Anal Stenosis

What is anal stenosis?

Anal stenosis is a narrowing of your anus (butthole), the spot where poop leaves your body. Healthcare providers may use the term “anal stricture.” The condition most commonly affects adults as a complication of surgery or chronic disease, but babies may also be born with narrow anuses (congenital anal stenosis).

Anal stenosis symptoms can be mild, moderate or severe, but almost always involve not being able to poop. Most of the time, changing what you eat and medication ease anal stenosis symptoms. But if you have severe anal stenosis, you may need surgery.

How common is anal stenosis?

Anal stenosis is rare, whether we’re talking about adults or congenital anal stenosis (CAS), but researchers are still gathering data on how often it happens.

What are the symptoms of anal stenosis?

Constipation is the overarching symptom for anyone with anal stenosis. But babies and adults may have varying symptoms.

Symptoms in adults

Adults may have constipation along with other symptoms like:

• Diarrhea.
• Fecal incontinence.
• Incomplete evacuation (feeling like you still need to poop after going to the bathroom).
• Narrow poops, like a poop that’s only as wide around as a pencil.
• Pain when you try to poop.
• Rectal bleeding.

Symptoms in babies

The most common symptom is when your newborn doesn’t pass meconium within 48 hours after they’re born. Other symptoms are:

• Crying and fussing that you can’t soothe.
• Narrow poops.
• Sunken spot on your baby’s head, fewer than six wet diapers a day and other symptoms of dehydration.
• Swollen belly.

What causes anal stenosis?

Anal stenosis in adults happens when scar tissue builds up in your anus, adding a layer of tough, non-stretchy fiber to your anus’ walls so it becomes narrower. The scar tissue may develop after medical treatment or surgery in or near your anus. It can also happen if you have a chronic (long-term) disease that causes inflammation.

Studies show that 90% of anal stenosis cases involve scar tissue that builds up after hemorrhoid surgery. Issues that may cause scar tissue buildup include:

• Anal sexually transmitted infections like chlamydia, genital herpes, human papillomavirus(anal warts), syphilis, gonorrhea, hepatitis A, hepatitis B and HIV.
• Inflammatory bowel disease.
• Overuse of laxatives.
• Radiation therapy to treat anal cancer may cause scar tissue that leads to anal stenosis.

Congenital anal stenosis

Anal stenosis in babies is a type of anorectal malformation that happens during fetal development. Experts don’t know the exact reason why.

What are the complications of anal stenosis?

Complications depend on your symptoms. For example, if you have fecal incontinence, you may develop sores around your anus. If you have chronic constipation, you could develop fecal impaction. If your baby has CAS (congenital anal stenosis), they can develop dehydration.

How do healthcare providers diagnose anal stenosis?

Diagnosis steps are different for babies and adults:

Diagnosing congenital anal stenosis (CAS)

Healthcare providers typically spot signs of congenital anal stenosis during a newborn examination that may include a digital rectal examination.

Your baby’s provider may suspect CAS if your baby doesn’t pass meconium within 24 to 48 hours after they’re born or if your baby’s first poops are unusually narrow. They may do the following tests to confirm your baby has CAS:

• Abdominal ultrasound.
• Barium enema.
• Computed tomography (CT) scan.

Diagnosing anal stenosis in adults

A healthcare provider will ask about your symptoms and your medical history. If you had surgery, they’ll review those records. They’ll do the following tests:

• Digital rectal examination.
• Anoscopy.
• Proctoscopy.

How is anal stenosis treated?

Whether you have anal stenosis, or your baby does, initial treatments will involve steps you can take to make it easier for you to pass larger poops. A healthcare provider may recommend:

• Using stool softeners for babies or laxatives and stool softeners for adults to help poop move more easily through a narrow anus.
• Changing what you eat and drink, so your daily meals include lots of fluid and fiber.

Sometimes, simply being able to pass stool that’s a normal size will stretch your anus naturally.

Other treatments for babies

Your baby’s provider may do anal dilatation to gently stretch your baby’s anus. Anal dilatation involves placing a small, lubricated device (dilator) in your baby’s anus. The provider removes the dilator after a few seconds.

Your baby may receive this treatment twice a day for several weeks. Each week, they’ll use slightly larger dilators so your baby’s anus eventually reaches a normal size. Your baby will have fewer treatments for the next few months.

Rarely, babies with anal stenosis will need an anoplasty.

Other treatments for adults

If changing what you eat or using laxatives doesn’t make a difference, your healthcare provider may recommend anal dilatation. They may do this treatment for you or show you how to use a dilator at home. They may recommend surgery if dilatation doesn’t improve your situation. Surgeries may be:

• Anoplasty: This surgery repairs issues in your anus that keep it from working correctly. Your surgeon will reconstruct your anus so it can relax and expand to its normal size.
• Sphincterotomy: In this procedure, your surgeon cuts into your internal sphincter muscle to reduce tension in your anus.

What can I expect if I have anal stenosis?

Treatment likely will help your anus return to its normal size and ease your anal stenosis symptoms. Unfortunately, anal stenosis often affects people with life-long inflammatory bowel disease (IBD). If that’s your situation, your healthcare providers will help you find ways to manage IBD.

Most of the time, treatment eases anal stenosis in babies. But as your baby grows up, be prepared to manage toddler constipation, particularly as your toddler masters toilet training.

How do I take care of myself?

If you have anal stenosis, your body’s probably been through a lot, like hemorrhoid surgery or managing an inflammatory bowel disease like Crohn’s disease. Anal stenosis may feel like one more challenge to your digestive health. Treatment may ease your symptoms. And here are some suggestions of things you can do to keep your poop moving:

• Drink up: Start your day with a glass of warm water. Feel free to follow that with a cup of coffee. Caffeine can wake up the muscles in your digestive system, which may help you to poop.
• Stay active: Whether you take a brisk walk or hop on a bike, movement stimulates your abdominal muscles and sends blood to your intestines. All that activity may lead to more regular poops.
• Consider stool softeners and laxatives: Sometimes, your body just needs a boost to get poop going. Your provider may prescribe stool softeners and laxatives, or you may take over-the-counter medication. But ask your provider for advice if you have inflammatory bowel disease that may affect the kind of laxative or stool softener you should take.

When should I see my healthcare provider?

Contact your provider if your anal stenosis symptoms don’t improve with treatment or if your symptoms get worse.