Perianal Complications in Puerperium and Associated Risk Factors

INTRODUCTION Puerperium is defined as the period of about six weeks after childbirth during which the mother's reproductive organs return to their original non-pregnant condition. Perianal problems, including Constipation, Hemorrhoids and Fissure, are among the most common digestive complications among women in puerperium, observed in about 30 to 50 percent of women. Considering this great prevalence and the paucity of similar research in this aspect in an Indian population, this study was done to assess the prevalence of perianal problems seen in puerperium and the risk factors associated with it. METHODS This was a prospective observational cohort study done over the span of 3 years on 902 puerperal ladies. A self structured questionnaire covered detailed history and per-rectal and proctoscopy examination. Patients were followed up telephonically for regression of perianal problems post management. RESULTS The Total prevalence of all the perianal problems in puerperium encountered in this study, out of 902 subjects, was 36.3% [327 subjects]. The Perianal problems encountered were Fissure in 185 patients [20.5%] followed by Haemorrhoids in 110 patients [12.2%], Perianal episiotomy infections in 25 patients [2.8%] and Perineal tears in 7 patients [0.8%]. On comparative analysis, Positive family history, macrosomia, past history of perianal diseases, second stage of labour >50 minutes showed a higher prevalence in Perianal disease Group as compared to the Healthy group. Out of these, Positive family history of perianal diseases [p=0.015], past history of perianal diseases [p=0.016] were statistically significant. The percentage of multipara with Hemorrhoids was more as compared to primipara [p=0.01], patients who had a past history of any perianal disease have higher chance of Hemorrhoids during puerperium [p=0.00]. Patient with constipation in pregnancy have higher chance of hemorroids in pregnancy [p=0.00]. Patients who had a past history of any perianal disease, had higher chance of fissure during puerperium [p=0.00]. 27.74% of study subjects with macrosomic babies had fissure in their puerperal period which on comparison with patients with non macrosomic babies was only 19.22% and this was statisticallty significant [p=0.02]. CONCLUSION Constipation, haemorrhoids, anal fissures are the most common perianal problems in postpartum period causing significant reduction in life quality of those afflicted with them.