Pregnancy, hemorrhoids & co.

Proctologists are among the most frequent visitors to obstetrics departments. Proctologic problems in pregnancy, and in particular constipation, hemorrhoids, anal fissures, and pelvic floor dysfunction, are indeed very frequent, and often persist even after sweet expectation. In fact, the peak is reached immediately after childbirth (especially if it was a vaginal delivery), with rates as high as over 30% for hemorrhoids; but the whole pregnancy, and especially the last trimester, can be affected.
The reason is simple: just think of the gradual increase in abdominal pressure that occurs during gestation. The baby develops and grows, and with it the uterus, which begins to compress the abdominal organs; constipation appears, which can be aggravated by taking iron supplements, often prescribed by gynecologists. Venous pressure increases, which hinders the outflow of blood from the hemorrhoid pads: which, along with constipation, can cause hemorrhoidal congestion and formation of a mucous prolapse. It is also not uncommon for thrombi, i.e., blood clots, to form within the hemorrhoids: these are usually very painful and often require urgent surgical treatment, which consists of incision of the thrombosed hemorrhoid and removal of the clots.
With constipation, then, anal fissure goes hand in hand. Anal fissure is a laceration of the anodermis, caused in most cases by the elimination of hard, dehydrated feces; it is a very painful lesion, especially at the time of defecation, and the pain may persist for hours after that. The mechanism that self-sustains fissures is diabolical: the anodermis is torn, which causes pain that causes spasm of the internal anal sphincter; this results in decreased blood flow to the area of the wound, which because of this does not tend to heal, and in this way the cycle begins again.

Proctological problems in pregnancy: what treatment?

Treatments of proctologic problems in pregnancy are limited by two considerations: the first is that many medications cannot be taken by mothers-to-be; for example, anal fissure therapy involves so-called chemical sphincterotomy, that is, the local application of ointments containing active ingredients that cause the release of the internal anal sphincter: these active ingredients are contraindicated in pregnancy. The second consideration is that we try to procrastinate surgical interventions as much as possible, because it is not uncommon that after childbirth the pathological condition is reduced, especially in the case of hemorrhoids: so an acute picture that would seem to indicate urgent intervention, often, a month after childbirth, is resolved with "simple" sessions of elastic ligatures.
How to avoid, of course as far as possible, proctological problems in pregnancy? The most important thing is to maintain regular bowel movements: going to the bowels regularly, if possible every day, and with soft stools shelters (within certain limits) the appearance of fissures and hemorrhoidal crises. Fiber supplements can be taken - there are plenty on the market - and it is extremely important to drink a lot (at least a couple of liters of water a day) and enrich the diet with fruits and vegetables. The advice of the coloproctologist is always essential.
The appearance of acute and worsening anal pain should prompt the new mother to urgently consult her trusted coloproctologist, who will know what to do, what to prescribe, and, at the limit, whether to indicate urgent surgery.