title: Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study.
abstract: OBJECTIVE
  To identify the incidence and risk factors of haemorrhoids and fissures during pregnancy and after childbirth.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  University hospital and outpatient clinics in Lithuania.
  
  
  METHODS
  A total of 280 pregnant women followed up until 1 month after delivery.
  
  
  METHODS
  Women were examined four times through pregnancy and after delivery; those that developed peri-anal diseases were compared with those that did not.
  
  
  METHODS
  Incidence, time and risk factors of haemorrhoids and fissures.
  
  
  RESULTS
  In all, 123 (43.9%) women developed peri-anal disease: 1.6% in the first trimester, 61% during the third trimester, 34.1% after delivery and 3.3% 1 month after delivery; 114 (40.7%) women were diagnosed with haemorrhoids, seven (2.5%) with haemorrhoids and anal fissure and two (0.71%) with anal fissure. Ninety-nine (80.5%) women had vaginal delivery and 24 (19.5%) women had undergone caesarean section. Multivariate analysis identified personal history of peri-anal diseases (odds ratio [OR] 11.93; 95% confidence interval [95% CI] 2.18-65.30), constipation (OR 18.98; 95% CI 7.13-50.54), straining during delivery for more than 20 minutes (OR 29.75; 95% CI 4.00-221.23) and birthweight of newborn>3800 g (OR 17.99; 95% CI 3.29-98.49) as significant predictors of haemorrhoids and anal fissures during pregnancy and perinatal period.
  
  
  CONCLUSIONS
  Haemorrhoids and fissures are common during the last trimester of pregnancy and 1 month after delivery, with constipation, personal history of haemorrhoids or fissures, birthweight of newborn>3800 g, straining during delivery for more than 20 minutes being independently associated risk factors.
authors.affiliation: Centre of Abdominal Surgery, Vilnius University, Vilnius, Lithuania.
authors.forename: T
authors.initials: T
authors.lastname: Poskus
authors.forename: D
authors.initials: D
authors.lastname: Buzinskienė
authors.forename: G
authors.initials: G
authors.lastname: Drasutiene
authors.forename: N E
authors.initials: NE
authors.lastname: Samalavicius
authors.forename: A
authors.initials: A
authors.lastname: Barkus
authors.forename: A
authors.initials: A
authors.lastname: Barisauskiene
authors.forename: J
authors.initials: J
authors.lastname: Tutkuviene
authors.forename: I
authors.initials: I
authors.lastname: Sakalauskaite
authors.forename: J
authors.initials: J
authors.lastname: Drasutis
authors.forename: A
authors.initials: A
authors.lastname: Jasulaitis
authors.forename: A
authors.initials: A
authors.lastname: Jakaitiene
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D015331:Cohort Studies; D003248:Constipation / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005401:Fissure in Ano / Q000453:epidemiology*; D006484:Hemorrhoids / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008097:Lithuania / Q000453:epidemiology; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000453:epidemiology*; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Anal fissure; haemorrhoids; pregnancy; prospective study; risk