Constipation, Hemorrhoids, and Anorectal Disorders in Pregnancy

Rao, Satish S.C.; Qureshi, Waqar; Yan, Yun; Johnson, David A.

doi:10.14309/ajg.0000000000001962

Cited by 16 publications

(8 citation statements)

References 46 publications

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“…[10] A prospective study of 165 pregnant women found that 1/3 of them had persistent external hemorrhoids after delivery. [13] And pregnancy is often complicated by symptoms of constipation, [14] which is a known risk factor for hemorrhoids, [10,15] most of which are accompanied by an uncoordinated defecation process, and this lack of synergy during defecation leads to degenerative disintegration of the connective tissue supporting the anal cushion, resulting in a distal displacement of the anal cushion. A meta-analysis comparing 3 studies found that the prevalence of hemorrhoids was significantly higher in constipated patients than in non-constipated patients.…”

Section: Discussionmentioning

confidence: 99%

“…In women with a history of multiple deliveries, the risk of developing hemorrhoids is greatly increased, [10] the process of childbirth strains the connective tissue, leading to a decrease in the tensile strength of the tissue and loss of elasticity. Second, hormonal changes (estrogen, progesterone, etc.)…”

Section: Discussionmentioning

confidence: 99%

“…[11] The mechanical stability of the anal cushion, blood vessels, and surrounding tissue anchoring system is reduced, [12] leading to the recurrence of hemorrhoids. [10] A prospective study of 165 pregnant women found that 1/3 of them had persistent external hemorrhoids after delivery. [13] And pregnancy is often complicated by symptoms of constipation, [14] which is a known risk factor for hemorrhoids, [10,15] most of which are accompanied by an uncoordinated defecation process, and this lack of synergy during defecation leads to degenerative disintegration of the connective tissue supporting the anal cushion, resulting in a distal displacement of the anal cushion.…”

Section: Discussionmentioning

confidence: 99%

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Establishment and validation of clinical prediction model for hemorrhoid recurrence after procedure for prolapse and hemorrhoids

Sun

Han

2023

Medicine

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This study aimed to establish a clinical model to predict the risk of hemorrhoid recurrence after procedure for prolapse and hemorrhoids. The clinical data of patients who underwent stapler hemorrhoidal mucosal circumcision in Shanxi Bethune Hospital from April 2014 to June 2017 were collected retrospectively and followed up regularly after the operation. Finally, 415 patients were included, which were divided into training group (n = 290) and verification group (n = 125). Logistic regression method was used to select meaningful predictors. The prediction model was constructed with nomographs, and the model was evaluated with correction curve, receiver operating characteristic curve and C index. The decision analysis curve was used to determine the clinical utility of the nomogram. Birth history, muscle attachment, postoperative anal urgency, anal resting pressure, postoperative nutritional index, body mass index, Wexner score, and hemorrhoid grading were included in the nomogram. The area under the curve of the prediction model was 0.813 and 0.679, respectively, in the training and verification groups, and 0.839 and 0.746, respectively, for the 5-year recurrence rate. The C index (0.737) and clinical decision curve showed that the model had high clinical practical value. The prediction model of hemorrhoid recurrence risk after hemorrhoidectomy based on multiple clinical indicators can be used for individualized prediction of hemorrhoid recurrence in patients after hemorrhoidectomy, and early intervention measures can be given to individuals with a high recurrence risk to reduce the risk of recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Establishment and validation of clinical prediction model for hemorrhoid recurrence after procedure for prolapse and hemorrhoids

Sun

Han

2023

Medicine

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“…Hemorrhoids are common during pregnancy, as discussed in detail in the articles on constipation, hemorrhoids (41), and fecal incontinence (42) in this monograph. Conservative, nonoperative management strategies including dietary changes (water, fiber), stool softeners, ointments, suppositories, toileting and hygiene changes, etc.…”

Section: Hemorrhoidsmentioning

confidence: 95%

Surgery in Pregnancy

Lightner

Mathis

2022

Am J Gastroenterol

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“…This guideline is limited to covering pharmacological interventions for the treatment of CIC in otherwise healthy adults and does not apply to pediatric populations or to individuals who are pregnant or with opioid-induced constipation or malignancy. The evidence on the management of constipation during pregnancy has been reviewed in a recent publication that discusses the safety of almost all the pharmacological agents assessed in this guideline (86). This guideline does not review anorectal evacuation disorders that were evaluated in a recent ACG guideline (87) and an AGA review (80).…”

Section: Limitations and Evidence Gapmentioning

confidence: 99%

American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation

et al. 2023

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INTRODUCTION:Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College of Gastroenterology, aims to inform clinicians and patients by providing evidence-based practice recommendations for the pharmacological treatment of CIC in adults.METHODS:The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of the following agents: fiber, osmotic laxatives (polyethylene glycol, magnesium oxide, lactulose), stimulant laxatives (bisacodyl, sodium picosulfate, senna), secretagogues (lubiprostone, linaclotide, plecanatide), and serotonin type 4 agonist (prucalopride). The panel prioritized clinical questions and outcomes and used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention. The Evidence to Decision framework was used to develop clinical recommendations based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations.RESULTS:The panel agreed on 10 recommendations for the pharmacological management of CIC in adults. Based on available evidence, the panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride for CIC in adults. Conditional recommendations were made for the use of fiber, lactulose, senna, magnesium oxide, and lubiprostone.DISCUSSION:This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation.

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Constipation, Hemorrhoids, and Anorectal Disorders in Pregnancy

Cited by 16 publications

References 46 publications

Establishment and validation of clinical prediction model for hemorrhoid recurrence after procedure for prolapse and hemorrhoids

Establishment and validation of clinical prediction model for hemorrhoid recurrence after procedure for prolapse and hemorrhoids

Surgery in Pregnancy

American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation

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