Anal fissure and thrombosed external hemorrhoids before and after delivery.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Abramowitz
Laurent
L
FAMA de Coloproctologie, Service de Gastroentérologie et de Gynécologie-Obstétrique, Hôpital Bichat-Claude Bernard, Paris, France.
Sobhani
Iradj
I
Benifla
Jean Louis
JL
Vuagnat
Albert
A
Daraï
Emile
E
Mignon
Michel
M
Madelenat
Patrick
P
D000328:Adult; D001003:Anal Canal / Q000098:blood supply / Q000293:injuries*; D016009:Chi-Square Distribution; D003248:Constipation / Q000150:complications*; D005260:Female; D005401:Fissure in Ano / Q000453:epidemiology / Q000209:etiology*; D006484:Hemorrhoids / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D011247:Pregnancy; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*