What a woman can do after childbirth to prevent and treat perineal and rectal issues

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Updated: 06.06.2024
What a woman can do after childbirth to prevent and treat perineal and rectal issues

The process of childbirth, which is essential for human reproduction, is a stressful experience for modern women. Therefore, understanding the potential problems that may arise in the postpartum period is crucial for young mothers to maintain their peace of mind. It is important to seek help promptly and have confidence in the ability of specialists to handle the difficulties they may encounter.

So, what are the potential complications of pregnancy and childbirth that could lead to the conditions we are discussing?

The appearance and worsening of hemorrhoids is a common problem during pregnancy, which can be a source of serious concern after childbirth. There are several reasons for this, including improper nutrition, intestinal disorders, constipation, increased abdominal pressure in pregnant women, the pressure of an enlarged uterus on the main vein in the abdominal cavity (the inferior vena cava), and changes in the structure of connective tissue during pregnancy.

Also, diseases of the perineum and rectum can lead to complicated labor, such as prolonged or excessive rapid labor, perineal tears, prolonged anhydrous intervals, large fetuses, young maternal age, a physiologically narrow pelvic cavity, and various accompanying pathologies, especially endocrinological conditions.

For most women, perineal injuries and tears are treated by an obstetrician-gynecologist at the time of delivery. However, many women still require the help of a proctologist or pelvic floor specialist to fully recover.

Such problems associated with postpartum trauma may be minor and do not require medical intervention. For example, pelvic floor prolapse of 1-2 degrees (pelvic organ prolapse), scars in the area of the tear, and hemorrhoids of 1-2 degrees. However, it is still worth consulting with a healthcare professional who can recommend a gentle procedure to remove these scars for hygiene and cosmetic reasons. This small surgery can often help reduce discomfort in the perineum.

For uncomplicated hemorrhoids, latex rings or ultrasound sclerosing of hemorrhoidal nodes can be used. To reduce small forms of pelvic organ prolapse and strengthen the perineal muscles, special exercises, biofeedback, or so-called tibial pelvic electrical stimulation are worth considering. These methods not only reduce the manifestations of pelvic prolapse but also improve the function of urinary retention, which can often occur in the early postpartum period.

For more serious issues, such as advanced stages of hemorrhoids, third- and fourth-degree pelvic prolapses, inflammation of ligaments and fistulas (poor healing of suture materials), and, of course, the most severe condition in this area, rectovaginal fistulas (abnormal connections between the rectum and vagina), you should consult a pelvic floor specialist as soon as possible.

Clinical manifestations of these conditions

Hemorrhoids at this stage are characterized by the prolapse of hemorrhoidal tissue, pain and itching in the anus, rectal bleeding after bowel movements, and staining of underwear.

Women with serious pelvic organ problems may experience cervical prolapse, which is a condition where the cervix protrudes out of the vaginal opening. They may also experience the need for manual assistance when passing stool, perineal pain, vaginal itching, and urinary incontinence when pushing. Additionally, they may notice the appearance of abnormal vaginal discharge.

Modern proctology has a wide range of high-tech treatments that can help women with postpartum hemorrhoids. For 3-4th degree hemorrhoids, a minimally invasive procedure called hemorrhoidal disarterization with mucopexy is recommended. This procedure involves the removal of the hemorrhoidal nodes and sewn up the area to prevent bleeding. After the procedure, hospitalization for 1-2 days is recommended, but for patients in Rostov, outpatient treatment is also an option.

In postpartum pelvic trauma, especially after multiple deliveries, with a clinic of severe pelvic organ prolapse, correction is performed through a vaginal incision and rectal surgery. We recommend this option for young women who are sexually active. This type of surgery restores the normal anatomy of the pelvic organs while simultaneously correcting defecation and urination issues. The latter procedure requires a 4-5 day hospital stay, as well as general anesthesia. However, the recovery process is relatively fast. For example, you can visit a swimming pool after a week, drive after 2 weeks, but you should abstain from sexual activity for about 2 months. No sutures or dressings need to be removed, but it is recommended to syringe the vagina 4-5 times a day and use antibacterial and anti-inflammatory suppositories.Despite its apparent simplicity, the operation is highly technical and requires a high level of professional expertise.

The most challenging aspect of the surgical treatment for rectovaginal fistulas is the lack of consistency in the results reported in the medical literature. There is a wide range of opinions, with some experts advocating for the use of an artificial anus in order to achieve positive outcomes, while others have reported successful results with simpler procedures. Over 100 different methods have been proposed for treating this condition.

The use of flap proctoplasty in this type of treatment has been revolutionary. This technique allows for excellent results in treating the most complex fistulas, which can cause severe fecal retention. The basis for successful performance of these operations is the use of a microsurgical technique with high magnification and the ultrasound «harmonic scalpel». This allows for the removal of a well-vascularized mucosal-muscular flap from the rectal wall, which has resulted in good outcomes not only for rectovaginal fistulas but also for other transsphincteric localizations.

The health protection of women of childbearing age, especially during the postpartum period, is a top priority for healthcare providers. Thanks to modern technology, this goal can be achieved in a safe and reliable manner.