Rectal Bleeding During Pregnancy

Rectal Bleeding During Pregnancy


Contents:

Pregnancy and Rectal Bleeding

Bleeding from the upper gastrointestinal divisions (esophagus, stomach and small intestine) can manifest itself through the rectum with the loss of blood of dark red color due to its quick passage, but usually melena is observed. Bleeding from the rectum is accompanied by severe/sudden blood loss. Patients with chronic blood loss are admitted with anemia of iron deficiency.

Causes of Rectal Bleeding During Pregnancy

Anorectal Diseases:

  • Hemorrhoids;
  • Anal fissure;
  • Rectal solitary ulcer syndrome (mucosal prolapse).

Diseases of the colon:

  • Inflammatory bowel disease;
  • Adenomatous polyps;
  • Cancer;
  • Arteriovenous malformations of Meckel Diverticulum.

Medical History and Examination of Rectal Bleeding During Pregnancy

A detailed medical history may give a clue to the root cause of colorectal bleeding. Discharge of bright red blood apart from the faeces may suspect an anorectal cause. Diarrhea and mucus, with dark blood, lead to suspect colitis or swelling. Changes in bowel function in the disease - constipation and diarrhea with intestinal discomfort — may suspect a cancer. Defecation urgency, acute bleeding and abdominal pain are more common for colitis. Examination of rectum and proctosigmoidoscopy help in the diagnosis of anorectal disease.

Colonoscopy, though hardly feasible in case of bleeding, at least, identifies the affected segment. Angiography of mesentery, if it is possible to perform, helps to determine the diagnosis. The examination of the surgeon is required when a women is admitted with acute rectal bleeding and hemodynamic disorders during emergency therapy. If the cause is not found in the lower divisions, endoscopic examination of the upper gastrointestinal divisions is recommended.

Anorectal Diseases

Hemorrhoids and anorectal fissures are the most common anorectal disorders during pregnancy, they cause considerable inconvenience. The real incidence of these diseases is unknown. During pregnancy, they are not diagnosed and not treated until delivery.

Hemorrhoids

Hemorrhoids during pregnancy occurs due to the increase in the volume of circulating blood, increasing venous stagnation caused by squeezing the upper rectal veins of the pregnant by the uterus, as well as the relaxing effect of progesterone on the smooth muscles of the walls of veins. Clinical symptoms of hemorrhoids are bleeding, loss of nodes, mucous discharge, itching and discomfort in the rectum. The diagnosis is set by simply inspecting the anus. During pregnancy sigmoidoscopy and colonoscopy are safe.

Treatment during pregnancy is mainly aimed at relieving the symptoms, especially the pain. Conservative treatment is a diet change, increase of fluid intake, medications, softening the feces, and analgesics. Most women have symptoms disappeared shortly after delivery. Therefore the final treatment is postponed until the postpartum period.

The ligation of hemorrhoids with rubber rings can be safely performed at pregnant women with internal hemorrhoids. The hemorrhoidectomy is performed with a significant loss of nodes or accompanying ulceration, strong bleeding, fissure, anal fistula and the absence of the effect of conservative treatment.

Anal Fissure

Anal fissure is a painful condition that occurs at a large part of the population. It usually occurs when solid faeces are passing through which damage and violate the integrity of the epithelium of the anus. Clinical symptoms are pain during defecation with blood or wiping the anus. At pregnant women the disease is especially prevalent due to frequent constipation. The increased production of progesterone during pregnancy leads to relaxation of smooth muscles and slowing of intestinal passage. Contributing factor is preventive and curative use of iron supplementation during pregnancy with constipating effect.

The choice of treatment method for optimal clinical results and causing the patient the least pain and inconvenience is always a difficult task for surgeons. Acute fissures are healed exceptionally by conservative methods, but for chronic fissures to reduce spasm of sphincter certain manipulations or surgical intervention are required.

Inflammatory Bowel Disease

Sometimes inflammatory bowel disease first manifests itself during pregnancy. Recurrence of Crohn's disease during pregnancy is usually manifested in the first trimester. A large part of patients regularly take some drugs.

Many patients with ulcerative colitis and surgical treatment with the anastomosis between the ileum and rectum in medical history are pregnant. Long-term outcomes of pregnancy and natural childbirth at such patients are good.

Colorectal Cancer

Treatment of colorectal cancer is performed with compliance with generally accepted principles. With indications, primary surgical treatment is always performed. In the later stages of pregnancy it is preferred to postpone the surgery until the fetal gestation and delivery. Most authors recommend to perform the primary surgical treatment of colon cancer in the first half of pregnancy because the deferral treatment before birth can lead to the spread of the tumor. Rectal cancer during pregnancy is treated somewhat differently than colon cancer. During the first 20 weeks of pregnancy, at patients wishing to carry the pregnancy, primary resection and chemotherapy are performed after delivery. If the patient chooses abortion, then after abortion she is treated as non-pregnant.

During pregnancy safe and timely surgical treatment of many diseases of the colon allows to save the life of the fetus and fertility of the woman. In benign diseases the possibility of conservative treatment is wider. For patients with malignant tumor the risk of delay of surgical treatment, chemotherapy or radiotherapy is unknown. It should be found out whether a woman plans to have more children. A multidisciplinary approach with the close interaction of obstetrician-gynecologist, surgeon, oncologist, pediatrician and neonatologist is recommended.

Prevention of Rectal Bleeding

As we have already said, the most common cause of the fissure and hemorrhoid is constipation, therefore tuning the digestive system is the first step to prevent the blood from the rectum during pregnancy.

Here are a couple of tips on how you can prevent or relieve constipation:

  1. Eat daily fiber-rich foods, such as cereals, wholemeal bread, fresh fruit and vegetables. For breakfast make yourself the grain porridge and add a couple of tablespoons of raw wheat bran.
  2. Drink plenty of water, you need to drink at least 8-10 glasses a day. A glass of fruit juice every day, especially plum juice, can also be helpful.
  3. Regularly engage in physical exercise. Walking, swimming and yoga will not only relieve constipation but also will improve your health.
  4. Empty the bowels in time. Never put off visiting the toilet, if you feel the urge to defecate.
  5. If you are taking iron supplements, they may be causing your constipation. Talk with your doctor-maybe ordinary vitamins for pregnant women will be enough, or the doctor will prescribe you a safe laxative.

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