What is anal stenosis?
Anal stenosis means narrowing of the anal canal. It refers to the loss of elasticity in the anus, which is normally soft and capable of expanding. It also means that the opening and closing functions of the anus become restricted.
What causes anal stenosis?
Long-standing anal fissures or poor healing after previous anal surgery create scar tissue. This tissue is stiff and has reduced stretching ability. Therefore, the opening and closing functions of the anus are impaired, and anal stenosis develops.
What are the causes of anal stenosis?
In adults, the most common cause is previous anorectal surgery. Other causes include:
- Long-lasting diarrhea,
- Frequent use of laxatives or enemas for constipation,
- Untreated chronic anal fissures,
- Anal trauma or receiving radiation therapy, which can also lead to anal stenosis.
What factors increase the risk of developing anal stenosis?
The increasing use of laser and other energy devices in surgeries for hemorrhoids, anal fissures, and perianal fistulas has caused a significant rise in the number of patients presenting with anal stenosis.
What symptoms does anal stenosis cause?
- Severe pain during or after bowel movements. This pain can last for hours, even throughout the day.
- Straining during defecation.
- Difficulty passing stool even without constipation
- A sensation of blockage during defecation
- Frequent formation of anal fissures
- Bleeding or itching may also occur
Loss of elasticity in the anus also causes incomplete closure… Some patients may experience fecal incontinence or leakage of liquid stool. This leads to irritation and soreness around the anus.
How is anal stenosis diagnosed?
Most of our patients diagnosed with anal stenosis have previously undergone surgery for hemorrhoids or anal fissures. Their postoperative complaints either never resolve or recur more severely shortly afterward. Some patients even say, “I wish I had never undergone surgery.”
When should you see a doctor for anal stenosis?
If you have had surgery for hemorrhoids or anal fissures and you experience:
- Severe postoperative pain that persists for a long time,
- Delayed recovery and prolonged difficulty in passing stool,
You should suspect anal stenosis and consult a specialist.
Which doctor should you see for anal stenosis?
Because there are not enough specialists dedicated to anal stenosis either worldwide or in our country, and because public awareness is low, diagnosis and treatment are often significantly delayed. Many patients remain unaware that treatment exists and struggle with this serious problem for years.
You should consult a specialist in anorectal diseases who is experienced in diagnosing and treating anal stenosis.
Does anal stenosis cause constipation?
Anal stenosis causes severe pain during bowel movements, which slows intestinal motility. This naturally increases the tendency toward constipation.
Is anal stenosis difficult to treat? Can it be treated without surgery?
Surgery is required for the treatment of true anal stenosis. The number of specialists skilled in the necessary surgical technique is quite limited. However, when performed with the correct technique, success rates are very high. It is a comfortable and not highly painful procedure for the patient.
Which surgical technique do we use for anal stenosis?
First, we identify the strictured segment of the anal canal. After making this individualized assessment, we plan the procedure. Once the strictured area is removed, we evaluate from where we can prepare a flap and how to repair the defect.
Anal stenosis generally occurs at the posterior part of the anal canal, less commonly at the front, and rarely on the sides.
After removing the strictured area, we prepare a flap. We usually prepare a house-flap, a flap shaped like a house. This flap is advanced into the anal canal to repair the defect. In this way, we remove the non-elastic tissue and replace it completely with flexible skin.
What should be considered after anal stenosis surgery?
We keep patients in the hospital for 3 days. During this time, they are not given food or liquids; they receive IV fluids. Daily wound care is performed. After 3 days, patients are discharged home.
For 15 days after surgery, we recommend soft stools. Later, we want patients to produce formed stool. To achieve this, we ask them to reduce stool softeners, stop liquid-based diets, and eat normal foods. Passing formed stool is very important for maintaining normal physiology.
What is the success rate of anal stenosis surgery? Does severe pain occur after the procedure?
Patients often fear postoperative pain due to their previous painful surgical experiences. However, contrary to expectations, patients do not experience severe pain after anal stenosis surgery. The healing process is generally comfortable.
When performed by an experienced specialist, the success rate of anal stenosis surgery is very high.
