in pregnancy. J. Obstet. Gynecol. 1964; 71: 960-2.

[17] King V.G., Boyles S.H., Worstell T.R., Zia J., Clark A.L., Gregory W.T. Using the Brink score to predict postpartumanal incontinence. Am. J. Obstet. Gynecol. 2010; 203: 486.e1-5.

[18] Åhlund S., Rådestad I., Zwedberg S., Edqvist M., Lindgren H. Haemorrhoids - a neglected problem faced by women after birth. Sex Reprod. Healthc. 2018; 18: 30-6. doi: 10.1016/j.srhc.2018.08.002

RIGHTS & PERMISSIONS

Eco-Vector