Perianal complications in puerperium and associated risk factors

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. (AU)

Doppler ultrasound testing suggests hemorrhoids in females may be a consequence of impaired blood flow Associated with pelvic organ prolapse

Abstract Background It has been observed that there is a high incidence of hemorrhoids in female patients with pelvic organ prolapse. Also, in these patients, hemorrhoidal disease improves after the surgical correction of the pelvic organ prolapse. Objective Our hypothesis was that a cause-effect relationship between pelvic organ prolapse, and hemorrhoids might be the key. The objective of this study was to find an element which connects these two conditions. Study Design We conducted a pilot study which consisted of two parts. An initial part, in which we asked several patients with grades III and IV pelvic organ prolapse and hemorrhoids, who have undergone surgery for prolapse, to determine the impact of the surgical restoration of the prolapsed organs on their hemorrhoidal disease. For the second part, on several patients with uncorrected uterine prolapse grades III and IV, we determined the resistive index of the hemorrhoidal branches within the rectal wall before and after manual reduction of the prolapse. Results First, more than 50% of patients who underwent uterine prolapse correction described an improvement of their hemorrhoidal disease of over 50%. Second, the resistive index of the hemorrhoidal branches was significantly lower after manual reduction of the prolapse. We consider that obstructed veins due to pelvic organ prolapse might induce the dilation of the hemorrhoids. The direct measurement of the resistive index of the hemorrhoidal branches allows us to directly assess the increased resistance in the rectal vascular system. Conclusion Venous stasis and impaired vascular flow might be the pathophysiological explanation for the association between pelvic organ prolapse and hemorrhoids. In these patients, the pathogenic treatment should aim at the restoration of a normal blood flow (prolapse surgical cure) instead of focusing on hemorrhoids only.(AU)

Evolución alejada de los pacientes operados por hemorroides complejas o más de tres paquetes con técnicas no hemorroidopexia / Remote evolution of patients operated by complex hemorrhoids or more than three packages with non-hemorrhoidopexy techniques

Introducción: Las hemorroides son una patología muy frecuente. La mayor parte de los pacientes son tratados con modificaciones en la dieta, aquellos que no responden al tratamiento son pasibles de tratamientos ambulatorios y los casos más avanzados quirúrgicos. Objetivos: Estudiar la evolución alejada de los pacientes con patología hemorroidal severa. Diseño: Estudio retrospectivo con encuesta telefónica. Material y Métodos: La serie estudiada son 304 pacientes operados entre 1980 y 2012, correspondiendo 124 a casos con más de 50% de la circunferencia comprometida por trombosis, gangrena o casos de importante prolapso, a quienes se efectuó la exéresis de las zonas afectadas y la reconstrucción del canal anal utilizando colgajos cutáneos, y 180 fueron tratados de tres o más paquetes con técnica de Ferguson. Resultados: En el período considerado consultaron por hemorroides 1832 pacientes, de los cuales a 180 (9,8%) se utilizó la técnica de Ferguson para tres o más paquetes y 124 (6,8%) fueron casos complejos. Presentaron complicaciones post operatorias el 13,71% de las complejas y el 6,11% de tres paquetes o más (n s). Por medio de la encuesta encontramos en los casos denominados complejos un 93% de asintomáticos y en los de más de 3 Paquetes un 81%, resultando esta diferencia significativa. Los síntomas más frecuentes, sangrado y dolor, fueron muy esporádicos en el 71,4% vinculado a constipación o transgresiones alimentarias manifestando el 93,5% sentirse mejor que antes de operados. Conclusiones: Tanto los resultados inmediatos como el seguimiento alejado en la serie presentada han sido muy satisfactorios.

Introduction: Hemorrhoidal disease is a very frequent pathology. Most hemorrhoids are medically treated with diet changes. Those who do not respond satisfactorily can receive office-based treatments and the most advanced cases require surgical intervention. Aims/objectives: Study of the long-term evolution of patients with severe hemorrhoidal pathology. Design: Retrospective study with telephonic survey. Material and Methods: The studied series comprises 304 patients operated on between 1980 and 2012, corresponding 124 cases to patients with more than 50% of the anal circumference compromised by thrombosis, gangrene or cases of significant prolapse. These cases underwent exeresis of the affected areas and reconstruction of the anal canal utilizing cutaneous flaps, and 180 cases, which presented more than three bundles, were treated with Ferguson´s technique. Results: In the referred period, 1832 patients consulted about hemorrhoids. Ferguson´s technique was used on 180 patients (9,8%) and 124 patients (6,8%) corresponded to complex cases. Post-surgical complications were seen in 13, 71% of the complex cases and in 6.11% of the cases with three or more hemorrhoidal bundles (n s). The survey showed that 93% of the complex cases were asymptomatic, in comparison to 81% of those with three of more hemorrhoidal bundles, resulting in a significant difference. The most frequent symptoms: bleeding and pain, were very sporadic in 71, 4% corresponding to constipation or dietary transgressions; 93, 5% stated feeling better than before being operated on. Conclusions: The immediate results as well as the long-term follow up of the presented series have both been very satisfactory.

Doença hemorroidária / Hemorroidary disease

Discussão sobre a fisiopatologia, fatores etiológicos, sintomatologia, diagnóstico e tratamento da doença hemorroidária.

Discussion on the pathophysiology, etiologic factors, symptoms, diagnosis and treatment of hemorrhoidal disease.

Lesiones anorrectales en pacientes HIV positivo y con SIDA: 12 años de experiencia clínica / Anorectal injuries in VIH seropositive and AIDS patients: 12 years of clinical experience

Se presenta grupo de 45 pacientes seropositivos al virus de la inmunodeficiencia humana, portadores anorrectal, que fueron separados en dos grupos: los HIV + (42,2 por ciento) y los con SIDA clínico (57,8 por ciento). Todos fueron de sexo masculino, jóvenes (edad promedio 32,2 años), siendo los factores de riesgo más frecuentes la homosexualidad (66,6 por ciento) y bisexualidad (22,2 por ciento). En los HIV+ la lesión más frecuente fue la considerada dentro de la de tipo común (47,3 por ciento), mientras que en los pacientes con SIDA clínico fue la ocasionada por inmunosupresión (50 por ciento). La patología común más frecuente en ambos grupos fue la enfermedad hemorroidaria. La enfermedad de transmisión sexual, también en ambos grupos, más frecuente fueron los condilomas. La respuesta al tratamiento en el grupo HIV+ fue óptima y/o buena en todos los casos. En los pacientes con SIDA clínico se observó evolución regular y mala, cuestión que resultó más frecuente en los sometidos a manejo quirúrgico (60 por ciento) que en los manejo médico (10 por ciento)

Hemorroides: conceptos actuales / Hemorrhoids: present concepts

Las hemorroides representan la patología más habitual en el ámbito protológico. Existe una serie de conceptos tradicionales sobre esta condición que muchas veces conducen a un manejo inadecuado de ella. En este artículo se revisan y actualizan algunos conceptos relevantes sobre su definición, etiopatogenia y tratamiento. Además se describen algunos criterios prácticos con relación al enfrentamiento de las hemorroides destacando el rol que le compete al manejo conservador, a los procedimientos ambulatorios y a la hemorroidectomía

Complicaçöes clínicas de injúrias medulares / Medical complications of spinal injuries

Lesöes medulares säo eventos catastróficos inesperados que acomentem anualmente milhares de indivíduos de todas as faixas etárias, determinando complicaçöes clínicas que persistiräo pelo restane de suas vidas. Com a melhoria da qualidade do atendimento , espera-se que em serviços especializados 94 por cento dos pacientes sobrevivam ao primeiro internamento hospitalar. O aumento da sobrevida, além da grande incidência de múltiplas complicaçöes (muitas delas restritas a tal grupo de pacientes, tais como hiperreflexia autonômica), aponta para a necessidade de uma maior divulgaçäo das peculiaridades fisiopatológicas a fim de possibilitar uma melhoria no manejo de tais pacientes. O objetivo do presente trabalho é revisar as complicaçöes clínicas imediatas e tardias das lesöes medulares

Non surgical treatment of hemorrhoids

Hemorrhoidal disease is one of the most common diseases of mankind. It is estimated that 50% of population over 50 years of age at any one time in the Western world has symptomtic Hemorrhoidal Disease. The figures are probably somewhat lower for the developing countries especially the ones whose diet includes a high fiber content. In the United States one third of the overall population has symptomatic Hemorrhoidal Disease at any one time. Although 80% of persons during their lifetime experience symptomatic Hemorrhoids, they postpone treatment as long as they can. One reason being the nature of the disease, the social taboo associated with it, and because of the concern regarding the treatment procedures. Most of the treatment modalities in the past have been directed towards the symptoms. This was followed by surgery, however, lately newer non-surgical methods have made the treatment much easier and more acceptable. This is especially true for the Laser and/or thermal treatment

Hemorroides y embarazo / Hemorrhoids and pregnancy

Se analizan los factores determinantes de las hemorroides del embarazo y se comenta su evolución. Se indican normas profilácticas y mencionan distintos procedimientos médicos, fisioterápicos, cruentos no quirúrgicos y operatorios para el tratamiento de esta dolencia.

Detalhes técnicos na execuçäo das hemorroidectomias / Technique details of hemorrhoidectomy

É apresentada pequena revisäo de história, anatomia, etiopatogenia e classificaçäo das hemorróidas, e säo comentados detalhes técnicos da hemorroidectomia

El valsalva en la fisiopatología del sistema venoso anorrectal: nuestra experiencia / Valsalva's in physiopathology of the venous anorrectal system: our experience

Se estudia y expone la acción fisiológica y fisiopatológica del Valsalva sobre los plexos venosos hemorroidales. Se expresan sus resultados y conclusiones

Hemorroides e hipertension portal / Hemorrhoides and portal hypertension

En tres grupos de pacientes estudiamos la relación entre hemorroides e hipertensión portal, no pudimos determinar diferencia entre pacientes de la misma edad que tenían hemorroides sintomáticas con o sin hipertensión portal. No parece haber, según nuestros resultados, ninguna relación importante entre la presencia de hemorroides e hipertensión portal