The Anal Stenosis Project

What is Anal Stenosis?  Stenosis is the abnormal narrowing of a passage in the body; anal stenosis refers to the inability of the anus to dilate in order to defecate.  This is commonly due to scarring from improperly performed hemorrhoidectomies.

This patient has sever anal stenosis.  She cannot have a normal bowel movement (BM).  BM's are extremely painful.  The area often tears and bleeds.  The stool that does come out ia described as "noodle" thin.

The patient had hemorrhoids that were improperly treated using sclerotherapy.  In the United States sclerotherapy has essentially been abandoned.  Sclerotherapy works by injecting a solution of phenol in oil into the base of the hemorrhoid.  It is critically important to get the oil into the base and nowhere else.   The phenol burns the hemorrhoid causing it to slough.  Although it can be uses in very isolated cases it biggest issue is the inability to control the slough.  Injecting into the wrong area can destroy the anal skin.  If circumferential a stenosis will result.  Most of the world now uses rubber band ligation instead.   A rubber band is placed on the base of the hemorrhoid which causes the hemorrhoid to slough.  It is much easier to control and there is no concern about extravasation and destruction of tissue not intended.

A 3 stage approach was developed for this problem.  First the doctors causing the problem needed to be identified and told to stop what they are doing.  This has been less than successful.   One major doctor responsible for the problem has merely changed who he refers his complications to.  Unfortunately the new referral has NO idea what to do so he then refers the patient back to us.  It is hard to teach someone who doesn't want to learn.

Second, I developed a PowerPoint presentation to educate the Cambodian doctors on how to treat hemorrhoids correctly  Third,  I established a program to repair the damage.  Luckily there is a procedure that will repair the damage.  Rotational flap anoplasty rotates flaps of canal into the anal to reline and expand it. 

Elliott Brender,
Jul 23, 2016, 1:49 PM