Hemorrhoids are defined as an aberrant downward movement in the anal cushions that results in venous dilatation.¹ Hemorrhoids are commonly associated with burning, itching, perianal discomfort, and bleeding.² This ailment is very common during pregnancy, especially throughout the third trimester as well as the postpartum period.³ A few clinical investigations found an incidence of hemorrhoids ranging from 15% to 41%, or even 85%, in select groups, with the frequency increasing with age and parity.⁴

Hemorrhoids in pregnancy are caused by a variety of physiological causes. Venous stasis of the perianal area is caused by an increase in circulating blood volume as well as an increase in intraabdominal pressure caused by uterine enlargement.⁵ Furthermore, the pregnancy hormone progesterone relaxes smooth muscles not just within the venous walls as well as in the colon, resulting in decreased motility as well as constipation.⁶ Several prospective studies have acknowledged some of these variables.⁷

Personal history of perianal illness, straining throughout delivery with more than 20 minutes, birth weight in new-born > 3800 g, and constipation are all significant risk factors with hemorrhoids as well as anal fissures, according to Poskus et al.⁸ Constipation and a history of anal issues, according to Ferdinande et al., are important risk factors for getting perianal illness during pregnancy.⁹ Despite constipation is one of the most well-known modifiable risk factors significantly linked to the occurrence of hemorrhoids following pregnancy, research on the subject is limited.¹⁰ There are currently no research examining dietary and behavioural strategies to reduce the prevalence of chronic hemorrhoids in pregnancy.¹¹

Hemorrhoids remain among the most prevalent adult illnesses globally, involving 4.4% up 36% of the world's population.¹² Incomplete figures reveal that at least 50% of people over the age of 50 have hemorrhoids, with mixed hemorrhoids accounting for the great majority.¹³ Hemorrhoids symptoms and indicators involve frequent stools, itching, discomfort, prolapse, and bowel movement blood. ¹⁴ These are frequently coupled alongside enlarged hemorrhoid pads, that might be a sign of various diseases.¹⁵ Hemorrhoids have a negative influence on one's quality of life. As a result, it is especially important to create and carry out timely scientific and efficient treatment programs within clinical practice.¹⁶ This paper aims to evaluate of hemorrhoid outcomes for pregnant women.

This paper was interested to evaluate of hemorrhoid outcomes for pregnant women where include patients who suffered of hemorrhoids in different hospitals in Iraq from 19^th July 2021 to 25^th June 2022. This paper was focused on patients who have ages in between 25-40 years. This paper was included to groups. Where the first represented the patients' group who still suffered of hemorrhoids after the process outcomes of the operative, while the second group presented patients who successes of prevent hemorrhoids where it, represented as intervention group with 164 cases where each group has 64 patients. The data were examined and recovered the outcomes of health outcomes by the SPSS program.

This paper was presented Distributions of hemorrhoid patients for pregnant women based on age, BMI, and marital status, which contain within Married and Single, where the demographic outcomes were found in Table 1, Table 2, and Table 3.

To follow-up, this paper was examined characteristics baselines into hemorrhoid patients for pregnant women based on symptoms which include aching anus, hard lumps near the anus, itching around the anus, Prolapsed hemorrhoid, and Rectal bleeding, which can be seen in Table 4.

In comparison of both groups, this paper studied Changes of the number of previous pregnancies into hemorrhoid patients for pregnant women, which have progressed with numbers which are 0, 1, 2, and >2, as well as Features of coloproctological outcomes with into hemorrhoid patients for pregnant women which History of hemorrhoids, Current perianal discomfort, Current perianal pain, Current perianal bleeding Current perianal lumps, History of perianal operations, and Family history of perianal disease, and Features of previous delivery outcomes with into hemorrhoid patients for pregnant women which get on Did not give birth, Vaginal delivery, and Caesarean delivery where can be seen in Figure 1, Figure 2, and Figure 3.

This paper was also examined of pregnancy outcomes with into hemorrhoid patients for pregnant women were had Newburn weight (kg), Newburn height (cm), and Head circumference (cm). It also studied examinations of birth of newborn outcomes with into hemorrhoid patients for pregnant women, where include Vaginal birth without assistance, Vaginal birth with assistance, and Caesarean delivery, which can be cleared in Figure 4 and Figure 5.

To further of results, this paper was evaluated of the rate of hemorrhoids in basics of Hemorrhoids rate (ITT) and Hemorrhoids rate (PP) and rate of spontaneous miscarriages in basics of Spontaneous miscarriage rate (ITT) and Spontaneous miscarriage rate (PP) into outcomes into hemorrhoid patients for pregnant women, which can be shown in Figure 6 and Figure 7.

Table 1: Distributions of hemorrhoid patients for pregnant women based on age

Table 2: Distributions of hemorrhoid patients for pregnant women based on BMI

Table 3: Distributions of hemorrhoid patients for pregnant women based on marital status

Table 4: Examinations of characteristics baselines into hemorrhoid patients for pregnant women based on physical activity

Table 5: Examinations of characteristics baselines into hemorrhoid patients for pregnant women based on symptoms

Figure 1: Changes of the number of previous pregnancies into hemorrhoid patients for pregnant women.

Figure 2: Features of coloproctological outcomes with into hemorrhoid patients for pregnant women

Figure 3: Features of previous delivery outcomes with into hemorrhoid patients for pregnant women

Figure 4: Examinations of pregnancy outcomes with into hemorrhoid patients for pregnant women

Figure 5: Examinations of birth of new-born outcomes with into hemorrhoid patients for pregnant women.

Figure 6: Evaluations of the rate of hemorrhoid outcomes into hemorrhoid patients for pregnant women.

Figure 7: Evaluations of the rate of spontaneous miscarriage outcomes into hemorrhoid patients for pregnant women

According to our findings, either ITT or PP analyses revealed that this intervention reduced hemorrhoids by about 60% of the overall rate. The prevalence of hemorrhoids following giving birth for the patient’s category (ITT-41%; PP-42%) was consistent with Poskus et al.'s observed rate of 40.7% in a comparable population.¹⁷

Implications for clinical and research Pregnant women are a particularly susceptible demographic. Consequently, the safety of patient group interventions was critical.¹⁸ We selected to examine the miscarriage rate to demonstrate whether it failed to result in poor pregnancy outcomes. The miscarriage incidence did not change substantially across groups, and patients weren't reporting any extra adverse effects that may be linked to the impact of an intervention. On research analysis, we discovered that a history of perianal illness as well as newborn height represented independent risk factors for developing hemorrhoids after delivery.¹⁹

The only preventive factor that significantly reduced the probability of hemorrhoids was in the control group. Our findings are comparable to those published by Ferdinande et al. and Poskus et al.,^20,21 who discovered that a history of perianal illness is strongly related with an increase in hemorrhoids during pregnancy. However, we did not discover that constipation before to the first trimester was linked to hemorrhoids after birth. Our intervention included dietary and behavioural adjustments, which are also advised for conservative hemorrhoid therapy in non-pregnant patients.

Due to the comparatively low miscarriage as well as hemorrhoid rates, small variations between research groups might have been ignored. Yet, the miscarriage rate was the most recognized result for assessing the safety of different prenatal procedures. Finally, our proposed method, which aims to change dietary and behavioral patterns, dramatically lowers the risk of hemorrhoids throughout pregnancy and may be safely advised to pregnant women.

1. Thomson, W.H.F. “The nature of hemorrhoids.” Br J Surg. 62 (1975):542–52. Jakubauskas, M. and Poskus, T. "Evaluation and management of hemorrhoids." Diseases of the Colon & Rectum 63.4 (2020): 420-424.
2. Poskus, T., Buzinskienė, D., Drasutiene, G., Samalavicius, N.E., Barkus, A., Barisauskiene, A., Tutkuviene, J., Sakalauskaite, I., Drasutis, J., Jasulaitis, A. and Jakaitiene, A. "Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study." BJOG 121.13 (2014): 1666-1671.
3. Abramowitz, L., Sobhani, I., Benifla, J.L., Vuagnat, A., Daraï, E., Mignon, M. and Madelenat, P. "Anal fissure and thrombosed external hemorrhoids before and after delivery." Diseases of the colon & rectum 45.5 (2002): 650-655.
4. Ferdinande, K., Dorreman, Y., Roelens, K., Ceelen, W. and De Looze, D. "Anorectal symptoms during pregnancy and postpartum: a prospective cohort study." Colorectal Disease 20.12 (2018): 1109-1116.
5. Medich, D.S. and Fazio, V.W. "Hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy." Surgical Clinics of North America 75.1 (1995): 77-88.
6. Gojnic, M., Dugalic, V., Papic, M., Vidaković, S., Milićević, S. and Pervulov, M. "The significance of detailed examination of hemorrhoids during pregnancy." Clinical and Experimental Obstetrics & Gynecology 32.3 (2005): 183-184.
7. MacLennan, A.H., Taylor, A.W., Wilson, D.H. and Wilson, D. "The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery." BJOG 107.12 (2000): 1460-1470.
8. Shin, G.H., Toto, E.L. and Schey, R. “Pregnancy and Postpartum Bowel Changes: Constipation and Fecal Incontinence.” American Journal of Gastroenterology 110.4 (2015):521–9.
9. Monika, S. and Rutherford, J.D. “Cardiovascular Physiology of Pregnancy Circulation.” "Cardiovascular physiology of pregnancy." Circulation 130.12 (2014): 1003-1008.
10. Folden, S.L. “Practice Guidelines for the Management of Constipation in Adults.” Rehabil Nurs. 27 (2002):169–75.
11. Marx, F.A. “Prevention of hemorrhoids by controlled defecation.” Dis Colon Rectum. 36 (1993):1084.
12. van Tol, R.R., Kleijnen, J., Watson, A.J.M., Jongen, J., Altomare, D.F. and Qvist, N, et al. “European Society of ColoProctology (ESCP) Guideline for Haemorrhoidal Disease.” :93.
13. Davis, B.R., Lee-Kong, S.A., Migaly, J., Feingold, D.L. and Steele, S.R. "The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids." Diseases of the Colon & Rectum 61.3 (2018): 284-292.
14. Abstracts P. Int J Gynecol Obstet. 155 (2021):127–532.
15. Füzün, M. “Anorektal Benign Hastalıklar.” Klinik Gastroenteroloji ve Hepatoloji. (2007).
16. Place, R., Hyman, N. and Simmang, C, et al. “The standart task force is the ASCRS.” Dis Colon Rectum. 46 (2003):573-6.
17. Creasy, R.K. and Resnik, R. “Maternal-fetal medicine.” Philadelphia: WB saunders (1984).
18. Wolff, B.G., Pemberton, J.H. and Wexner, S.D, et al. “Hemorrhoidal Disease.” The
19. ASCRS Textbook of Colon and Rectal Surgery(2007).
20. Avsar, A.F. and Keskin, H.L. “Hemorrhoids during pregnancy.” J Obstet Gynaecol. 30(2010):231-7.
21. Mirhaidari, S.J., Porter, J.A. and Slezak, F.A. "Thrombosed external hemorrhoids in pregnancy: a retrospective review of outcomes." International journal of colorectal disease 31.8 (2016): 1557-1559.