Review article
Anal stenosis and mucosal ectropion

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Definition, etiology, and incidence

Anal stenosis (AS) or stricture is defined as the loss of compliant natural elasticity of the anal opening, which then becomes abnormally tight and fibrous. It is a very disabling condition, worsened by the patient's embarrassment, yet uncommon.

AS may follow any circumstance that causes scarring over the anordermal area. Khubchandani has classified anal stenosis as congenital, primary, and secondary. Among the congenital forms are imperforate anus and anal atresia. Primary stenosis can be seen

Symptoms and diagnosis

There is a low correlation between the clinical findings and the symptomatology of the patient. Elderly patients with a narrow anal canal opening can have a relatively comfortable lifestyle and show no signs of AS.

Symptoms of constipation, a decrease in stool size, dyschezia, and tenesmus will prompt patient evaluation. Symptoms and rate of occurrence are listed below [1], [7], [8]:

  • Pain, 37%–71%

  • Constipation, 22%–37%

  • Bleeding, 21%–47%

  • Leakage, 10%–23%

  • Diarrhea, 14%

  • Digitalization, 11%

Pain seems to

Nonoperative or conservative management

Mild stenosis with minimal symptoms can usually be managed with dietary modifications and “bulking” agents. Anal dilatation should be done with the “natural” stretch of the passage of the fecal bolus through the rectum and the anal canal. Despite reports in the literature of self-dilatation after an initial exam and dilatation under anesthesia, using a Hegar's dilator, the resultant hematoma and further fibrosis may worsen the AS [1]. In patients with inflammatory bowel disease, however, this

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      Although the diagnosis of this condition is obvious and visual examination of perianal skin, anal canal along with a digital rectal examination, is generally sufficient to confirm the presence of anal stenosis, it is important to learn the cause of the stricture in order to find out appropriate therapy. Multiple therapies with their advantages and disadvantages have been described in literature for the correction or improvement of anal stenosis or stricture.3,6,9–14 For planning a therapy for anal stenosis it is very important to know the severity of the disease.

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      A single quadrant or two separate areas of ectropion can be treated with house or diamond-style island advancement flaps. Circumferential ectropion is best treated with S-plasty advancement flaps.48,49 Recurrent symptoms can occur following all treatment options for hemorrhoids.

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      2010, Surgical Clinics of North America
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      Pain with defecation is the most frequent complaint followed by constipation and bleeding, but frequently there is an overlap of symptoms.7 Constipation may be so severe that many patients begin to rely on laxatives, enemas, suppositories, and digital manipulation to aid in defecation, which can ultimately lead to more trauma, further aggravating their condition,1,8 Diarrhea noted in these patients is often the result of chronic laxative use leading to “paraffin anus” or from fecal overflow secondary to impaction.8 Physical examination is obviously very important in making the diagnosis and identifying the cause of anal stenosis, but often, anatomic findings may not directly correspond with the severity of symptoms.

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