Anal Stenosis: Causes, Symptoms, and Treatment Options

Anal stenosis

Hello, Director Ke.
My husband had surgery to remove internal hemorrhoids a month ago, but he is still experiencing pain in the anal area.
There is excess skin at the anal opening, and his stools have become as thin as a finger.
He is still taking stool softeners.
A few days ago, during a follow-up visit, the attending physician said that the wound healing is okay, but he mentioned that removing the excess skin would help the recovery process.
As for the thin stools, he attributed it to the use of stool softeners.

We also consulted another doctor who believes that the attending physician "removed too much tissue," leading to slight anal stenosis, which is causing the stools to be thin.
However, this doctor did not suggest any treatment for the anal stenosis; he only advised against using stool softeners and prescribed anal suppositories.

I researched online, and it seems that anal stenosis is assessed by whether a finger can pass through the anus smoothly.
However, since finger sizes vary among individuals, the experience of passing may differ as well.
Is there an objective method to assess this condition besides the finger examination? Additionally, can stool softeners really cause stools to become thinner? How deep should the suppository be inserted—up to one knuckle? Lastly, should the excess skin be removed? If it is removed, will the anal stenosis worsen? I appreciate your time in responding.
Thank you.

yul, 30~39 year old female. Ask Date: 2018/01/08

Dr. Ke Fangxu reply Surgery

Of course, everyone's finger thickness varies, but the differences are not significant.
However, this serves as a convenient guideline for assessment.
If an objective criterion is required, the insertion of a one-centimeter diameter anal dilator causing pain can also be a method of judgment.
However, dilators are not readily available everywhere, and each person's pain threshold is different, making it impossible to achieve complete objectivity.
Stool softeners can indeed make stools slightly thinner.
As for suppositories, they only need to be inserted into the anus.
The removal of excess skin does not affect anal stenosis; it only impacts the appearance.
New excess skin may also develop after removal.

Reply Date: 2018/01/08

More Info

Anal stenosis, or narrowing of the anal canal, can be a challenging condition, especially following surgical procedures such as hemorrhoidectomy. Understanding the causes, symptoms, and treatment options is crucial for managing this condition effectively.

Causes of Anal Stenosis
Anal stenosis can occur due to several reasons, including:
1. Surgical Complications: As in your husband's case, surgical removal of hemorrhoids can sometimes lead to excessive tissue removal, resulting in scarring and narrowing of the anal canal.

2. Inflammation: Conditions like inflammatory bowel disease (IBD) can lead to inflammation and subsequent narrowing.

3. Trauma: Any trauma to the anal area, including childbirth or injury, can lead to scarring and stenosis.

4. Congenital Conditions: Some individuals may be born with anatomical abnormalities that predispose them to anal stenosis.

Symptoms of Anal Stenosis
Common symptoms include:
- Pain: Discomfort or pain during bowel movements is often reported.

- Narrowed Stool: Patients may notice that their stools are thinner, resembling a pencil or finger, which is a direct result of the narrowed passage.

- Straining: Difficulty passing stools can lead to straining during bowel movements.

- Bleeding: In some cases, there may be bleeding associated with bowel movements.

Treatment Options
1. Observation: If the symptoms are mild, sometimes observation is all that is needed, especially if the condition is expected to improve over time.

2. Dietary Changes: Increasing fiber intake can help form bulkier stools, which may ease the passage through a narrowed anal canal.

3. Medications: Softening agents, such as stool softeners, can help, but they may also lead to thinner stools, as you have noted. It is essential to find a balance.

4. Surgical Intervention: If the stenosis is significant and causing distress, surgical options may include:
- Dilation: This involves gently stretching the anal canal to widen it.

- Surgical Revision: In some cases, a more extensive surgical procedure may be necessary to correct the narrowing.

Objective Assessment of Stenosis
While the finger test is a common method to assess anal stenosis, it is subjective and can vary from person to person. More objective assessments can include:
- Anoscopy: A procedure where a small tube is inserted into the anal canal to visualize the area and assess for narrowing.

- Endoscopy: This can provide a more detailed view of the anal canal and rectum.

- Imaging Studies: In some cases, imaging studies like MRI may be used to evaluate the anal canal's structure.

Regarding Softener Use and Anal Suppositories
Softening agents can lead to thinner stools, especially if they are overused. It is crucial to monitor the dosage and adjust it based on the stool consistency. As for anal suppositories, they should be inserted gently, typically about one inch or one finger's length, depending on the product's instructions.

Decision on Skin Tags
Regarding the skin tags (or "excess skin") that you mentioned, the decision to remove them should be made in consultation with your healthcare provider. If they are causing discomfort or contributing to the narrowing, removal may be beneficial. However, there is a risk that removing them could exacerbate the narrowing if not done carefully.

Conclusion
In summary, anal stenosis can be a complex issue following hemorrhoid surgery, and it is essential to work closely with your healthcare provider to determine the best course of action. Monitoring symptoms, adjusting dietary habits, and considering surgical options are all part of managing this condition effectively. If your husband continues to experience significant discomfort, seeking a second opinion from a colorectal specialist may provide additional insights and treatment options.

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