Abstract
Introduction Puerperium is defined as the period of about 6 weeks after childbirth during which
the mother's reproductive organs return to their original nonpregnant 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, the present 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 women. 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 the
present study, out of 902 subjects, was 36.3% (327 subjects). The perianal problems
encountered were fissure in 185 patients (20.5%) followed by hemorrhoids 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, and second stage of labour > 50 minutes showed
a higher prevalence in the perianal disease group as compared with the healthy group.
Out of these, positive family history of perianal diseases (p = 0.015) and past history of perianal diseases (p = 0.016) were statistically significant. The percentage of multipara with hemorrhoids
was more when compared to primipara (p = 0.01), patients who had a past history of any perianal disease have a higher chance
of hemorrhoids during puerperium (p = 0.00). Patients with constipation in pregnancy have higher chance of hemorrhoids
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). A total of 27.74% of the study subjects with macrosomic babies had fissure
in their puerperal period which on comparison with patients with non macrosomic babies
was only 19.22%, which was statistically significant (p = 0.02).
Conclusion Constipation, hemorrhoids, and anal fissures are the most common perianal problems
in postpartum period causing significant reduction in the quality of life of those
afflicted with them.
Keywords
puerperium - constipation - haemorrhoids - anal fissures
