Common anorectal complications in pregnancy. Methods of management

The hormonal, anatomic and pelvic vascular changes of pregnancy have a profound effect on the anorectum, making hemorrhoidal disease the most common anorectal complication of pregnancy. Anal infections such as fissures, abscesses and fistulas are relatively infrequent.Physiologic engorgement of the hemorrhoidal vessels during pregnancy is quite common, transitory and requires only simple palliation. True symptomatic hemorrhoidal disease, however, is less common, more permanent and will usually need corrective treatment to prevent immediate complications and future aggravation. Serious rectal and colonic diagnostic problems demand endoscopic investigation regardless of the pregnancy. Clinical experience and studies seem to indicate that extreme conservatism in the treatment of severe complicated hemorrhoidal disease during pregnancy appears to be unwarranted. After consultation and agreement, surgical treatment of severe, disabling, symptomatic hemorrhoids that are not responsive to palliation can be safely accomplished during the second trimester of pregnancy. Once true hemorrhoidal disease develops, correction should be done before a subsequent pregnancy to avoid later increased aggravation and morbidity.