Anal Stenosis: Causes, Symptoms, and Surgical Options

Anal stenosis

Hello, doctor! On July 16, 2017, I underwent traditional electrosurgical treatment at a general hemorrhoid clinic due to persistent itching.
Nine months after the procedure, I still experienced occasional bleeding during bowel movements.
I later discovered that I had significant difficulty with bowel movements, and the tissue around my anus felt thicker.
Every time I tried to have a bowel movement, I felt the urge at the anal opening, but no matter how hard I tried, I couldn't pass stool.
Recently, I've noticed that the anal opening feels very small, and I have to use my index finger to assist.
Currently, I spend about an hour in the bathroom each time, which is really painful.
What should I do? Are there any recommended surgical options? Also, if treatment is necessary, how long would the procedure take, and what is the recovery time? As I am currently a student and living in a shared apartment, it is quite inconvenient.

Yū, 30~39 year old female. Ask Date: 2018/11/06

Dr. Xu Kaixi reply Surgery

Hello, based on your description, you have undergone surgical treatment for hemorrhoids and are currently experiencing bowel movement issues.
You mentioned that the anal opening has become smaller.
I recommend that you first return to the clinic of the surgeon who performed your procedure for a follow-up examination of the post-operative condition of the anal opening.
It is important to confirm whether there is a narrowing issue before discussing further management and treatment options.

Reply Date: 2018/11/06

More Info

Anal stenosis is a condition characterized by the narrowing of the anal canal, which can lead to significant discomfort and difficulty during bowel movements. Understanding the causes, symptoms, and surgical options available for anal stenosis is crucial for effective management and treatment.

Causes of Anal Stenosis
Anal stenosis can arise from various factors, including:
1. Surgical Procedures: As you mentioned, previous surgeries such as hemorrhoidectomy or other anal surgeries can lead to scar tissue formation, resulting in narrowing of the anal canal.

2. Inflammatory Conditions: Conditions like inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, can cause inflammation and subsequent scarring in the anal region.

3. Trauma: Any trauma to the anal area, whether from childbirth, injury, or other causes, can contribute to the development of stenosis.

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

Symptoms of Anal Stenosis
The symptoms you are experiencing are common in patients with anal stenosis and may include:
- Difficulty with Bowel Movements: As you described, the sensation of needing to have a bowel movement but being unable to pass stool is a hallmark symptom.

- Pain and Discomfort: Pain during bowel movements is often reported, which can lead to avoidance of bowel movements and further complications.

- Bleeding: Occasional bleeding, especially if there is straining involved, can occur.

- Itching or Irritation: The anal area may feel itchy or irritated due to the difficulty in passing stool and the potential for skin breakdown.

Surgical Options for Anal Stenosis
If conservative measures such as dietary changes, stool softeners, and laxatives do not alleviate your symptoms, surgical intervention may be necessary. Here are some surgical options:
1. Anal Dilation: This procedure involves gently stretching the anal canal to widen it. It can be done in a doctor's office or under anesthesia, depending on the severity of the stenosis.

2. Sphincterotomy: In cases where the anal sphincter is contributing to the stenosis, a sphincterotomy may be performed to relieve pressure and allow for easier passage of stool.

3. Resection: If there is significant scar tissue or abnormal tissue, a surgical resection may be necessary to remove the narrowed segment of the anal canal.

4. Colostomy: In severe cases where other surgical options are not effective, a temporary or permanent colostomy may be considered to divert stool away from the anal canal.

Recovery and Considerations
The recovery time after surgery can vary based on the specific procedure performed and individual patient factors. Generally, you can expect:
- Anal Dilation: Recovery is usually quick, and many patients can return to normal activities within a few days.

- Sphincterotomy or Resection: Recovery may take a week or two, with some restrictions on physical activity and diet.

- Colostomy: If this is necessary, recovery can take longer, and additional adjustments may be needed for living with a colostomy.

Next Steps
Given your symptoms and the impact they have on your daily life, it is essential to consult with a colorectal surgeon or a gastroenterologist who specializes in anal disorders. They can perform a thorough examination, possibly including an anoscopy or colonoscopy, to assess the extent of the stenosis and recommend the most appropriate treatment options.

In the meantime, consider maintaining a high-fiber diet, staying hydrated, and using stool softeners to ease bowel movements. However, these measures may only provide temporary relief, and professional medical intervention is likely necessary to address the underlying issue effectively.

Conclusion
Anal stenosis can significantly affect your quality of life, but with appropriate medical evaluation and treatment, you can find relief. Don't hesitate to seek help from a specialist who can guide you through the options available and help you return to a more comfortable and functional state.

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