Anal Stricture

What is Anal Stricture

Anal stenoses or anorectic stricture is an uncommon disabling condition. It is a narrowing of the anal canal. This narrowing may result from a true anatomic stricture or muscular and functional stenosis. This narrowing comprises of a tight band of scar tissue that constricts the anal opening, interfering with the ability to pass stool comfortably.

Anal strictures or contracture can be caused by radiation treatment for cancers located near the anal area, some sexually transmitted diseases, and direct trauma to the anus or sometimes surgery to remove hemorrhoids.

Homoeopathic medicines help in:

  • Reducing pain and discomfort during stool.
  • Regulating bowel movement.
  • Alleviating constipation.

There are 119 remedies which give great relief in anal stricture / anorectic stricture or stenosis / anal contracture. However, the correct choice and the resulting relief is a matter of experience and right judgment on the part of the physician. The treatment is decided after thorough case taking of the patient. Thus remedies are designer made unlike conventional treatment in which all patients receive the same surgery or drugs although trade name may be different.

The goal of homoeopathic treatment is to alleviate the underlying cause. For example, if inflammation is the cause of stricture, correction of the underlying inflammatory process is necessary. If laxative abuse is the cause, this habit must be corrected to prevent recurrence.

Surgical removal of scar tissue is usually the most effective treatment in conventional system. Digital or instrumental dilatation may be beneficial; however, it may cause additional tears and splits of the anal mucosa. The mainstay of surgery is to produce cuts in the muscles surrounding the anus to reduce anal spasms. The same goal can be achieved with homoeopathy without using knife.

Homoeopathic medicines are basically aimed at enhancing the healing process of the stricture. They facilitate healing, improve blood circulation to the affected parts, relieve the anal spasm, alleviate pain, prevent infection, relieve constipation and treat all the symptoms related to anal stricture in totality. This goes a long way to prevent recurrence of the condition.

It is always better to take homoeopathic treatment and remedies for problems like anal fissure, hemorrhoids, and fistula, because these are the conditions for which patients go for surgery and do not realize the bad effect of surgery. In most cases surgery is the ultimate cause for stricture of rectum or anal stenosis or contracture.

Anal stricture is an uncommon but well recognized complication following hemorrhoidectomy. Twenty-seven (3.8%) out of 704 (500 elective and 204 emergency) cases of hemorrhoidectomy performed at the Singapore General Hospital over a 24 month period had clinical evidence of anal stricture post hemorrhoidectomy.

Ninety percent of anal stenosis cases are caused by hemorrhoidectomy. Removal of large areas of endoderm and hemorrhoid rectal mucosa, without sparing of adequate muco-cutaneous bridges, leads to scarring and a progressive chronic stricture.

Usually this problem recurs following conventional treatment. But in homoeopathic therapy chances of recurrence are next to nil. The treatment is based upon individual study and evaluation of the each particular case of anal stricture or anorectic stenosis.

Symptoms

  • Discomfort or pain during bowel movements.
  • Difficulty in passing stool because the anal opening feels too tight or too small.
  • The patient typically reports a history of anorectic surgery, radiation to the pelvic area, or laxative abuse.
  • He may describe excessive straining to have a bowel movement and a feeling of incomplete bowel evacuation.
  • Other clinical features are pain, bleeding, and pruritus.

Causes

  • Sepsis, ischemia (lack of blood supply) from occlusion of lower mesenteric artery or upper rectal artery
  • AIDS
  • Venereal lymphogranuloma
  • Gonorrhea
  • Amoebiasis
  • Anorectal congenital disease may lead to anal stenosis
  • Rectal trauma
  • Chronic abuse of ergotamine tartrate for the treatment of migraine headache attack may sometimes lead to anorectal stricture.
  • Radiation causes : Radiotherapy treatment for pelvic tumors like uterine carcinoma, prostatic carcinoma promotes anal stenosis formation
  • Surgical procedure complication like hemorrhoidectomy
  • Infectious disorders like lymphogranuloma venereum
  • Anal fistula
  • Neoplastic disorders like anal carcinoma
  • Autoimmune disorder
  • Inflammatory bowel disease
  • Tuberculosis
  • Damage or degeneration of nerves

Diagnosis

Diagnosis of anal stricture or anorectal stenosis or contracture is straightforward. The patient usually reports difficult or painful bowel movements. The patient may also have rectal bleeding and narrow stools.

The fear of fecal impaction or pain usually causes the patient to rely on daily laxatives or enemas.

Suspicion of anal stenosis is heightened by a history of hemorrhoidectomy, Crohns’ disease, or excessive laxative use.

Physical examination confirms the diagnosis. Visual examination of the anal canal and perianal skin, along with a digital rectal examination, is usually sufficed to establish the presence of anal stenosis. Occasionally the patient is too anxious or the anal canal too painful to allow an adequate examination. In this situation, anesthesia is needed to perform a proper examination of the anal canal. Visual inspection and digital examination are used to confirm the diagnosis.

No specific diagnostic tests are performed for this disorder. Inspection reveals narrowing of the anal canal; digital examination discloses anal tenderness and tightness.

Prevention

Diabetes, alcohol, anticonvulsant drugs for epilepsy and liver disease can all increase the risk of developing anal stricture or anorectal stenosis. Avoiding excessive intakes of alcohol may help to reduce the risk of developing it in susceptible individuals.

It is always better to take homoeopathic treatment for problems like anal fissure, haemorroids, and fistula, because these are the conditions for which patients go for surgery and do not realize the bad effect of surgery. Surgery is the ultimate cause for stricture in the rectum.

Anal stricture is an uncommon but well recognized complication following hemorrhoidectomy. Twenty-seven (3.8%) out of 704 (500 elective and 204 emergency) cases of hemorrhoidectomy performed at the Singapore General Hospital over a 24 month period had clinical evidence of anal stricture post hemorrhoidectomy.