Anal Stenosis After Hemorrhoidectomy: Avoidance and Management

Hemorrhoidal disease is a very common problem, affecting a large number of patients. The majority of patients with hemorrhoids can be managed nonoperatively; however, for patients who fail nonoperative therapy, hemorrhoidectomy is a safe and effective option. Anal stenosis is an uncommon complication after hemorrhoidectomy, but can be a potentially debilitating condition. The majority of patients with anal stenosis can be managed nonoperatively with a combination of stool bulking agents, stool softeners, increased fluid intake, and, occasionally, anal dilation. If patients fail nonoperative management, there are multiple options for surgical therapy including sphincterotomy, rectal mucosal flap reconstruction, and perianal tissue flaps. When choosing the surgical approach to anal stenosis, it is important to appropriately diagnose the level of stenosis and determine whether the patient has a functional, anatomic, or combined stenosis.