Anal stenosis, also known as anal or rectal stenosis, is a relatively rare but uncomfortable condition that affects the anal canal and all of its functions. For some, it can become very problematic and lead to other, more serious health complications. Depending on its severity, the stenosis can affect quality of life because it causes pain, discomfort and discomfort. Treatment of anal stricture is often successful, but it is much better to seek treatment early to avoid some of the more annoying complications it can lead to.
If your anus feels tight, you may have anal stenosis. However, other conditions can present with similar symptoms, so this article will cover the most important questions about anal stricture to help you figure out if this is the problem.
What is anal stricture?
Anal stenosis is the narrowing of the anal canal, which is responsible for the tight feeling of the anus. Understandably, this contraction can mean you have trouble passing stool, leading to toilet strain and anal fissures.
During bowel movements, it is natural for the muscles to expand and contract, which helps move stool through the anus. However, when anal stricture occurs, the muscles become too tight to allow stool to pass easily.
What causes anal stricture?
Understanding and treating anal stricture requires consideration of possible causes. There are many reasons why the anus can become narrowed, but some are more common than others.
The most likely causes of anal stricture include:
Scar tissue from surgery or pelvic radiation therapy
Scar tissue formation is the most common cause of anal stricture. It usually occurs after surgery in the area. For example, removing hemorrhoids or skin tags requires incisions around the anus or into the anal canal. This can lead to what is known as ‘circular scarring’. Scar tissue is located just under the skin of the anal margin, and since scar tissue is not as flexible as normal tissue, it will not stretch enough to allow comfortable or complete passage of stool – especially larger ones.
Radiation therapy can also lead to scar tissue in the pelvic area, which is why it is a common cause of vaginal stenosis. The same is true of rectal radiation, which can also cause vaginal problems.
Anal fissures and sphincter spasms
Sphincters are muscular rings that surround and protect the opening or closing of a tube, and the anus has two of them: one is internal and the other is external. The inner clamp (located inside the outer clamp) cannot be controlled at will, while the outer clamp can. The sphincters act as seals that prevent stool from passing at the wrong time, and you can voluntarily contract the outer sphincter if you can’t use the toilet when you have the urge.
Sometimes spasms of the internal sphincter occur because of anal fissures, which are tears in the tissues of the anus that cause sharp, stinging pain and bleeding. Hard or bulky stools or constipation and straining can cause fissures, which can be considered chronic when they do not heal for prolonged periods. Every bowel movement can prevent healing or trigger a new one. Fissures can cause involuntary spasms, which over time can lead to rectal stricture.
Chronic diarrhea
Having diarrhea on a regular basis, or continuously over time, means that the anal passage is not working properly. It does not need to stretch (expand) and contract to pass firm stool, which leads to a loss of ability to expand. This problem is commonly seen in people with autoimmune or inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease, so there is sometimes a link between these conditions and anal strictures.
Sepsis
Sepsis is a very serious infection of the blood resulting from a systemic response to a local infection, and rectal sepsis is likely to develop for a number of reasons. Sepsis can endanger the vital organs of the human body and should be treated immediately in hospital. Symptoms of sepsis include hyperthermia, tachycardia, tachypnea, hypotension, and altered mental status.
Parasitic infection
Although much rarer, rectal stricture can result from a parasitic infection caused by the amoeba Entamoeba histolytica. It is only possible if you have visited developing countries and come into contact with water containing human excrement.
Other possible causes of rectal stricture may be:
- Congenital deformity
- Trauma to the area
- Rectal infection
- Sexually transmitted diseases
- Intestinal malabsorption
- Weak blood vessels
- Age-related atrophy
- Age-related Alzheimer’s or senility (so taking medications and laxatives for constipation)
Again, the above causes are not the initial reason for anal stricture: it is always the scar tissue that causes the stricture.
What are the symptoms of anal stricture?
The symptoms of anal stricture are not always exactly the same, but there are some general signs. For example, constipation is inevitable due to difficulty in bowel movement. Symptoms of anal stricture may also include:
- Bleeding from the rectum
- Blood in the stool
- Abdominal pains
- Bloating in the abdomen
- Pain during defecation
- Faecal leakage
- Small (pellet-like) or thin stools
For those with Crohn’s disease, there is an important distinction to be made: one that may require the discernment of an experienced healthcare professional. Crohn’s disease is an inflammatory bowel disease that is often associated with a narrowing of the anus. It can cause stricture of the anus, but it can also lead to a misdiagnosis, as symptoms of Crohn’s disease sometimes mimic symptoms of rectal stricture.
How is anal stricture diagnosed?
The diagnosis of anal stricture can be classified as mild, moderate or severe. If you only have a mild or moderate case, it should be possible to insert an anal dilator. This is something your doctor may do as part of an assessment. You’ll need a physical exam to evaluate the anus and skin, and your doctor may perform a digital rectal exam. If the test is too painful, they may use a local anesthetic. They will also discuss and evaluate your recurring symptoms.
Another possibility is that your doctor may perform rectal manometry. This is a test to check the muscle tone of the anus. It also measures rectal sensation and reflexes. The test consists of a small balloon, which is attached to a probe-like tool. This tool is connected to a machine that measures pressure levels. The tool will be inserted into the rectum and inflated and the machine will record the readings.
Anal stenosis does not have to be a burden for the rest of your life. However, since many of the symptoms can create a “vicious cycle” effect, it may not go away without some level of treatment. Treatments are generally considered effective, but it is best not to wait until further complications arise. Look for our article on treatment options for anal stricture, which provides helpful information to help you heal from this trying condition.
Diastolic therapy for anal stricture
Anal dilatation is performed to prevent the smaller opening of the anus and in turn increase the size of the opening to relieve pain. Anal dilators come in a variety of sizes and slowly stretch the anus. They are needed after rectal surgery or result from a diagnosis after a rectal examination. Your surgeon/doctor will explain how often and for how long you need to use rectal dilators. This can range from a few weeks to months.
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