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External hemorrhoids thrombosis affects 8% of women during last trimester pregnancy and 20% of women immediately after delivery. Their treatment is medical with local treatment (with corticoid and anesthetic), defecation regulation and paracetamol. NSAID can be used after delivery in absence of breath-feeding. Local excision is not possible in most of the cases because of inflammation. Surgery has to be an exception because medical treatment is sufficient in almost all cases. Anal fissure is the most frequent differential diagnosis, encountered in 15% after all deliveries. Symptoms associate anal pain during and after defecation with blood on toilet paper. The only identified risk factor for hemorrhoids thrombosis (and anal fissure) is dyschesia. We have to think about it., (Copyright © 2011. Published by Elsevier Masson SAS.)

Objectives: Although the usual methods of exploring anorectal disorders give information on specific aspects of defecation, they do not take into account the related effect of disorders involving the pelvic contents including the genital and urinary tract. We therefore used physical examination and global imaging to demonstrate the effect of urinary and genital anomalies in female patients with dyschesia., Methods: A prospective study was conducted in 50 consecutive female patients (age range 21-83) who consulted for dyschesia. The following protocol was used. History taking included a search for urinary and gynaecology surgery or medical treatment and the number of pregnancies and instrumental deliveries as well as a precise scoring of defecation disorders. The general physical examination included a search for signs of prolapsus or ulcerations. A rectocolpocystogram was performed in all patients., Results: There were 7 patients under 40 years of age, 25 from 41 to 61 years and 18 over 61. Urinary incontinence was the most frequent functional complaint (80%). In 92% of the patients, the rectocolpocystogram revealed associated anatomic anomalies. Dynamic stimulation was associated with cervicocystoptosis (72%), hysteroptosis (50%) and rectocele (66%)., Conclusion: Female dyschesia is a complex phenomena involving the anatomic status of the urinary, genital and anorectal tracts. Therapeutic management should be based on a complete examination including an evaluation of the pelvic contents and the perineum.