Editing Anal stricture


Almost always a complication of previous anorectal surgery

* Occurs after fibrotic     replacement of the normally pliable anoderm or distal rectal mucosa
* Distinct from anal stenosis     (a functional narrowing of the anal canal secondary to muscle hypertrophy     or spasm)

Causative factors

* Haemorrhoidectomy - excessive     anoderm excision
*

== Presentation ==

* Pain with bowel movements
* Bleeding
* Difficulty evacuating
* Narrow calibre
* Incontinence
* Tenesmus
* Urgency

Examination

* Inspection: look for active     disease processes
* DRE: identify location and     severity of stricture
*

== Treatment ==

* Treat underlying condition     first - e.g. any inflammatory condition
* If the procedure was within     the past month, wait for 2 months after the procedure to permit healing     and resolution of inflammation
* Medical
** Hydration
** Fibre supplement
** Stool softeners
** Manual dilatation
*** Gentle insertion of       well-lubricated Hegar dilators
*** Begin with size 5 in rooms,       and continue up to size 18 in most patients
*** Subsequent dilatations can       be done at home using a size 14 dilator (advise to avoid excessive       force)
* Surgical
** Severe strictures or those      not responding to conservative management
** Beware smokers,      immunocompromised, diabetics - high risk of treatment failure, maximise      conservative therapy first
** Outcomes in crohn's/previous      RTx are poor regardless
** Malignancies - resection
** Anastomotic/Crohns      strictures - needs incision with or without stricturoplasty
** Anoplasty: release or      excision of the fibrotic strictured tissue and replacement with normal,      pliable tissue with a tension-free, well-vascularised flap
**
** Complications - recurrence,      flap failure, UTI, haematoma, infection, abscess, chronic pain, ectropion

[[Category:Colorectal]]