{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:37:29Z","timestamp":1785411449763,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"publisher","award":["SUBK.K010.25.032."],"award-info":[{"award-number":["SUBK.K010.25.032."]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]},{"award":["SUBK.K010.25.032."],"award-info":[{"award-number":["SUBK.K010.25.032."]}],"id":[{"id":"https:\/\/ror.org\/01qpw1b93","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objective: Anorectal disorders are a common yet underdiagnosed component of pelvic floor dysfunction, particularly among postpartum women. These conditions, including hemorrhoids, anal fissures, and fecal incontinence, are associated with physical discomfort and may negatively affect psychological well-being. Self-esteem has been identified as a potential mediator linking somatic symptoms to mental health outcomes, including depression. We aimed to assess the relationship between anorectal symptoms, self-esteem and the severity of depressive symptoms in a Polish population of postpartum women. Methods: A cross-sectional questionnaire-based study was conducted between June and December 2025, including 120 women aged &gt;18 years, at least 3 months postpartum. Data were collected using online and paper questionnaires. The assessment tools included the Pelvic Floor Distress Inventory\u2014Short Form 20 (PFDI-20), Rosenberg Self-Esteem Scale (RSES), and Beck Depression Inventory (BDI). Statistical analyses included the multiple regression model, logistic regression and Spearman\u2019s rank correlation. Results: The most frequently reported anorectal symptoms included pain (45.83%), bleeding (42.5%), and pruritus (41.7%). The mean PFDI-20 score was 41.15 (SD 31.13). High self-esteem was observed in 55% of participants, whereas depressive symptoms were present in varying degrees of severity, ranging from no depressive symptoms (55.83%), mild (30%) to severe (0.83%). Significant positive correlations were found between pelvic floor dysfunction severity (particularly CRADI-8 and UDI-6 subscales) and depressive symptoms (BDI), while their correlation with self-esteem (RSES) was negative. The strongest positive correlation was observed between the overall PFDI-20 score and depression (r = 0.389). Multiple regression analyses identified anorectal symptoms, parity, hypothyroidism, and pre-pregnancy depression or anxiety as significant predictors of self-esteem. Anorectal symptoms and hormonal contraceptive use were significant predictors of depressive symptom severity. Among women who delivered vaginally, perineal tear was independently associated with greater depressive symptom severity (OR = 1.07, 95% CI: 1.01\u20131.14, p = 0.019). Conclusions: Postpartum anorectal and pelvic floor dysfunction symptoms are significantly associated with poorer psychological outcomes, including higher depressive symptoms and lower self-esteem. These findings highlight the importance of a multidisciplinary approach with routine psychological screening in postpartum care.<\/jats:p>","DOI":"10.3390\/jcm15135018","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T08:45:20Z","timestamp":1782722720000},"page":"5018","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Symptoms of Benign Anorectal Disorders on Self-Esteem and the Severity of Depression in Postpartum Women"],"prefix":"10.3390","volume":"15","author":[{"given":"Natalia","family":"Kuciel","sequence":"first","affiliation":[{"name":"Department of Clinical Physiotherapy and Rehabilitation, University Center of Physiotherapy and Rehabilitation, Faculty of Physiotherapy, Wroc\u0142aw Medical University, 50-368 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3326-0840","authenticated-orcid":false,"given":"Dominik","family":"Marciniak","sequence":"additional","affiliation":[{"name":"Department and Division of Pharmaceutical Technology, Faculty of Pharmacy, Wroc\u0142aw Medical University, 50-556 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1051-4430","authenticated-orcid":false,"given":"Roma","family":"Roemer-\u015alimak","sequence":"additional","affiliation":[{"name":"Department and Division of Family Medicine, Faculty of Medicine, Wroc\u0142aw Medical University, 51-141 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1556-0177","authenticated-orcid":false,"given":"Karolina","family":"Biernat","sequence":"additional","affiliation":[{"name":"Department of Clinical Physiotherapy and Rehabilitation, University Center of Physiotherapy and Rehabilitation, Faculty of Physiotherapy, Wroc\u0142aw Medical University, 50-368 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8983-0286","authenticated-orcid":false,"given":"Justyna","family":"Mazurek","sequence":"additional","affiliation":[{"name":"Department of Clinical Physiotherapy and Rehabilitation, University Center of Physiotherapy and Rehabilitation, Faculty of Physiotherapy, Wroc\u0142aw Medical University, 50-368 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1602-8978","authenticated-orcid":false,"given":"Edyta","family":"Sutkowska","sequence":"additional","affiliation":[{"name":"Department of Clinical Physiotherapy and Rehabilitation, University Center of Physiotherapy and Rehabilitation, Faculty of Physiotherapy, Wroc\u0142aw Medical University, 50-368 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1111\/1471-0528.12838","article-title":"Haemorrhoids and Anal Fissures during Pregnancy and after Childbirth: A Prospective Cohort Study","volume":"121","author":"Drasutiene","year":"2014","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_2","first-page":"860","article-title":"Prospective evaluation of hemorrhoids and anal fissures across pregnancy trimesters and the postpartum period","volume":"32","author":"Ansari","year":"2025","journal-title":"J. Popul. Ther. Clin. Pharmacol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Bu\u017einskien\u0117, D., Sabonyt\u0117-Bal\u0161aitien\u0117, \u017d., and Po\u0161kus, T. (2022). Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women\u2019s Quality of Life and Treatment Methods. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.788823"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Alharbi, R., Almajed, E., Alqntash, N., Alenzi, E.O., Bin Salamah, R., Altamimi, R., and Alotaibi, K. (2026). Prevalence and Determinants of Anorectal Disorders in Adult Patients with Urinary Incontinence: A Retrospective Cohort Study. J. Clin. Med., 15.","DOI":"10.3390\/jcm15031131"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.bpg.2007.06.001","article-title":"Impact of Pregnancy and Parturition on the Anal Sphincters and Pelvic Floor","volume":"21","author":"Quigley","year":"2007","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1111\/codi.14324","article-title":"Anorectal Symptoms during Pregnancy and Postpartum: A Prospective Cohort Study","volume":"20","author":"Ferdinande","year":"2018","journal-title":"Color. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/00006199-199607000-00007","article-title":"Self-esteem as a mediator of the effects of stressors and social resources on depressive symptoms in postpartum mothers","volume":"45","author":"Hall","year":"1996","journal-title":"Nurs. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1037\/0278-6133.19.6.576","article-title":"Stress, psychosocial resources, and depressive sympto-matology during pregnancy in low-income, inner-city women","volume":"19","author":"Ritter","year":"2000","journal-title":"Health Psychol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.sopen.2023.02.004","article-title":"Quality of Life in Patients with Hemorrhoidal Disease","volume":"12","author":"Davidsen","year":"2023","journal-title":"Surg. Open Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3687","DOI":"10.1007\/s11136-025-04056-0","article-title":"Association between Pilonidal Sinus Disease and Depression: A Population-Based Cohort Study","volume":"34","author":"Krieg","year":"2025","journal-title":"Qual. Life Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1097\/AOG.0b013e3181d4160d","article-title":"Quality of Life in Women with Postpartum Anal Incontinence","volume":"115","author":"Lo","year":"2010","journal-title":"Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Motofelea, N., Berceanu, C., Voita-Mekeres, F., Galis, R., Szasz, F.O., Motofelea, A., Hoinoiu, T., Papava, I., Olaru, F., and Soava, D.V. (2026). Associations Between Self-Esteem and Postpartum Depression and Anxiety: A Cross-Sectional Study Using the Rosenberg Scale in Romanian Women. J. Clin. Med., 15.","DOI":"10.3390\/jcm15031135"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s00192-018-3715-2","article-title":"Validation of the Polish Version of the Pelvic Floor Distress Inventory","volume":"30","author":"Grzybowska","year":"2019","journal-title":"Int. Urogynecol. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1177\/0163278709356187","article-title":"Psychometric Properties of the Rosenberg Self-Esteem Scale: Overall and across Demographic Groups Living within the United States","volume":"33","author":"Sinclair","year":"2010","journal-title":"Eval. Health Prof."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1590\/1516-4446-2012-1048","article-title":"Psychometric Properties of the Beck Depression Inventory-II: A Comprehensive Review","volume":"35","author":"Wang","year":"2013","journal-title":"Rev. Bras. Psiquiatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s11894-025-01000-7","article-title":"Postpartum anorectal and pelvic floor disorders: Evaluation, treatment, and prevention","volume":"27","author":"Sitaraman","year":"2025","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Opondo, C., Harrison, S., Sanders, J., Quigley, M.A., and Alderdice, F. (2023). The Relationship between Perineal Trauma and Postpartum Psychological Outcomes: A Secondary Analysis of a Population-Based Survey. BMC Pregnancy Childbirth, 23.","DOI":"10.1186\/s12884-023-05950-6"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1007\/s00192-024-05785-5","article-title":"Factors Associated with Obstetric Anal Sphincter Injury During Vacuum-Assisted Vaginal Delivery","volume":"35","author":"Chill","year":"2024","journal-title":"Int. Urogynecol. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ejogrb.2015.12.028","article-title":"Association of post-partum depressive symptoms and urinary incontinence: A cohort study","volume":"198","author":"Fritel","year":"2016","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.ajog.2024.02.307","article-title":"Urinary Incontinence Increases Risk of Postpartum Depression: Systematic Review and Meta-Analysis","volume":"231","year":"2024","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e101517","DOI":"10.1136\/bmjopen-2025-101517","article-title":"Impact of postpartum urinary and anal incontinence on patient-reported quality of life and risk of depressive disorder in women receiving primary and secondary care in the Netherlands: A prospective cohort study","volume":"15","author":"Mooren","year":"2025","journal-title":"BMJ Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1007\/s00192-019-04044-2","article-title":"The effect of the first vaginal birth on pelvic floor anatomy and dysfunction","volume":"30","author":"Urbankova","year":"2019","journal-title":"Int. Urogynecol. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"590648","DOI":"10.1155\/2012\/590648","article-title":"The link between thyroid function and depression","volume":"2012","author":"Hage","year":"2012","journal-title":"J. Thyroid. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1111\/j.1365-2826.2008.01774.x","article-title":"The thyroid\u2013brain interaction in thyroid disorders and mood disorders","volume":"20","author":"Bauer","year":"2008","journal-title":"J. Neuroendocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jad.2014.12.041","article-title":"Magnitude and risk factors for postpartum symptoms: A literature review","volume":"175","author":"Norhayati","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ystrom, E. (2012). Breastfeeding cessation and symptoms of anxiety and depression: A longitudinal cohort study. BMC Pregnancy Childbirth, 12.","DOI":"10.1186\/1471-2393-12-36"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"H\u00f6der, A., Stenbeck, J., Fernando, M., and Lange, E. (2023). Pelvic floor muscle training with biofeedback or feedback from a physiotherapist for urinary and anal incontinence after childbirth: A systematic review. BMC Women\u2019s Health, 23.","DOI":"10.1186\/s12905-023-02765-7"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Abebe, S.A., Gashaw, F., Tsegaye, A., Abebaw, D., Kindie, E.A., and Dejen, A.M. (2024). Prevalence and determinants of depression among women with urinary incontinence: A systematic review and meta-analysis worldwide. BMC Women\u2019s Health, 24.","DOI":"10.1186\/s12905-024-03432-1"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"409","DOI":"10.2147\/IJWH.S164266","article-title":"Questionnaires to evaluate pelvic floor dysfunction in the postpartum period: A systematic review","volume":"10","author":"Zuchelo","year":"2018","journal-title":"Int. J. Women\u2019s Health"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5018\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T09:50:35Z","timestamp":1782726635000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,27]]},"references-count":29,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135018"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135018","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,27]]}}}