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31 Jan 2017

Anal and Rectal Stenosis


Stenosis is a term medically used to define a problem when a tubular part such as the organ canals and blood vessels for some reason start constricting in size, making the passage extremely narrow. Anal stenosis, also known as anal stricture, is a condition wherein the anal canal right before the anal sphincter narrows down and stops functioning properly. Generally, more than one factor is accountable to the occurrence of anal stricture. Constipation, strained stools, fissures, colon diseases such as Crohn’s disease, ano-rectal infection, itching, inflammation and damaged blood vessels are the common causes of stenosis. In certain cases, stenosis is congenital but most often develops after an ano-rectal surgery.

When rectal ulceration and healing becomes a chronic problem, scar tissue deposition begins to obstruct the anal canal due to the inflexible nature of the tissue. Similarly, procedures to remove or cure skin tags and piles from the anal canal can lead to the trauma of constant dilation and narrowing, resulting in build-up of the scar tissues; 90% of strictures are a result of previous haemorrhoidectomy. The development of strictures may be quite gradual; sometimes people fail to differentiate the constriction from a regular case of constipation. The tug of straining to push the anal and rectal muscles and empty the bowel result in tearing of anal lining; thus, damaging the blood vessels and tissues, which in turn triggers healing and later scarring. Ani muscles constitute most important muscles of the pelvic floor. Sometimes, rectal spasms and trapping of the muscles can also aggravate the problem and finally constrict the rectal canal.


Grading of Anal Stenosis: Pediatrics, Univ of British Columbia

Causes

  • Trauma of ano-rectal surgeries
  • Ano-rectal malignancy
  • Radiation therapy to treat tumour in pelvic area
  • Long term use of laxatives to ease constipation
  • Chronic use of migraine control drugs that contain ergotamine tartate
  • Sepsis in adjoining organs
  • Extreme blood loss inside a specific portion of the body weaken the blood vessels of anal canal
  • Colonic disorder and inflammatory problems
  • Sexually transmitted diseases like AIDS and gonorrhoea
  • Infection causes by a particular strain of bacteria called entamoeba histolytica

Symptoms

  • Constipation or diarrhoea
  • Excruciating pain while emptying the bowels
  • Rectal bleeding
  • Difficulty in clearing the bowels and stools are expelled in the form of pellets due to constricted anal canal

Treatment

Anal stenosis is quite an uncomfortable condition, disabling a person’s quality of routine besides the pain and trauma it entails. Having fibre rich diet and taking supplements for a healthy gut and smooth bowel movement is the best preventive mechanism to ward off strictures. In acute cases, surgery is the only option and the procedure is known as anoplasty. Strictures can be in the form of a thin strip - diaphragm sort, shape of a ring - anular or tube like - tubular. Anoplasty is the most effective way towards permanent remedy from stricture, the procedure has varied methods and opted based on the size and shape of the stricture. Although, there has to be an extra care taken after the surgery to not keep the area too moist or apply pressure when sitting while the stenosis is healing and ensure to have lighter low spice diet with addition intake of fluids and water.

Koya Stopiles Clinic in Hyderabad, and now in Bangalore, is a specialized clinic with expertise in diagnosis and treatment of ano-rectal problems. The team of doctors and surgeons carry years of experience, and in addition sought monitored help from experts overseas. To ensure complete discretion, proper diagnosis and treatment of individual cases without hesitation, there is arrangement for men to discuss with male doctors and vice versa. The techniques are US-FDA approved and minimally invasive in treatment of haemorrhoids, fistulas, fissures and other ano-rectal problems like stenosis.




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