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Fathallah N, Alam A, Rentien AL, La Greca G, Co J, Pommaret E, Barré A, Kegne S, Beaussier H, Spindler L, de Parades V. Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management. J Visc Surg 2024; 161:161-166. [PMID: 38580520 DOI: 10.1016/j.jviscsurg.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
INTRODUCTION There are very few French studies on hemorrhoidal disease and its management. PATIENTS AND METHODS Prospective single-center study from July to December 2021 including 472 patients. RESULTS Bleeding, prolapse and pain were the main reasons for consultation. Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%). After treatment, the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively), but improvement was more marked in the surgery group with a better rate of "very good satisfaction" (73% vs. 54%, P=0.003). Factors associated with likelihood of surgical treatment were: age>44years, hypertrophic perianal skin tags, high scores (Bristol>5, bleeding>5, prolapse>2), severe impact on quality of life, smoking and reading during bowel movements. We have developed an online application, which aims to assess the risk of requiring hemorrhoidal surgery. CONCLUSION Less than 20% of patients who present with hemorrhoidal disease require surgical treatment, but it is associated with better effectiveness despite more complex postoperative consequences that sometimes motivate patient refusal. We have highlighted factors associated with surgical management, which can guide the practitioner in their therapeutic choices.
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Affiliation(s)
- Nadia Fathallah
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - Amine Alam
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Anne L Rentien
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Giorgio La Greca
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Joshua Co
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Elise Pommaret
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Amélie Barré
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Stéphane Kegne
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Hélène Beaussier
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Lucas Spindler
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Vincent de Parades
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
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D'Alfonso A, De Carolis F, Serva A, Valiyeva S, Guido M, Pietroletti R. Haemorrhoidal disease in pregnancy: results from a self-assessment questionnaire administered by means of a social network. BMC Gastroenterol 2024; 24:150. [PMID: 38698334 PMCID: PMC11064321 DOI: 10.1186/s12876-024-03228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/15/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The anal symptoms occurring during pregnancy and post-partum, mainly related to Haemorrhoidal Disease (HD), have been reported with in a wide range of incidence in the literature. Although in many cases the course of the disease is mild and self-limiting, sometimes it is severe enough to affect quality of life. METHODS Our study has been conducted through a questionnaire administered via social media with the aim of obtaining epidemiologic data on the incidence of the symptoms of HD in an unselected population of pregnant women. In addition, we looked for the presence of those factors notoriously predisposing or associated to HD (constipation, straining on the toilet, low dietary fibres and fluid intake). RESULTS Out of 133 patients 51% reported symptoms of HD during pregnancy, mainly in the second and third trimester. Constipation, straining on the toilet, low dietary fibres and fluid intake were not significantly related to incidence of HD. Only a previous history of HD was correlated to onset of symptoms of HD in pregnancy and reached a statistical significance (odds ratio = 5.2, p < 0.001). CONCLUSION Although with the limitations posed by the nature of our retrospective study via a self-assessment interview, our results suggest that the occurrence of HD in pregnancy seems not sustained by the classical risk factors observed in the general population. At the moment, specific therapeutic measures are lacking and treatment relies on empiric suggestions concerning diet, fluid intake, bowel care, local ointment. Further studies are needed in order to identify a targeted etiologic treatment.
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Affiliation(s)
- Angela D'Alfonso
- Unit of Obstetrics and Gynaecology, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca De Carolis
- Surgical Coloproctology, University of L'Aquila, Hospital Val Vibrata, Sant'Omero, TE, Italy
| | - Alessandro Serva
- Unit of Obstetrics and Gynaecology, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sayali Valiyeva
- Surgical Coloproctology, University of L'Aquila, Hospital Val Vibrata, Sant'Omero, TE, Italy
| | - Maurizio Guido
- Unit of Obstetrics and Gynaecology, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Renato Pietroletti
- Surgical Coloproctology, University of L'Aquila, Hospital Val Vibrata, Sant'Omero, TE, Italy.
- Department of Clinical Sciences and Biotechnology, University of L'Aquila, Surgical Coloproctolgy Hospital Val Vibrata Sant'Omero, 64027, Sant'Omero, TE, Italy.
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Togo A, Kanté L, Poudiougo A, Traoré A, Bocoum A, Traoré Y, Konaté M, Dicko MY, Samaké M, Amadou B, Touré H, Abramowitz L. Anal disorders in pregnant and postpartum women: epidemiological, diagnostic and therapeutic aspects in 10 maternities of Bamako in Mali. Pan Afr Med J 2024; 47:66. [PMID: 38681103 PMCID: PMC11055179 DOI: 10.11604/pamj.2024.47.66.36210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/07/2024] [Indexed: 05/01/2024] Open
Abstract
Bowel transit disturbances favored by pregnancy and injuries during childbirth would be triggering or aggravating factors for anal pathologies. The objective of this work was to study the epidemiology, diagnosis, and treatment of anal pathologies during pregnancy and 6 weeks after delivery. We carried out a prospective, multi-centric, and analytical study in 10 obstetric units in Bamako from June 1st, 2019, to May 31st, 2020. After informed consent, we enrolled all first-trimester pregnant women admitted to the hospitals and who were followed up through the postpartum. We conducted a rectal examination in each participant and an anoscope in those with an anal symptom. Hemorrhoidal diseases were diagnosed in the case of external hemorrhoids (thrombosis or prolapse) or internal hemorrhoids. During the study period, we followed up 1,422 pregnant women and we found 38.4% (546) with anal pathologies (hemorrhoidal diseases in 13% (192), anal fissure in 10.5% (150) and anal incontinence in 8.6% (123). Risk factors for the hemorrhoidal disease were age of patient ≥30 years old aRR=5.77, 95% CI 4.57-7.34; p=0.000; a existence of chronic constipation aRR=2.61, 95% CI 1.98-3.44; p=0.000; newborn weight >3500 g aRR= 1.61, 95% CI 1.25-2.07; p=0.000 and fetal expulsion time >20 minutes aRR= 6.04, 95% CI 5.07-7.27; p=0.000. The clinical signs observed were constipation, anal pain, bleeding, and pruritus. The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation. Anal pathologies were common during pregnancy and 6 weeks after delivery. Pregnant women must be screened systematically for such pathologies. Early diagnostic and appropriate treatment would reduce serious complications.
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Affiliation(s)
- Adégné Togo
- Department of Surgery, Teaching Hospital Gabriel Toure, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Lassana Kanté
- Department of Surgery, Teaching Hospital Gabriel Toure, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Abdoulmouinou Poudiougo
- Department of Surgery, Teaching Hospital Gabriel Toure, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Amadou Traoré
- Department of Surgery, Teaching Hospital Gabriel Toure, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Amadou Bocoum
- Department of Gynecology Teaching Hospital Gabriel Toure, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Youssouf Traoré
- Department of Gynecology Teaching Hospital Gabriel Toure, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Madiassa Konaté
- Department of Surgery, Teaching Hospital Gabriel Toure, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Moussa Younoussa Dicko
- Department of Hepato-gastroenterology Teaching Hospital Gabriel Toure, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Moussa Samaké
- Department of Surgery Secondary Hospital Commune IV, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Bah Amadou
- Department of Surgery, Teaching Hospital Gabriel Toure, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Hawa Touré
- Department of Gynecology Teaching Hospital Gabriel Toure, University of Sciences, Techniques and Technologies of Bamako (USTTB)/Faculty of Medicine and Dentistry (FMOS), Bamako, Mali
| | - Laurent Abramowitz
- Department of Hepato-gastroenterology Teaching Hospital, Bichat, Paris, France
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Boughton RS, Brophy C, Corbett G, Murphy S, Clifford J, Hanly A, Fitzpatrick M, O'Brien L. Haemorrhoids and Anal Fissures in Pregnancy: Predictive Factors and Effective Treatments. Cureus 2024; 16:e53773. [PMID: 38327723 PMCID: PMC10849161 DOI: 10.7759/cureus.53773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Haemorrhoids and anal fissures (HAF) are common in pregnancy and can severely affect the quality of life of those suffering from them. Despite the condition being common, there is limited evidence, formal guidelines or recommendations on treatment, and little is known about the natural course during pregnancy. Methods This was a prospective, observational cohort study conducted at a tertiary-referral university maternity hospital (The National Maternity Hospital, Dublin), conducted over a nine-month period. The first part of the study was a case-control study of antenatal patients over 34 weeks' gestation. The second part of the study involved a cohort of postnatal patients. Anonymous patient surveys were performed and analysed. Results Two hundred and fifty-eight patients were recruited into the study from the outpatient clinics and wards of one maternity hospital from April to December 2021. Of the antenatal patients, 82/184 (45%) of these patients had symptoms of HAF and 102/184 (55%) antenatal patients were unaffected, acting as controls. In addition, 74 affected postnatal patients were also included. In the affected antenatal group, 36/82 (44%) of patients had self-reported HAF (symptoms or signs of HAF); 50/82 (61%) of patients diagnosed with HAF on their own. 12/82 (15%) noticed symptoms in the first trimester, 25/82 (30%) in the second and 45/82 (55%) in the third. 142/184 (77%) of antenatal patients used conservative methods to manage their symptoms, including an increase in dietary fibre. 144/184 (78%) used medical treatments including suppositories. Only one patient had surgery. 70/156 (45%) of postnatal patients' symptoms resolved within days, 42/156 (27%) in weeks and 44/156 (28%) within months. Conclusion HAF affect almost half of the pregnancies. Age over 35 was significantly associated with antenatal haemorrhoids or anal fissures. Concerningly, the majority of patients (64%) self-diagnose and manage the condition without either seeking or receiving guidance from medical professionals. In terms of the natural course of the disease, it was encouraging that 45% of patients' symptoms resolved within a few days. This will help when counselling patients with distressing symptoms. Conservative measures such as increased dietary fibre, increased fluid intake and bath salts were effective in relieving symptoms for the majority of patients.
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Affiliation(s)
- Rebecca S Boughton
- Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, IRL
| | - Caroline Brophy
- Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, IRL
| | - Gillian Corbett
- Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, IRL
| | - Sophie Murphy
- Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, IRL
| | - Jacqui Clifford
- Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, IRL
| | - Ann Hanly
- Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, IRL
| | - Myra Fitzpatrick
- Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, IRL
| | - Laoise O'Brien
- Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, IRL
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Porwal A, Gandhi P, Mokashi-Bhalerao N, Borkar N, Khobragade K. Efficacy and Safety of Oral Euphorbia prostrata Tablet and Topical Cream in the Management of Hemorrhoids During Pregnancy: Results From a Prospective Multicenter Study. Cureus 2024; 16:e54152. [PMID: 38496090 PMCID: PMC10940957 DOI: 10.7759/cureus.54152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 03/19/2024] Open
Abstract
This is a non-randomized, open-label, prospective single-arm interventional multicentric study conducted between 2021 and 2022 at three different centers situated in Pune, India. It was conducted to evaluate the efficacy and safety of the Sitcom® tablet (Euphorbia prostrata 100 mg) once daily and Sitcom® cream (Euphorbia prostrata 1%w/w) for 14 days in hemorrhoids during pregnancy. The endpoints were to assess hemorrhoidal symptoms relief during the follow-up periods (one, two, four, and eight weeks and 30 days postpartum), relapse of symptoms, improvement in the disease condition at week two and 30 days postpartum, and adverse events. A total of 100 patients (mean age 24.1 years) were included; the majority (71.0%) had mild per-rectal bleeding, 69.0% with mild itching and 46.0% with moderate pain during defecation. The mean score of per-rectal bleeding and pain at defecation showed a significant reduction at each visit (86.6% and 49.3% (two weeks), 95.3% and 59.9% (four weeks), and 100% and 77.6% (eight weeks)). The mean pain score at defecation, itching, exudates, and swelling showed a significant reduction of 77.6%, 96.9%, 100%, and 84.5% at eight weeks (p<0.001). After two weeks and post postpartum follow-up, >90% and 100% good to excellent overall improvement in the disease condition were noted, respectively. No adverse events in the mother or newborn were noted. This pivotal study underscores the potential of a combination therapy with Euphorbia prostrate 100 mg tablet and cream 1% as a potential solution for managing the distressing burden of hemorrhoids in pregnant women. Furthermore, these observations will empower clinicians in the judicious selection of the most suitable course of action for hemorrhoid management during pregnancy.
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Affiliation(s)
| | | | - Nameeta Mokashi-Bhalerao
- Obstetrics, Gynaecology and Reproductive Medicine, Cloudnine Hospital, Pune, IND
- Surgery, Healing Hands Clinic, Pune, IND
| | - Nilesh Borkar
- Medical Affairs, Mankind Pharma Ltd., Navi Mumbai, IND
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De Guadalupe Quintana-Coronado M, Bravo C, Álvarez-Mon M, Ortega MA, De León-Luis JA. News in pharmacology for the main medical pathologies of gestation. Front Pharmacol 2024; 14:1240032. [PMID: 38239189 PMCID: PMC10794658 DOI: 10.3389/fphar.2023.1240032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
Obstetric diseases represent a highly complex medical challenge, especially regarding its clinical approach. The use of pharmacological agents during pregnancy is one of the main therapeutic alternatives in this group of patients; however, there is a general lack of knowledge about its use, efficacy, and possible adverse effects that may occur in routine clinical practice, even among medical professionals themselves. The high percentage of pregnant women who undergo drugs at some point during pregnancy, together with the developments that have occurred in recent years in the field of pharmacology, show the need for a detailed analysis that shows the existing current knowledge and helps in the clinical decision making. In this sense, the aim of this work is to conduct a review of the available scientific literature on the novelties in pharmacology for the main medical pathologies of pregnancy. Thus, the role of this field in analgesia, antibiotic therapy, digestive, respiratory, urological, psychiatric and neurological pathologies will be detailed, evaluating the indications, precautions and considerations that must be taken into account for its use.
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Affiliation(s)
- María De Guadalupe Quintana-Coronado
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Coral Bravo
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Alcalá de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Juan A. De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
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Chen YY, Chang CY, Lin CH, Cheng LY, Shih WT, Chen KJ, Yang YH. Prevalence, Characteristics, and Treatment of Hemorrhoids During Pregnancy: A Nationwide Population-Based Cohort Study in Taiwan. J Womens Health (Larchmt) 2023; 32:1394-1401. [PMID: 37582215 DOI: 10.1089/jwh.2023.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Background: Hemorrhoids, a gastrointestinal tract disorder, are common during pregnancy. However, large-scale epidemiological studies on hemorrhoids during pregnancy are limited. Therefore, this study used analyzed data from a nationwide population-based database to investigate the prevalence, characteristics, and treatment of hemorrhoids in Taiwan. Materials and Methods: This retrospective population-based study used data from the National Health Insurance Research Database and Taiwan Birth Certificate Application to collect the medical records of women who were pregnant at any time during 2009-2018. Hemorrhoids was defined by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) (455. X) and International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) (K64.X, O22.4X) with related treatment. Results: We enrolled 1,608,804 deliveries in 1,070,708 women. The proportion of hemorrhoids increased with age in both primipara and multipara women. Of the pregnant women, 31% received oral medication, and 93.2% used the topical ointment to treat their hemorrhoids. Few patients (1.8%) required procedure or surgery during pregnancy, and 41.4% of those patients underwent procedure or surgery in their first trimester. The cumulative incidence of hemorrhoids during pregnancy was significantly higher in women with a history of hemorrhoids and those with multifetal pregnancies. No significant difference in the incidence of hemorrhoids was observed between multiparous and primiparous women. Conclusion: Women with a history of hemorrhoids or those carrying multiple fetuses had an increased risk of hemorrhoids during pregnancy. The most commonly used treatment for hemorrhoids during pregnancy was topical ointments, with only a small proportion (1.8%) of patients requiring procedure or surgery.
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Affiliation(s)
- Yu-Ying Chen
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Chao-Yang Chang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Chih-Hsuan Lin
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Ling-Yun Cheng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Puzi, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Tai Shih
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Ko-Jung Chen
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Puzi, Taiwan
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Puzi, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Luo H, He X, Wang M, Zheng X, Peng R, Wang C, Li Q, Yang B. Comparision of Ligasure hemorrhoidectomy and conservative treatment for thrombosed external hemorrhoids (TEH) in pregnancy. BMC Surg 2023; 23:15. [PMID: 36658522 PMCID: PMC9850810 DOI: 10.1186/s12893-023-01910-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Ligasure hemorrhoidectomy for thrombosed external hemorrhoids in pregnancy has been rarely studied. OBJECTIVE The purpose of this article is to study the efficacy and safety of Ligasure hemorrhoidectomy comparing with conservative treatment for thrombosed external hemorrhoids in pregnancy. DESIGN This was a retrospective cohort study. SETTING The patients were treated at a tertiary referral center in China. PATIENTS 94 pregnant patients hospitalized for thrombosed external hemorrhoids from September 2020 to December 2021. INTERVENTIONS Ligasure hemorrhoidectomy treatment or conservative treatment according to the patient's wishes. MAIN OUTCOME MEASURES Symptom relief, recurrence and satisfaction of thrombosed external hemorrhoids in pregnancy with different interventions. RESULTS There were no differences between groups in maternal age, gestational age, body mass index, parity, constipation and a prior history of thrombosed external hemorrhoids. The pain scores were less in surgical group than in conservative group in post-treatment days 1 and 7. Time to return to normal activities was shorter in surgical group than in conservative group (6.51 vs. 13.52 days, P < 0.001). Post-treatment complications were mild in surgical group and there were no significant differences concerning the rate of abortion, preterm birth, cesarean delivery and weight of fetus. Recurrence rate was significantly lower in surgical group (8.57% vs. 30.43%, P = 0.017). The patient satisfaction scores were significantly higher in surgical group than in conservative group (Z = - 2.979, P = 0.003). LIMITATIONS This was a retrospective study with a limited number of patients, the data was obtained from only one center. CONCLUSIONS Comparing with conservative treatment, Ligasure hemorrhoidectomy for TEH in pregnancy results in more rapid pain relief, shorter time to return to normal activities, lower incidence of recurrence, and better patient satisfaction. This type of surgery has low and mild postoperative complications, is not attended by any risk to the mother or her fetus.
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Affiliation(s)
- Huihua Luo
- grid.410745.30000 0004 1765 1045Department of Colorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China ,grid.33199.310000 0004 0368 7223Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xiaojun He
- grid.33199.310000 0004 0368 7223Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Min Wang
- grid.410745.30000 0004 1765 1045Department of Colorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaosong Zheng
- grid.33199.310000 0004 0368 7223Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Rong Peng
- grid.33199.310000 0004 0368 7223Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Chenwei Wang
- grid.33199.310000 0004 0368 7223Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Qiu Li
- grid.33199.310000 0004 0368 7223Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Bolin Yang
- grid.410745.30000 0004 1765 1045Department of Colorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Rathi R, Sanshita, Kumar A, Vishvakarma V, Huanbutta K, Singh I, Sangnim T. Advancements in Rectal Drug Delivery Systems: Clinical Trials, and Patents Perspective. Pharmaceutics 2022; 14:2210. [PMID: 36297645 PMCID: PMC9609333 DOI: 10.3390/pharmaceutics14102210] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 07/30/2023] Open
Abstract
The rectal route is an effective route for the local and systemic delivery of active pharmaceutical ingredients. The environment of the rectum is relatively constant with low enzymatic activity and is favorable for drugs having poor oral absorption, extensive first-pass metabolism, gastric irritation, stability issues in the gastric environment, localized activity, and for drugs that cannot be administered by other routes. The present review addresses the rectal physiology, rectal diseases, and pharmaceutical factors influencing rectal delivery of drugs and discusses different rectal drug delivery systems including suppositories, suspensions, microspheres, nanoparticles, liposomes, tablets, and hydrogels. Clinical trials on various rectal drug delivery systems are presented in tabular form. Applications of different novel drug delivery carriers viz. nanoparticles, liposomes, solid lipid nanoparticles, microspheres, transferosomes, nano-niosomes, and nanomicelles have been discussed and demonstrated for their potential use in rectal administration. Various opportunities and challenges for rectal delivery including recent advancements and patented formulations for rectal drug delivery have also been included.
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Affiliation(s)
- Ritu Rathi
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Sanshita
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Alpesh Kumar
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | | | | | - Inderbir Singh
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Tanikan Sangnim
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi 20131, Thailand
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10
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Bužinskienė D, Sabonytė-Balšaitienė Ž, Poškus T. Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women's Quality of Life and Treatment Methods. Front Surg 2022; 9:788823. [PMID: 35252326 PMCID: PMC8894587 DOI: 10.3389/fsurg.2022.788823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Hemorrhoids and anal fissures occur in about 40% of pregnant women and women during postpartum period. Usually they occur during the third trimester of pregnancy and 1–2 days after giving birth. Constipation during pregnancy, perianal diseases during previous pregnancy and childbirth, instrumental delivery, straining duration of more than 20 min, and weight of the newborn more than 3,800 g are associated with hemorrhoids. Perianal diseases reduce the quality of life of both pregnant and postpartum women. In the absence of acute conditions, surgical treatment of hemorrhoids is delayed after pregnancy, childbirth, and lactation. Thrombosed internal hemorrhoids and perianal thrombosis are to be treated conservatively in most instances by prescribing adequate pain relief, oral, and topical flavonoid preparations.
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Affiliation(s)
- Diana Bužinskienė
- Clinic of Obstetrics and Gynecology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Tomas Poškus
- Clinic of Gastroenterology, Nephrourology, and Surgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- *Correspondence: Tomas Poškus
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11
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Hong YS, Jung KU, Rampal S, Zhao D, Guallar E, Ryu S, Chang Y, Kim HO, Kim H, Chun HK, Sohn CI, Shin H, Cho J. Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults. Sci Rep 2022; 12:129. [PMID: 34996957 PMCID: PMC8741788 DOI: 10.1038/s41598-021-03838-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/06/2021] [Indexed: 12/11/2022] Open
Abstract
Hemorrhoidal disease is a highly prevalent anorectal condition causing substantial discomfort, disability, and decreased quality of life. Evidence on preventable risk factors for hemorrhoidal disease is limited. We conducted a cross-sectional study of 194,620 healthy men and women who completed a health screening exam including colonoscopy in 2011–2017. We evaluated potential risk factors of hemorrhoidal disease, including lifestyle factors, medical history, birth history, gastrointestinal symptoms, and anthropometric measurements. The prevalence of hemorrhoidal disease was 16.6%, and it was higher in females than in males (17.2 vs. 16.3%; P < 0.001). Compared to men, the prevalence of hemorrhoidal disease was higher in parous women (adjusted odds ratio [OR] 1.06; 95% confidence interval [CI] 1.02–1.10), and lower in nulliparous women (adjusted OR 0.92; 95% CI 0.86–0.98). In the adjusted analyses, older age, female sex, smoking, overweight, and being hypertensive were independently associated with the presence of hemorrhoidal disease. The prevalence of hemorrhoidal disease was positively associated with body mass index and waist circumference in parous women. The prevalence of hemorrhoidal disease was higher in older age, females, ever-smokers, and hypertensive participants. The association of excess adiposity with the prevalence of hemorrhoidal disease differed by sex and parity.
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Affiliation(s)
- Yun Soo Hong
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, South Korea
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala, Lumpur, Malaysia
| | - Di Zhao
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seungho Ryu
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosoo Chang
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Ook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, South Korea
| | - Hungdai Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, South Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, South Korea.
| | - Chong Il Sohn
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hocheol Shin
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Juhee Cho
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. .,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.
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12
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Story L, Rafique S, Samadi N, Mawdsley J, Singh B, Banerjee A. Lower gastrointestinal bleeding in pregnancy: Differential diagnosis, assessment and management. Obstet Med 2021; 14:129-134. [PMID: 34646340 PMCID: PMC8504301 DOI: 10.1177/1753495x20948300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022] Open
Abstract
Rectal bleeding is a common symptom experienced by pregnant women. Although the majority of cases are attributable to benign conditions such as haemorrhoids and anal fissures, other more serious diagnoses such as inflammatory bowel disease and malignancy should not be overlooked. Most investigations are safe during pregnancy and these should not be withheld as significant implications on both fetal and maternal morbidity may result. In these cases, a multidisciplinary team approach is essential. This review explores the differential diagnosis, investigation and management of rectal bleeding during pregnancy.
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Affiliation(s)
- L Story
- Department of Women and Children's Health King's College, London, UK.,Women's Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Rafique
- King's College London Medical School, London, UK
| | - N Samadi
- King's College London Medical School, London, UK
| | - J Mawdsley
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B Singh
- Department of Surgery, University Hospitals Leicester, Leicester, UK
| | - A Banerjee
- Women's Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
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13
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De Marco S, Tiso D. Lifestyle and Risk Factors in Hemorrhoidal Disease. Front Surg 2021; 8:729166. [PMID: 34485376 PMCID: PMC8416428 DOI: 10.3389/fsurg.2021.729166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Constipation, a low fiber diet, a high Body Mass Index, pregnancy, and a sedentary lifestyle are often assumed to increase the risk of hemorrhoidal disease (HD). However, evidence regarding these factors is controversial. This mini-review aims to examine and critically analyze the association between main risk factors and the prevalence of HD, focusing both on the patient's clinical history and on a tailored treatment. Moreover, some practical suggestions about lifestyle and conservative approaches are given to help clinicians in the management of patients with HD and to obtain the best results from therapy.
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Affiliation(s)
| | - Domenico Tiso
- Department of Nutrition, Accredited Hospital "Villa Maria, " Rimini, Italy
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14
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Madsen C, Tolstrup J, Siddiqi MZ, Lauenborg J. A flexible silicone patch for treatment of hemorrhoids after birth: a pilot study of HEMOCIN® Patch. Int J Colorectal Dis 2021; 36:1069-1072. [PMID: 33392664 DOI: 10.1007/s00384-020-03817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE To test a non-pharmacological silicone patch for treatment of symptomatic hemorrhoids with focus on usability, safety, and self-reported short-term effect. METHODS Puerperal women in a Danish maternity ward were cluster randomized to treatment with the HEMOCIN® patch (intervention) or no systematic treatment (control group). On inclusion and after 2 weeks, they completed a questionnaire regarding history and hemorrhoid symptoms scored from 0 to 10. Women in the intervention group also reported on the usability of the patch and any side effects. RESULTS We included 31 women in the intervention group and 33 in the control group. Twenty-eight (90.3%) women in the intervention group and 27 (81.8%) women in the control group responded to follow-up. Except from a difference in the severity of swelling at inclusion, there were no differences between the two groups for any symptoms, neither at inclusion, nor at follow-up, or in the change of symptoms during the two weeks (p > 0.05). Twenty-three women (85.2%) in the control group used medical treatment vs. one woman in the intervention group. The patch was used on an average of 9.3 days, 15.5 h/day and for 7.1 h before changing the patch. No severe side effects were reported. CONCLUSION This pilot study finds that the HEMOCIN® patch is a safe and feasible treatment option for hemorrhoids. However, we did not detect any significant effect on hemorrhoid symptoms. The patch could be an option for people who seek non-pharmacological treatment for symptomatic hemorrhoids or need long-term treatment without steroid side effects.
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Affiliation(s)
- Caroline Madsen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital Herlev, Herlev, Denmark.
| | - Johan Tolstrup
- Department of Abdominal Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - M Zara Siddiqi
- Department of Gynecology and Obstetrics, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Jeannet Lauenborg
- Department of Gynecology and Obstetrics, Copenhagen University Hospital Herlev, Herlev, Denmark.,Department of Gynecology, Obstetrics and Pediatrics, Nykoebing Falster Hospital, Nykoebing Falster, Denmark
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15
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Xia W, Barazanchi AWH, Coomarasamy C, Jin J, Maccormick AD, Sammour T, Hill AG. Epidemiology of haemorrhoids and publicly funded excisional haemorrhoidectomies in New Zealand (2007-2016): a population-based cross-sectional study. Colorectal Dis 2021; 23:265-273. [PMID: 32978872 DOI: 10.1111/codi.15376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/26/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023]
Abstract
AIM Haemorrhoids are frequently encountered by the general or colorectal surgeon. Although a benign disease, those with symptomatic, advanced grades frequently require excisional haemorrhoidectomy for definitive management. Despite their widespread nature, the epidemiological burden of haemorrhoids and haemorrhoidectomies on populations is not well described. This study seeks to establish the incidence of both haemorrhoids diagnosed and haemorrhoidectomies performed in New Zealand. METHOD This is a population-based cross-sectional study examining the incidence of all patients who were newly diagnosed with haemorrhoids in New Zealand public hospital outpatient clinics and those who received excisional haemorrhoidectomy in New Zealand public hospitals from 2007 to 2016. Data were extracted and linked using the New Zealand National Minimum Dataset and the National Non-Admitted Patient Collection. Variables collected included age group, sex, ethnicity and geographical location. RESULTS A total of 46 095 recorded diagnoses of haemorrhoids were made, with a total of 18 739 haemorrhoidectomies in the 10-year period recorded. The incidence rate of diagnosis increased from 84.6 to 120.5 per 100 000 and the incidence rate of haemorrhoidectomies performed from 30.4 to 51.1 per 100 000, a significantly increased annual incidence. There was a unimodal peak prevalence in the fifth decade of life with women more affected. Europeans formed the largest group affected, with Asians showing the highest rate of increased incidence. CONCLUSION There is an increasing incidence of patients with symptomatic haemorrhoids presenting to the New Zealand public healthcare system, with a preponderance in working age adults, especially women.
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Affiliation(s)
- Weisi Xia
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| | - Ahmed W H Barazanchi
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| | - Christin Coomarasamy
- Counties Manukau Research Office, Ko Awatea, Counties Manukau District Health Board, Auckland, New Zealand
| | - James Jin
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| | - Andrew D Maccormick
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau District Health Board, Auckland, New Zealand
| | - Tarik Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrew G Hill
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau District Health Board, Auckland, New Zealand
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16
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Lee KY, Lee JI, Park YY, Kim YS, Lee DH, Chae HS, Lee TK, Sohn TS, Jeong SC, Lee YB, Han K. Hemorrhoids Are Associated with Urinary Incontinence. J Womens Health (Larchmt) 2020; 29:1464-1468. [PMID: 32762610 DOI: 10.1089/jwh.2019.8168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Hemorrhoids are a common anal disorder and are more frequent in women than in men. Urinary incontinence (UI) also occurs more frequently in women than in men. Although both diseases share similar risk factors, research on the association between the two diseases is lacking. This study aimed to investigate the relationship between hemorrhoids and UI in adult Korean women. Methods: This study was based on the data of the 2008-2009 Korean National Health and Nutrition Examination Survey. Logistic regression test was performed to determine the relationship between hemorrhoids and UI after adjusting for age, body mass index (BMI), smoking, heavy drinking, physical activity, education level, income, diabetes mellitus, and hypertension. Results: Analysis of the data of 8,139 adult women revealed that the prevalence of hemorrhoids, which were self-reported and diagnosed by a physician, was 17.5% and 7.9%, respectively. Both types of hemorrhoids were more prevalent in older women with spouses, those with a large waist circumference, and those with a high BMI. The prevalence of UI was significantly high in the hemorrhoid group, regardless of whether it was self-reported or diagnosed by a physician. Multiple logistic regression analyses revealed a significant association between the prevalence of UI and hemorrhoids, both of which were found to peak at 19-39 years of age. Conclusions: Our findings demonstrate that hemorrhoids are significantly correlated with UI in adult Korean women. When treating adult women with hemorrhoids, it is, therefore, necessary to consider other pelvic floor diseases such as UI.
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Affiliation(s)
- Kil-Yong Lee
- Department of Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu-si, Korea
| | - Jae Im Lee
- Department of Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu-si, Korea.,Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Korea
| | - Youn Young Park
- Department of Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu-si, Korea
| | - Young Soo Kim
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Korea
| | - Dong-Hee Lee
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Korea
| | - Hyun Suk Chae
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Korea
| | - Tae-Kyu Lee
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Korea
| | - Tae Seo Sohn
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Korea
| | - Seong Cheol Jeong
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Korea
| | - Young Bok Lee
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Korea
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17
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Godeberge P, Sheikh P, Zagriadskiĭ E, Lohsiriwat V, Montaño AJ, Košorok P, De Schepper H. Hemorrhoidal disease and chronic venous insufficiency: Concomitance or coincidence; results of the CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research). J Gastroenterol Hepatol 2020; 35:577-585. [PMID: 31512275 PMCID: PMC7187474 DOI: 10.1111/jgh.14857] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/19/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) was conducted to provide data on patients presenting with hemorrhoidal disease (HD) in clinical practice and to explore the frequency with which it coexists with chronic venous disease (CVD) and shared risk factors. METHODS This international, noninterventional study enrolled adult patients attending a consultation for hemorrhoidal complaints. The questionnaire completed by physicians established the subjects' demographic and lifestyle characteristics and collected information on HD grade and symptoms and signs of CVD. RESULTS A total of 5617 patients were analyzed. Symptoms commonly reported were bleeding (71.8%), pain (67.4%), swelling (55.0%), itching (44.1%), and prolapse (36.2%). Multivariate analysis revealed the variables with the strongest association with HD severity were older age, higher CVD CEAP (Clinical manifestations, Etiologic factors, Anatomic distribution of disease, and underlying Pathophysiology) class, constipation, and male gender (all P < 0.0001). Elevated BMI was a risk factor for HD recurrence. Among women, number of births had a significant association with both HD grade and recurrence. The presence of CVD, reported in approximately half the patients (51.2%), was strongly associated with advanced grade of HD (P < 0.0001). Treatments most commonly prescribed were venoactive drugs (94.3%), dietary fiber (71.4%), topical treatment (70.3%), analgesics (26.3%), and surgery (23.5%). CONCLUSIONS CHORUS provides a snap shot of current profiles, risk factors, and treatments of patients with HD across the globe. The coexistence of HD and CVD in more than half the study population highlights the importance of examining for CVD among patients with a hemorrhoid diagnosis, particularly when shared risk factors are present.
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Affiliation(s)
- Philippe Godeberge
- Department of GastroenterologyMutualist Institute Montsouris, Paris Descartes UniversityParisFrance
| | - Parvez Sheikh
- Department of GastroenterologySaifee Hospital MumbaiMumbaiIndia
| | | | - Varut Lohsiriwat
- Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | | | - Pavle Košorok
- Department of ProctologyIatros Medical CentreLjubljanaSlovenia
| | - Heiko De Schepper
- Department of Gastroenterology and HepatologyUniversity Hospital AntwerpEdegemBelgium
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18
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Ferdinande K, Dorreman Y, Roelens K, Ceelen W, De Looze D. Anorectal symptoms during pregnancy and postpartum: a prospective cohort study. Colorectal Dis 2018; 20:1109-1116. [PMID: 29972721 DOI: 10.1111/codi.14324] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 06/06/2018] [Indexed: 02/08/2023]
Abstract
AIM The aim was to determine the prevalence and risk factors of anal symptoms prepartum and postpartum. METHOD A prospective observational cohort study was carried out in Ghent University Hospital, Belgium. Ninety-four pregnant women between their 19th and 25th week of pregnancy were included. An anal symptom questionnaire was filled in at four different times: in the second and third trimester, immediately postpartum and 3 months postpartum. Descriptive data were obtained from patient files. A proctological diagnosis was presumed on the basis of combined symptoms (i.e. rectal bleeding, anal pain and swelling). Constipation was defined by the Rome III criteria. Risk factors were identified using multivariate analysis. RESULTS Sixty-eight per cent of the patients developed anal symptoms. The most prevalent symptom was anal pain. Constipation was reported by 60.7% during the study period. Seven women (7.9%) suffered from faecal incontinence. The most prevalent diagnoses were haemorrhoidal thrombosis (immediately postpartum), haemorrhoidal prolapse (in the third trimester and immediately postpartum) and anal fissure (not episode related). The two independent risk factors for anal complaints were constipation, with a 6.3 odds ratio (95% CI 2.08-19.37), and a history of anal problems, with a 3.9 odds ratio (95% CI 1.2-13). The Bristol Stool Chart was shown to be a reliable indicator in pregnancy and postpartum as significant correlations were observed in all study periods. CONCLUSION Two-thirds of pregnant women have anal symptoms during pregnancy and postpartum, especially haemorrhoidal complications and anal fissure. The most important risk factor is constipation. The prevention of constipation in pregnant women is therefore highly recommended.
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Affiliation(s)
- K Ferdinande
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Gent, Belgium
| | - Y Dorreman
- Department of Gynaecology and Obstetrics, Ghent University Hospital, Ghent University, Gent, Belgium
| | - K Roelens
- Department of Gynaecology and Obstetrics, Ghent University Hospital, Ghent University, Gent, Belgium
| | - W Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent University, Gent, Belgium
| | - D De Looze
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Gent, Belgium
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19
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Åhlund S, Rådestad I, Zwedberg S, Edqvist M, Lindgren H. Haemorrhoids - A neglected problem faced by women after birth. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 18:30-36. [PMID: 30420084 DOI: 10.1016/j.srhc.2018.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the prevalence and severity of haemorrhoids after birth among first-time mothers in relation to management during the second stage of labour and to describe the women's experiences with haemorrhoids. METHOD A mixed method explanatory sequential design was used. Nulliparous women were allocated to an intervention group for whom the second-stage of labour practice followed the MIMA model (Midwives management during second stage of labour) or to a control group for whom standard-care practice was followed. Data were collected three weeks and 1.5 years after birth. RESULT A total of 496 (82.1%) women responded to the questionnaire three weeks after birth, 120 (70%) responded to the questionnaire 1.5 years after the birth. The women in the intervention group had fewer symptoms from haemorrhoids three weeks after birth compared to the women in the control group (adj. OR 0.6 95% CI 0.4-0.9). Half of the women in the intervention and control group (50.8%) who reported problems with haemorrhoids three weeks after birth still experienced problems after 1.5 years. The majority of all women did not seek medical care due to their symptoms. The women who described that they experienced haemorrhoids as a problem after birth felt neglected by the healthcare system. CONCLUSION A substantial percentage of women had symptoms from haemorrhoids after birth. Many of these women felt that their problems were neglected. Women who experienced a slow birth of the baby's head and spontaneous pushing suffered less from haemorrhoids 3 weeks after birth.
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Affiliation(s)
- Susanne Åhlund
- Department of Women's and Children's Health, Karolinska Institute, Sweden.
| | - Ingela Rådestad
- Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Sofia Zwedberg
- Department of Women's and Children's Health, Karolinska Institute, Sweden; Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; Department of Obstetrics, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Malin Edqvist
- Department of Women's and Children's Health, Karolinska Institute, Sweden; Department of Obstetrics, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institute, Sweden
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Hemorrhoids during pregnancy: Sitz bath vs. ano-rectal cream: A comparative prospective study of two conservative treatment protocols. Women Birth 2017; 31:e272-e277. [PMID: 29055673 DOI: 10.1016/j.wombi.2017.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/04/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hemorrhoids are a very common ano-rectal condition affecting pregnant females worldwide and representing a major medical and socioeconomic problem. In this paper, we aim to compare the effectiveness of the Sitz bath method with an ano-rectal cream as part of a conservative management protocol to treat hemorrhoids among pregnant Saudi Arabian females. METHODS A prospective comparative study of the results of two conservative treatment protocols of 495 pregnant females diagnosed to have hemorrhoids during pregnancy between January 2010 and December 2014 was done. The first conservative protocol consisted of three times per day salty warm Sitz bath (using 20g of commercial salt) for 284 patients. The second protocol consisted of topical cream twice daily for 211 patients. Both protocols included the supportive treatments of 2g glycerin suppositories per rectum 20min before defecation as lubricant and Metamucil bulk-forming fiber (a mix of one dose (sachet) within 240ml (8 oz) of cold liquid) once daily after breakfast for constipation. RESULTS Complete healing was achieved in all patients 284 (100%) in the Sitz bath group, compared to 179 (84.8%) in the cream group. Sitz bath was found to represent a statistically significant difference in achieving complete healing for hemorrhoids in pregnant Saudi Arabian females compared to an ano-rectal cream (p-value<0.05). CONCLUSION A conservative treatment protocol for hemorrhoids during pregnancy, in which Sitz bath is an essential modality, showed very promising outcomes compared to an ano-rectal cream.
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Sudarmi K, Dudhamal TS. Comparative clinical study of Apamarga Kshara application, infrared coagulation and Arshohara Vati in the management of Arsha (1 st and 2 nd degree hemorrhoids). Ayu 2017; 38:122-126. [PMID: 30254391 PMCID: PMC6153910 DOI: 10.4103/ayu.ayu_94_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: In anorectal disorders, incidences of piles and fissures are increasing in Indian population due to western lifestyle. Many surgical methods are available to cure anorectal disorders, but now a days, demand for Ayurveda and herbal preparation is increasing in society. Materials and Methods: In this study, Apamarga Kshara application, infrared coagulation (IRC) procedure and Arshohara Vati (AV) tablet were administered for the management of internal hemorrhoid (Arsha). This study was an open labelled, prospective, interventional study, in which patients of piles [n = 30 (10 each group)] were selected from OPD of Institutional hospital. Apamarga Kshara application (AKA) was done on the internal piles for 1–3 sittings as per requirement, IRC was applied at the base of piles for one sitting and two tablets (500 mg each tablet) of AV were given orally thrice a day for 15 days. In all the three groups, the patients were assessed every week for 1 month and were followed up for another 1 month for relief in signs and symptoms. Results: Obtained results were analyzed and encouraging results were observed after completion of the treatment. Conclusion: The study concluded that Apamarga Kshara application is the most effective treatment for the management of internal hemorrhoid of 1st and 2nd degree in comparison to IRC procedure and administration of Arshohara Vati.
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Affiliation(s)
- Komang Sudarmi
- PhD (Scholar), Associate Professor and I/C HOD, IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
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Lin LH, Siu JJY, Liao PC, Chiang JH, Chou PC, Chen HY, Ho TJ, Tsai MY, Chen YH, Chen WC. Association of chronic obstructive pulmonary disease and hemorrhoids: A nationwide cohort study. Medicine (Baltimore) 2017; 96:e6281. [PMID: 28272246 PMCID: PMC5348194 DOI: 10.1097/md.0000000000006281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the "interior-exterior" relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490-492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50-1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77-0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20-39 years), 1.19 (95% CI: 1.14-1.26), and 1.18 (95% CI: 1.12-1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine.
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Affiliation(s)
- Lih-Hwa Lin
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Division of Chinese Medicine, An Nan Hospital, China Medical University, Tainan
| | - Justin Ji-Yuen Siu
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Po-Chi Liao
- Department of Urology, Taichung Veterans General Hospital
| | - Jen-Huai Chiang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Pei-Chi Chou
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Huey-Yi Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Tsung-Jung Ho
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Division of Chinese Medicine, An Nan Hospital, China Medical University, Tainan
- Division of Chinese Medicine, China Medical University Beigang Hospital, Yunlin
| | - Ming-Yen Tsai
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung
| | - Wen-Chi Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
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Cabalzar-Wondberg D, Turina M. [Not Available]. PRAXIS 2017; 106:77-83. [PMID: 28103166 DOI: 10.1024/1661-8157/a002583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Der auf Höhe der Linea dentata gelegene Corpus cavernosum recti spielt eine tragende Rolle bei der Regulierung der Feinkontinenz. Kommt es zu einer pathologischen Vergrösserung des Corpus cavernosum verbunden mit Symptomen, spricht man von einem Hämorrhoidalleiden. Das Hämorrhoidalleiden ist eine Volkskrankheit mit einer Inzidenz von ca. 40 %, wobei die Rate an Selbsttherapien hoch ist. Im klinischen Alltag fällt der stadienadaptierten Therapie eine wichtige Rolle zu: Hämorrhoiden Grad I sind die Domäne der konservativen Therapie, Hämorrhoiden Grad II können in Abhängigkeit der Schwere der Symptome konservativ oder operativ angegangen werden. Hämorrhoiden Grad III und Grad IV sollten einer Operation zugeführt werden.
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Affiliation(s)
- Daniela Cabalzar-Wondberg
- 1 Departement Chirurgie, Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich
| | - Matthias Turina
- 1 Departement Chirurgie, Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich
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Sakai T, Kubota H, Gawad A, Gheyle L, Ramael S, Oishi K. Effect of fermented milk containing Lactobacillus casei strain Shirota on constipation-related symptoms and haemorrhoids in women during puerperium. Benef Microbes 2016; 6:253-62. [PMID: 25380801 DOI: 10.3920/bm2014.0076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Constipation and haemorrhoids are common complaints after childbirth. The objective of this pilot study was to evaluate impact of fermented milk containing Lactobacillus casei strain Shirota (LcS) on stool consistency and frequency, constipation-related symptoms and quality of life, and incidence of haemorrhoids in women during puerperium. Forty women who had natural childbirth were randomised to group consuming either one bottle/day of fermented milk containing at least 6.5×109 cfu of LcS, or placebo, for 6 weeks after childbirth. Subjects filled in a diary on their bowel habits including number of bowel movement, stool consistency and incidence of haemorrhoids, and answered questionnaires on constipation-related symptoms (PAC-SYM) and quality of life (PAC-QOL) during the study period. The probiotic group showed the better scores on overall PAC-SYM (P=0.013), PAC-SYM subscales of abdominal symptoms (P=0.043) and rectal symptoms (P=0.031), and PAC-QOL satisfaction subscale (P=0.037) in comparison with the placebo group. In the probiotic group, two to four subjects experienced haemorrhoids during the first 3 weeks of treatment. The number decreased in week 4 and no one had haemorrhoids on most days in week 5-6. In the placebo group, on average four subjects had haemorrhoids from the beginning, and no obvious change was observed until week 6. No statistically significant effect was observed on stool consistency and frequency. The study products did not cause any adverse event in the subjects. Results of this study indicate that continuous consumption of fermented milk containing LcS might alleviate constipation-related symptoms, provide satisfactory bowel habit and result in earlier recovery from haemorrhoids in women during puerperium. Nonetheless, there are several limitations in interpretation of the results attributed to the study design, including lack of baseline data. Further study is required in order to confirm the efficacy.
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Affiliation(s)
- T Sakai
- Yakult Honsha European Research Center for Microbiology ESV, Technologiepark 4, 9052 Zwijnaarde, Belgium Yakult Central Institute, 5-11 Izumi, Kunitachi-shi, Tokyo, 186-8650 Japan
| | - H Kubota
- Yakult Honsha European Research Center for Microbiology ESV, Technologiepark 4, 9052 Zwijnaarde, Belgium Yakult Central Institute, 5-11 Izumi, Kunitachi-shi, Tokyo, 186-8650 Japan
| | - A Gawad
- Yakult Honsha European Research Center for Microbiology ESV, Technologiepark 4, 9052 Zwijnaarde, Belgium
| | - L Gheyle
- SGS Life Science Services, Clinical Pharmacology Unit Antwerpen, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium
| | - S Ramael
- SGS Life Science Services, Clinical Pharmacology Unit Antwerpen, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium
| | - K Oishi
- Yakult Honsha European Research Center for Microbiology ESV, Technologiepark 4, 9052 Zwijnaarde, Belgium Yakult Central Institute, 5-11 Izumi, Kunitachi-shi, Tokyo, 186-8650 Japan
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Peery AF, Sandler RS, Galanko JA, Bresalier RS, Figueiredo JC, Ahnen DJ, Barry EL, Baron JA. Risk Factors for Hemorrhoids on Screening Colonoscopy. PLoS One 2015; 10:e0139100. [PMID: 26406337 PMCID: PMC4583402 DOI: 10.1371/journal.pone.0139100] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/09/2015] [Indexed: 01/23/2023] Open
Abstract
Background Constipation, a low fiber diet, sedentary lifestyle and gravidity are commonly assumed to increase the risk of hemorrhoids. However, evidence regarding these factors is limited. We examined the association between commonly cited risk factors and the prevalence of hemorrhoids. Methods We performed a cross sectional study of participants who underwent a colonoscopy in a colorectal adenoma prevention trial and who had a detailed assessment of bowel habits, diet and activity. The presence of hemorrhoids was extracted from the subjects’ colonoscopy reports. We used logistic regression to estimate odds ratios and 95% confidence intervals while adjusting for age and sex. Results The study included 2,813 participants. Of these, 1,074 had hemorrhoids recorded. Constipation was associated with an increased prevalence of hemorrhoids (OR 1.43, 95% CI 1.11, 1.86). Of the fiber subtypes, high grain fiber intake was associated with a reduced risk (OR for quartile 4 versus quartile 1 = 0.78, 95% CI 0.62, 0.98). We found no association when comparing gravid and nulligravida women (OR 0.93, 95% CI 0.62–1.40). Sedentary behavior was associated with a reduced risk (OR 0.80, 95% CI 0.65–0.98), but not physical activity (OR 0.83, 95% CI 0.66–1.03). Neither being overweight nor obese was associated with the presence of hemorrhoids (OR 0.89, 95% CI 0.72–1.09 and OR 0.86, 95% CI 0.70–1.06). Conclusions Constipation is associated with an increased risk of hemorrhoids. Gravidity and physical activity do not appear to be associated. High grain fiber intake and sedentary behavior are associated with a decreased risk of hemorrhoids.
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Affiliation(s)
- Anne F. Peery
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
- * E-mail:
| | - Robert S. Sandler
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Joseph A. Galanko
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Robert S. Bresalier
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Jane C. Figueiredo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Dennis J. Ahnen
- University of Colorado Anschutz Medical Campus, Denver, CO, United States of America
| | - Elizabeth L. Barry
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - John A. Baron
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
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The anal canal as a risk organ in cervical cancer patients with hemorrhoids undergoing whole pelvic radiotherapy. TUMORI JOURNAL 2015; 101:72-7. [PMID: 25702647 DOI: 10.5301/tj.5000219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 12/18/2022]
Abstract
AIMS AND BACKGROUND Tolerance of the anal canal tends to be ignored in patients with cervical cancer undergoing whole pelvic radiotherapy. However, patients with hemorrhoids may be troubled with low radiation dose. We tried to analyze the dose-volume statistics of the anal canal in patients undergoing whole pelvic radiotherapy. METHODS The records of 31 patients with cervical cancer who received definite or postoperative radiotherapy at one institution were reviewed. Acute anal symptoms, such as anal pain and bleeding, were evaluated from radiotherapy start to 1 month after radiotherapy completion. Various clinical and dosimetric factors were analyzed to characterize relations with acute anal complications. RESULTS The anal verge was located an average of 1.2 cm (range -0.6~3.9) below the lower border of the ischial tuberosity and an average of 2.7 cm (range -0.6~5.7) behind the sacral promontory level. The presence of hemorrhoids before radiotherapy was found to be significantly associated with acute radiation-induced anal symptoms (p = 0.001), and the mean induction dose for anal symptoms was 36.9 Gy. No patient without hemorrhoids developed an anal symptom during radiotherapy. Dosimetric analyses of V30 and V40 showed marginal correlations with anal symptoms (p = 0.07). CONCLUSIONS The present study suggests a relation between acute anal symptoms following radiotherapy and acute hemorrhoid aggravation. Furthermore, the location of the anal verge was found to be variable, and consequently doses administered to the anal canal also varied substantially. Our results caution careful radiation treatment planning for whole pelvic radiotherapy, and that proper clinical management be afforded patients with hemorrhoids during radiotherapy.
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Gastrointestinal distress in pregnancy: prevalence, assessment, and treatment of 5 common minor discomforts. J Perinat Neonatal Nurs 2015; 29:23-31. [PMID: 25633397 DOI: 10.1097/jpn.0000000000000078] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gastrointestinal discomforts are a very common complaint in pregnancy. In fact, most pregnant women will experience at least one discomfort. This article focuses on 5 common conditions that occur in pregnancy: gastroesophageal reflux disease, diarrhea, constipation, hemorrhoids, and pica. While these conditions do occur in men and nonpregnant women, they occur more frequently in pregnancy because of the anatomic and physiologic changes associated with gestation. The type and severity of symptoms can vary from individual to individual, making treatment a challenge for healthcare providers, particularly when caring for pregnant women because the effects of medications and other treatments on the developing fetus are often not extensively studied. While these discomforts are rarely life-threatening, they can cause significant distress and impair quality of life. The goal of this article was to provide a summary of the anatomic and physiological changes during pregnancy that contribute to the increasing incidence of these discomforts and to provide information about each condition including prevalence, symptoms, and treatment modalities.
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Lee JH, Kim HE, Kang JH, Shin JY, Song YM. Factors associated with hemorrhoids in korean adults: korean national health and nutrition examination survey. Korean J Fam Med 2014; 35:227-36. [PMID: 25309703 PMCID: PMC4192796 DOI: 10.4082/kjfm.2014.35.5.227] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 08/12/2014] [Indexed: 12/21/2022] Open
Abstract
Background Although hemorrhoids are one of the most common anal diseases among Koreans, risk factors for hemorrhoids have not been well identified. Methods We analyzed the data from the 4th Korean National Health and Nutrition Examination Survey (KNHANES) between 2007 and 2009. Study subjects were 17,228 participants of KNHANES who were aged 19 years or older. Logistic regression analysis was conducted to evaluate associations between hemorrhoids and probable risk factors. Results Overall prevalence of hemorrhoids among study subjects was 14.4%, being more prevalent among women (15.7%) than among men (13.0%). Obesity and abdominal obesity were associated with a higher risk of hemorrhoids with odds ratio (OR) (95% confidence intervals, 95% CI) of 1.13 (1.01 to 1.26) and 1.16 (1.04 to 1.30), respectively. Both self-reported depression (OR, 1.83; 95% CI, 1.62 to 2.08) and physician diagnosed depression (OR, 1.71; 95% CI, 1.35 to 2.17) were associated with significantly higher risk of hemorrhoids. No regular walking (OR, 1.11; 95% CI, 1.00 to 1.23) and experience of pregnancy (OR, 1.62; 95% CI, 1.17 to 2.25) for women were also associated with higher risk of hemorrhoids. However, educational level, alcohol consumption, physical activities, diabetes mellitus, hypertension, fiber, fat intake, and energy intake were not associated with a risk of hemorrhoids. Low quality of life assessed with EuroQol-5 Dimension and EuroQol-Visual Analogue Scale was significantly associated with hemorrhoids. Conclusion This nationwide cross-sectional study of Korean adults suggests that obesity, abdominal obesity, depression, and past pregnancy may be risk factors for hemorrhoids and hemorrhoids affect quality of life negatively.
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Affiliation(s)
- Jong-Hyun Lee
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Eun Kim
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hun Kang
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Young Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Eshkevari L, Trout KK, Damore J. Management of Postpartum Pain. J Midwifery Womens Health 2014; 58:622-31. [DOI: 10.1111/jmwh.12129] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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30
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Thomas GP, dos Santos IM, Ouro SM, Thomas-Gibson S, Vaizey CJ. Colorectal disorders during pregnancy: a review. Br J Hosp Med (Lond) 2013; 74:625-30. [PMID: 24220524 DOI: 10.12968/hmed.2013.74.11.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- G P Thomas
- Research Fellow, Sir Alan Parks Department of Physiology, St Marks Hospital and Academic Institute, Harrow
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Kim HS, Baik SJ, Kim KH, Oh CR, Lee JH, Jo WJ, Kim HK, Kim EY, Kim MJ. Prevalence of and risk factors for gastrointestinal diseases in korean americans and native koreans undergoing screening endoscopy. Gut Liver 2013; 7:539-45. [PMID: 24073311 PMCID: PMC3782668 DOI: 10.5009/gnl.2013.7.5.539] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 12/03/2012] [Accepted: 12/14/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS In South Korea, health check-ups are readily accessible to the public. We aimed to compare the prevalence of upper gastrointestinal (GI) and lower GI diseases in Korean Americans and native Koreans to determine differences and risk factors. METHODS In total, 1,942 subjects who visited Gangnam Severance Hospital from July 2008 to November 2010 for a health check-up were enrolled. Basic characteristics and laboratory data for the subjects were collected. Esophagogastroduodenoscopy and colonoscopy were performed. In total, 940 Korean Americans (group 1) and 1,002 native Koreans (group 2) were enrolled. RESULTS The overall prevalence of GI diseases for each group (group 1 vs group 2) were as follows: reflux esophagitis (RE) (9.65% vs 7.9%), gastric ulcer (2.8% vs 3.4%), duodenal ulcer (2.3% vs 3.6%), gastric cancer (0.4% vs 0.3%), colorectal polyp (35.9% vs 35.6%), colorectal cancer (0.5% vs 0.5%), and hemorrhoids (29.4% vs 21.3%). The prevalence of hemorrhoids was significantly higher in group 1 than in group 2 (p=0.001). In the multivariable analysis of group 1, male sex, age over 50 years, hypercholesterolemia and hypertriglyceridemia predicted colorectal polyps. Male sex and high fasting glucose levels were associated with RE. CONCLUSIONS Our study showed that the prevalence of GI diseases (except hemorrhoids) in Korean Americans was similar to that observed in native Koreans. Therefore, the Korean guidelines for upper and lower screening endoscopy may be applicable to Korean Americans.
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Affiliation(s)
- Hee Sun Kim
- Department of Gastroenterology, Health Promotion Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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