Addressing Anal Stenosis: Surgical and Self-Treatment Options

Anal stenosis issue

Hello doctor, I am a member of the LGBTQ+ community.
I previously underwent fistula and hemorrhoid surgery at another clinic, but since the surgery, I have found it difficult to engage in anal intercourse, and it feels much narrower than before.
The previous physician assessed that there was no issue with anal stenosis.
Can this be addressed through self-dilation (which I have been trying for a while), or is surgical treatment an option?

Ju Ju, 30~39 year old female. Ask Date: 2023/02/02

Dr. Zhang Shuhao reply Surgery

After surgery for fistulas and hemorrhoids, the wound area may slightly lose elasticity; however, if the external anal sphincter is not damaged, it will not cause severe stenosis.
Mild stenosis can be improved through self-dilation, but it is important to ensure adequate lubrication and to proceed gradually, avoiding any bleeding or pain.
Severe stenosis (where even a little finger cannot be inserted) requires surgical intervention, and it is recommended to seek treatment from a colorectal surgery or plastic surgery department at a major hospital.

Reply Date: 2023/02/02

More Info

Addressing anal stenosis can be a complex issue, especially for individuals who have undergone previous surgeries for conditions such as hemorrhoids or fistulas. Anal stenosis refers to a narrowing of the anal canal, which can lead to difficulties in bowel movements and, in some cases, can affect sexual function, particularly anal intercourse.
In your case, it seems that after your previous surgeries, you have experienced a significant change in the width of your anal canal, making anal intercourse difficult. It's important to note that while some physicians may not classify your condition as anal stenosis, your symptoms and experiences are valid and warrant further exploration.

Self-Treatment Options
1. Self-Dilation: Self-dilation is a common method used to treat anal stenosis. This involves the use of anal dilators or even fingers to gradually stretch the anal canal. It is crucial to approach this method with caution to avoid injury or further complications. Start with smaller dilators and gradually increase the size as tolerated. Lubrication is essential to minimize discomfort and prevent tearing of the tissue.

2. Warm Baths: Soaking in warm baths can help relax the anal sphincter and may make self-dilation easier. This can also provide relief from any discomfort associated with the narrowing.

3. Topical Treatments: Some individuals find relief using topical anesthetics or steroid creams to reduce inflammation and discomfort in the anal area. However, these should be used under the guidance of a healthcare provider to avoid potential side effects.

Surgical Options
If self-treatment does not yield satisfactory results, or if the stenosis is severe, surgical options may be considered:
1. Anal Dilation Surgery: This procedure involves surgically widening the anal canal. It can be performed under local or general anesthesia, depending on the severity of the stenosis and the patient's overall health. This option is often effective for patients who have not responded to conservative measures.

2. Fistulectomy or Hemorrhoidectomy Revision: If the narrowing is a result of previous surgeries, a revision of the original procedure may be necessary. This could involve removing scar tissue or correcting any anatomical issues that may have arisen from the initial surgery.

3. Sphincteroplasty: In cases where the anal sphincter has been damaged or scarred, a sphincteroplasty may be performed to repair and restore function to the anal sphincter.

Consultation with a Specialist
Given the complexity of your situation, it is highly recommended to consult with a colorectal surgeon or a gastroenterologist who specializes in anal disorders. They can perform a thorough examination, including possibly an anoscopy or flexible sigmoidoscopy, to assess the extent of the stenosis and recommend the most appropriate treatment options tailored to your specific needs.

Conclusion
In summary, while self-treatment options such as dilation and warm baths can be beneficial, they may not be sufficient for everyone. Surgical options are available and can provide significant relief for those suffering from anal stenosis. It is essential to work closely with a healthcare provider to determine the best course of action for your situation. Your comfort and quality of life are paramount, and addressing these issues with a specialist can lead to a more satisfactory outcome.

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