Influence of Bowel Habit and Hormonal Changes on the Development of Hemorrhoidal Disease During Pregnancy and Post Delivery Period: A Prospective Cohort Study

BACKGROUND Haemorrhoidal disease in women during pregnancy is common in clinical practice. However, there are scarce prospective data on its real prevalence and women's demographics. OBJECTIVE The aim was to determine the prevalence of haemorrhoidal disease during pregnancy and to assess its impact on quality of life. Additionally, to identify the relationship between patients' characteristics, bowel habits, hormonal changes, and the presence of symptomatic haemorrhoids. DESIGN Prospective longitudinal cohort study. SETTING This study was conducted in Obstetrics Department for pregnancy follow-up. PATIENTS A cohort of pregnant women. INTERVENTION The study was designed to follow up a homogeneous cohort of women for 15 months. Visits took place in the first and third trimesters of pregnancy, and 3 and 6 months after delivery. Women's demographics (age, past medical history, bowel habit, Bristol stool scale) and serum determination of pregnancy-related hormones (estrogen, progesterone, and relaxin) were determined. MAIN OUTCOME MEASURES The primary outcome was the development of hemorrhoidal disease. RESULTS Overall, 109 women (mean age, 31.2 ± 5.4 years) were included in the study. The prevalence of symptoms and physical findings of haemorrhoidal disease was present in 11% in the first trimester, 23% in the third trimester, 36.2% at 1 month post-delivery, and 16.9% at 3 months post-delivery. A previous medical history of haemorrhoidal disease was significantly associated with diagnosis of haemorrhoids in the first trimester (p<0.0001) and third trimester (p=0.005). Symptoms of constipation were associated with this clinical disorder in the first trimester (p=0.011) and third trimester of pregnancy (p=0.022), respectively. No association was found between hormonal changes and development of haemorrhoidal disease. LIMITATIONS a larger sample would provide more information. CONCLUSIONS Prevalence of women with haemorrhoidal disease increased during pregnancy and post-delivery. A previous history of haemorrhoidal disease and constipation were significantly associated with diagnosis of symptomatic haemorrhoidal disease. See Video Abstract at http://links.lww.com/DCR/B504.