PREGNANT AND POSTPARTUM HEMORRHOIDS: FREQUENCY, RISK FACTORS AFFECTING WOMEN’S QUALITY OF LIFE, TREATMENT. LITERATURE REVIEW
Summary. The aim of this study is to review the prevalence, risk factors, treatment methods and diseases impact to quality of life of women and women with anal defects while giving birth. Anal disease (hemorrhoids and anal fissures) is a common pathology during pregnancy and after childbirth lacking focus by specialists’, both coloproctologist and obstetrician-gynecologist. It is important to evaluate the prevalence and risk factors of these diseases, their relation to pregnancy and childbirth factors, to diagnose and treat these diseases in time and to find ways to prevent it, thus improving the quality of life of women during pregnancy and childbirth, and after childbirth. Methods. Scientific literature review of European and US guidelines for the treatment of hemorrhoids was performed. Results and conclusions. During pregnancy, symptoms of hemorrhoids appear or worsen up to 40% of women, with the most common diagnosis (>90%) being hemorrhoids. It usually occurs in the third trimester of pregnancy and 1–2 days after giving birth. The main risk factors for hemorrhoids are: anal disease during pregnancy and childbirth, constipation during pregnancy, instrumental delivery (vacuum fetal extraction and forceps), prolonged period of stiffness and large newborn. Anal diseases worsen the quality of life of pregnant women. Perianal thrombosis and internal thrombosis hemorrhoids are acute condition of pregnant women’ anus. Both diseases present with intense, sudden onset pain and force patients to seek medical help quickly. Conservative treatment with adequate pain relief, oral and topical flavonoids is recommended for these patients. One of the most commonly used preparations is the combination of tribenoside and lidocaine. The drug is used in the form of a rectal cream Tribenosidum 5%/Lidocainum 2% and suppositories Tribenosidum 400 mg/Lidocainum 40 mg (http://www.vvkt.lt). It may be used during pregnancy from the 4th month of pregnancy; however, it should not be used during the first trimester of pregnancy (http://www.vvkt.lt). The recommended dose should not be exceeded in any cases. The medicine should be taken both in the morning and evening until the symptoms disappear, usually for 7 to 10 days. Thereafter, the dose may be reduced to once a day for up to three weeks. Warm baths are recommended while using this medicine, thus, by reducing the tone of the inner anus, improves the blood flow to the anus and relieves pain. In exceptional cases of perianal thrombosis, of a very large hemorrhoidal nodule, thrombectomy can be performed, but it is not recommended by most surgeons. Surgical interventions for internal hemorrhoidal thrombosis are also not recommended, as they increase the risk of anal injury and anal stenosis. In the absence of acute conditions, as with most other surgical diseases, surgical treatment of hemorrhoids is delayed until after the pregnancy and childbirth, and most commonly until after the end of the lactation period.