When a doctor finds that a patient has defecation problems due to an abnormality of the anus, this abnormality may be congenital or acquired later. Most patients present with symptoms of anal stenosis and difficulty holding stool caused by abnormal anal sphincter muscles or sphincter muscles that have been severed. In such cases, treatment with a method called Anoplasty is required.
Why does the anus become abnormal or narrowed?
One common cause of acquired anal abnormalities is improper treatment of hemorrhoids or treatment by doctors without direct expertise.
Sometimes patients feel anxious or embarrassed to visit a hospital, have limited time, believe advertisements, or worry about surgery, so they seek treatment at substandard facilities. These may use injections or chemicals to destroy hemorrhoid tissue, causing wounds. This method causes the hemorrhoid tissue as well as the normal tissue around the hemorrhoids to necrotize simultaneously, resulting in a large necrotic wound.
After the necrosis or inflammation begins to improve, the wound healing phase starts. This healing causes contraction of the tissue around the anus, leading to anal stenosis. The elasticity of the tissue around the anus, which is essential for defecation, is lost. When the anal opening cannot stretch well during stool passage, problems arise.
Additionally, anal stenosis may result from inappropriate hemorrhoid surgery, such as removing too wide an area or too many hemorrhoids. After suturing, anal stenosis and loss of anal elasticity are observed, causing patients to suffer during defecation. In some cases, even a little finger cannot pass through the anus. Patients often resort to taking laxatives daily to produce loose stools, causing distress every time they defecate.
Treatment of anal stenosis
If the doctor assesses that the symptoms are mild and the anal opening is not severely narrowed, less complicated treatments may be tried first, such as dilating the anus with fingers or dilators, either in the examination room or in the operating room under anesthesia or spinal anesthesia, including removing some fibrotic tissue that obstructs defecation.
In severe cases, such as very narrow anal openings where dilation with instruments is not feasible, the doctor will consider surgery using the Anoplasty method. This involves using normal, elastic skin from the perianal area to reconstruct the anus. This surgery allows patients to defecate normally, reduces pain during defecation, and enables normal stool retention.
Patients undergoing Anoplasty need to stay in the hospital for 2-3 days. Most patients can bathe, clean the anus, and use soap normally one day after surgery. They can return to work or daily activities within 5-7 days. Surgical complications are rare, and the surgical wound usually heals completely within 6 weeks.
When to see a doctor for abnormal anal or defecation symptoms
- Patients with bloody stools do not always have hemorrhoids, as bleeding may be caused by other reasons such as anal fissures (acute or chronic), anal inflammation, or tumors or cancers of the anus and colon. Therefore, if you notice blood in your stool or mixed with stool, you should promptly see a specialist to determine the exact cause and receive appropriate treatment.
- Current hemorrhoid treatment does not require surgery for every patient, as some cases can improve with dietary and defecation behavior adjustments combined with medication. Other treatments include hemorrhoid injections and rubber band ligation. Surgery is usually the last option when other treatments fail.
- For patients requiring hemorrhoid surgery, modern methods are less complicated and wound care is easier than before. Most patients do not need spinal anesthesia but receive sedation combined with local anesthesia. Surgery usually takes less than 1 hour.
Additionally, surgery may be performed without special instruments or, in some cases, laser treatment may be appropriate. Patients who undergo hemorrhoid surgery with sedation and local anesthesia can sit up and eat immediately after waking and can defecate normally. Most patients no longer need to soak the anus in warm water as in the past and can bathe and use soap normally. Complications are very rare.
However, after hemorrhoid treatment by any method, recurrence is possible. Therefore, avoid sitting on the toilet for long or frequent periods, whether constipated or having diarrhea. Also, avoid using a phone or reading while defecating, as this prolongs the time spent on the toilet, which is a key factor in developing hemorrhoids.
Dr. Ton Kongpensuk
Colorectal and Anal Surgeon Specialist
Colorectal and Anal Disease Center, Phyathai 2 Hospital
