Proctology Blog

Pregnancy is a condition associated with a lot of changes in a woman’s body. Gastrointestinal symptoms like nausea, vomiting, reflux, and constipation affect majority of pregnant women. Almost two thirds of women during pregnancy and in post partum period suffer from anal problems like haemorrhoid and fissure. The most important cause of which is constipation.
Constipation during pregnancy is due to the various physiological and anatomical changes taking place in the body of a pregnant lady. For example the increased levels of progesterone reduces the bowel motility and increases transit time of stool. This leads to more water absorption from the gut making the stool dry and hard. Decreased physical activity, use of vitamin and iron supplement further contributes to constipation. In later stages of pregnancy, the bulky uterus compresses the colon. All these factors predispose to anal problems like haemorrhoid and anal fissure mostly either ignored or diagnosed inaccurately by the patients’ themselves or by their primary physician.
Haemorrhoids are dilated tortuous veins in the rectum or anal canal. First degree haemorrhoids maybe asymptomatic or can cause bleeding. Whereas the second and third degree, along with bleeding, prolapse out of the anal canal. In this condition they can become thrombosed and infected leading to severe pain.
Anal fissure is described as a vertical cut, wound or ulcer in the anoderm usually in the posterior midline. There is associated spasm of the internal anal sphincter leading to severe pain. In fact acute anal fissure is the commonest cause of painful rectal bleeding.
Both conditions can easily be diagnosed by a rectal examination and proctoscopy.
The mainstay of managing these conditions is treatment of constipation. Therefore it is imperative for pregnant women to increase their fluid intake add more fibre to their diet, be physically active and exercise regularly. As a second line of treatment various stool softeners, laxatives and bulk forming agents maybe prescribed which are safe to use in pregnancy. Although osmotic and stimulant laxatives should be used with caution.
The symptoms associated with first, second degree haemorrhoids and acute anal fissure are significantly relieved by these measures. Besides some locally applied creams and ointments can be used for their treatment .However thrombosed haemorrhoids and chronic anal fissure may require some surgery. Minimally invasive procedure using laser are available but ideally any surgical procedure is deferred during pregnancy unless it is an emergency .Therefore the patients should seek expert medical advice at the earliest when the problems can be managed conservatively.

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