The Impact of Symptoms of Benign Anorectal Disorders on Self-Esteem and the Severity of Depression in Postpartum Women

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 >18 years, at least 3 months postpartum. Data were collected using online and paper questionnaires. The assessment tools included the Pelvic Floor Distress Inventory—Short 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’s 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: 1.01–1.14, 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.