Is Anal Stenosis Possible After Hemorrhoid Surgery?

Could it be anal stenosis?

Hello, Dr.
Ke.
About four months ago, I underwent surgery for mixed hemorrhoids.
My post-operative condition was normal, but recently I've noticed that I have to exert a lot of effort to have a bowel movement.
Sometimes it requires significant straining, but the stool that comes out is not very thin.
Could this be a sign of anal stenosis? Is it possible for anal stenosis to occur several months after hemorrhoid surgery? Thank you.

Tianxingzhe, 50~59 year old female. Ask Date: 2019/04/13

Dr. Ke Fangxu reply Surgery

After hemorrhoid surgery, anal stenosis may occur a few months later due to scar contraction, leading to a narrowing of the anal outlet.
The main symptoms include pain during bowel movements and a thinner stool.
However, it is essential to have a physician evaluate the condition for a definitive diagnosis.

Reply Date: 2019/04/13

More Info

Anal stenosis can indeed occur after hemorrhoid surgery, although it is not a common complication. Hemorrhoid surgery, particularly procedures like hemorrhoidectomy, can lead to changes in the anal canal's structure and function. This can result in scarring or narrowing of the anal canal, which may manifest as difficulty in passing stool, requiring increased effort during bowel movements, or a sensation of incomplete evacuation.

In your case, experiencing difficulty with bowel movements four months post-surgery could suggest the possibility of anal stenosis. While it is more typical for symptoms of stenosis to appear soon after surgery, it is possible for them to develop later, especially if there has been significant scarring or if the healing process has not gone as expected. Factors such as the surgical technique used, the extent of tissue removed, and individual healing responses can all influence the risk of developing stenosis.

Anal stenosis can lead to a range of symptoms, including:
1. Straining during bowel movements: As you described, needing to exert considerable effort to pass stool can indicate a narrowing of the anal canal.

2. Pain or discomfort: Some patients may experience pain during bowel movements, which can further complicate the process.

3. Changes in stool caliber: While you mentioned that your stool is not particularly thin, some individuals may notice a change in the shape or size of their stools, which can be a sign of a narrowed passage.

It is essential to differentiate between anal stenosis and other potential causes of your symptoms, such as constipation or anal fissures, which can also lead to straining and discomfort. Constipation can be influenced by dietary factors, hydration, and overall bowel habits, and it is crucial to ensure that you are consuming enough fiber and fluids to facilitate regular bowel movements.

If you suspect that you may have anal stenosis, it is advisable to consult with your surgeon or a gastroenterologist. They may perform a physical examination and possibly a flexible sigmoidoscopy or anoscopy to assess the anal canal's condition. Treatment options for anal stenosis can vary depending on the severity of the narrowing. Mild cases may be managed with dietary modifications, stool softeners, and increased hydration. More severe cases may require interventions such as anal dilation or surgical revision to alleviate the narrowing.

In conclusion, while anal stenosis is a potential complication following hemorrhoid surgery, it is essential to evaluate your symptoms in the context of your overall health and recovery. Prompt medical attention can help address your concerns and improve your bowel function, ensuring that you can manage your symptoms effectively.

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