Groupe Hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185 rue Raymond Losserand, 75014 Paris, France
Groupe Hospitalier Paris Saint-Joseph, service de gynécologie et d’obstétrique, 185 rue Raymond Losserand, 75014 Paris, France
The period during pregnancy and after childbirth is associated with the onset or recurrence of anorectal symptoms, predominantly haemorrhoids and fissures. Haemorrhoidal thrombosis is the most common event during the third trimester and after childbirth. Treatment is almost exclusively medical and cases requiring an excision procedure or surgical treatment are unusual. In this context, the main constraint is that non-steroidal anti-inflammatory drugs are contraindicated during the third trimester and can be substituted by a short course of corticosteroids. Anal fissures are most often observed after childbirth. These fissures tend to be anterior and are accompanied by anal hypertonia in rare instances, which may signify a possible role in birth trauma. Treatment is also medical to a large extent and is mainly focussed on regulating bowel movements. For fistulas, which are more uncommon and less well-known, there are three possible scenarios : rectovaginal fistulas, conventional cryptoglandular fistulas and fistulas that appear to be cryptoglandular which manifest in the episiotomy scar. They are largely related to the traumatic nature of childbirth. Treatment is complex, as it involves young women of childbearing age, and primarily relies on a sphincter-saving technique.