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Anorectal Stricture, Stenosis, or Contracture

Anorectal stricture is a narrowing of the anal canal that results from intraluminal inflammation or scarring. Stenosis or contracture prevents sphincter dilation.

Causes

Common causes:

  • Injury (including burns)
  • Reduced use (for example, from immobilization)
  • Damage or degeneration of the nerves
  • Inherited disorders

Signs and Symptoms

The patient typically reports a history of anorectal 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.

Inspection reveals narrowing of the anal canal; digital examination discloses examination discloses anal tenderness and tightness.

Diagnostic tests

Visual inspection and digital examination are used to confirm the diagnosis. No diagnostic tests are performed for this disorder.

Treatment

The goal of therapy 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. Digital or instrumental dilatation may be beneficial; however, it may cause additional tears and splits of the anal mucosa. Balloon dilatation may also be successful.

Prevention

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

The aim of any treatment is to release the contracture and improve the function of the hand. This can be achieved with open surgery or the less invasive surgical procedure called needle fasciotomy.



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