Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study

BJOG. 2014 Dec;121(13):1666-71. doi: 10.1111/1471-0528.12838. Epub 2014 May 9.


Objective: To identify the incidence and risk factors of haemorrhoids and fissures during pregnancy and after childbirth.

Design: Prospective observational cohort study.

Setting: University hospital and outpatient clinics in Lithuania.

Population: A total of 280 pregnant women followed up until 1 month after delivery.

Methods: Women were examined four times through pregnancy and after delivery; those that developed peri-anal diseases were compared with those that did not.

Main outcome measures: Incidence, time and risk factors of haemorrhoids and fissures.

Results: In all, 123 (43.9%) women developed peri-anal disease: 1.6% in the first trimester, 61% during the third trimester, 34.1% after delivery and 3.3% 1 month after delivery; 114 (40.7%) women were diagnosed with haemorrhoids, seven (2.5%) with haemorrhoids and anal fissure and two (0.71%) with anal fissure. Ninety-nine (80.5%) women had vaginal delivery and 24 (19.5%) women had undergone caesarean section. Multivariate analysis identified personal history of peri-anal diseases (odds ratio [OR] 11.93; 95% confidence interval [95% CI] 2.18-65.30), constipation (OR 18.98; 95% CI 7.13-50.54), straining during delivery for more than 20 minutes (OR 29.75; 95% CI 4.00-221.23) and birthweight of newborn>3800 g (OR 17.99; 95% CI 3.29-98.49) as significant predictors of haemorrhoids and anal fissures during pregnancy and perinatal period.

Conclusions: Haemorrhoids and fissures are common during the last trimester of pregnancy and 1 month after delivery, with constipation, personal history of haemorrhoids or fissures, birthweight of newborn>3800 g, straining during delivery for more than 20 minutes being independently associated risk factors.

Keywords: Anal fissure; haemorrhoids; pregnancy; prospective study; risk.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Birth Weight*
  • Cohort Studies
  • Constipation / epidemiology
  • Delivery, Obstetric / statistics & numerical data
  • Female
  • Fissure in Ano / epidemiology*
  • Hemorrhoids / epidemiology*
  • Humans
  • Incidence
  • Infant, Newborn
  • Lithuania / epidemiology
  • Middle Aged
  • Pregnancy
  • Pregnancy Complications / epidemiology*
  • Prospective Studies
  • Puerperal Disorders / epidemiology*
  • Risk Factors
  • Time Factors
  • Young Adult