The question “What causes anal stricture?” is often asked by patients who experience difficulty and pain during bowel movements. Anal stricture is a significant health issue that negatively affects quality of life, causing difficulty and discomfort during defecation. Often unnoticed, this condition can result from previous surgeries, chronic inflammations, trauma, or some congenital structural abnormalities.
Narrowing of the anal canal not only causes physical discomfort but can also lead to psychological distress. In this article, we will discuss the causes of anal stricture, its risk factors, and ways to prevent it.
What Causes Anal Stricture?
The most common cause of anal stricture is a history of previous anal surgeries. Patients who have undergone surgery for hemorrhoids, anal fissures, or anal fistulas are at higher risk. Postoperative symptoms may persist, and new complaints related to anal stricture may develop. Common signs include severe pain after defecation, difficulty during bowel movements, and in advanced cases, thinning of stool diameter. These symptoms usually begin around three months after surgery and gradually worsen.
Other causes of anal stricture include:
• Untreated chronic anal fissures
• Chronic constipation or prolonged diarrhea
• Trauma to the anal area
• Radiotherapy
What Are the Risk Factors for Anal Stricture?
Certain risk factors contribute to the development of anal stricture, including:
• Energy devices (cautery, laser, vessel-sealing devices): These surgical tools can leave thermal injury in the tissue. The resulting scar tissue reduces the elasticity of the anal canal, leading to narrowing.
• Combination of hemorrhoids and anal fissures: In some patients, a fissure develops first, followed by hemorrhoids due to increased pressure. Treating only hemorrhoids while ignoring the fissure can eventually set the stage for anal stricture.
• Long-term use of stool softeners: Some patients continue using stool softeners post-surgery due to fear of pain. Prolonged use can alter the structure of the anal canal.
How Can Anal Stricture Be Prevented?
To prevent anal stricture, attention should be paid to the following:
• Limit the use of energy devices during surgery, and use them carefully when necessary.
• Avoid chronic constipation and prolonged diarrhea.
• During radiotherapy planning, the distal anal canal should be spared whenever possible.
• Seek medical attention promptly when symptoms appear.
