Anal Dilation Treatment

Because of its potential side effects, including fecal incontinence, anal dilation is no longer a method of choice for the treatment of hemorrhoids. Nevertheless, this method may help younger men and women with overly tight sphincters, who otherwise would have needed surgery. It may also help those with strangulated and thrombosed prolapsed hemorrhoids.

By carefully selecting patients and using the correct technique, anal dilation can help reduce the pain of hemorrhoids and speed up the healing process.

The Logic for Anal Dilation

Swollen internal hemorrhoids can sometimes increase the pressure on the anal sphincter muscle, a circular muscle that controls the passage of feces from the anus. This starts a worsening cycle, as this increase in pressure further weakens the rectal vein walls and therefore promotes even more swelling.

When swollen, these hemorrhoids can also prevent the normal passage of stool. Straining to pass constipated feces can cause the swollen hemorrhoids to be pushed out of the anal canal, a condition called prolapsed hemorrhoid. If the sphincter muscle suddenly closes while the hemorrhoid is outside of the anus, blood supply to the hemorrhoid is then suddenly cut off – thereby causing the pile to be strangulated. Blood clot may develop, causing a complication called thrombosed hemorrhoid.

To break this worsening cycle of ever increasing pressure and swelling, a procedure in which the anal sphincter is stretched out can be used. Here, by dilating or manually stretching out the circular muscle, the pressure on the hemorrhoid can be reduced. This helps prevent the worsening of hemorrhoids, particularly of prolapsed hemorrhoid, and gives the hemorrhoids a chance of healing.

In cases of strangulated hemorrhoids, emergency anal dilation can result in instant pain relief and accelerated healing process.

Anal Dilation Procedure

1. Proper Diagnosis
   
   Proper diagnosis, including careful history, digital examination, sigmoidoscopy or colonoscopy should first be performed.
   
   
2. Anesthesia
   
   General anesthesia is often used, although a caudal block or local pain killer can also be used.
   
   
3. Position
   
   The most often used position is the left lateral position, where the patient is laid down on the left side with knees drawn up and buttocks projecting over the edge of the surgical table.
   
   
4. Manual dilation
   
   The doctor first lubricates the anus and his gloves, and then inserts two of his left fingers into the anus. By partially hooking these fingers and lifting them up, the anal canal is then opened. The doctor inserts his right index finger and presses downward to locate the constricting band.
   
   Once the band is identified, the initial dilation begins with gentle ironing out motions by two index fingers. More fingers are inserted as required once the band starts to give way, until there are no more constrictions. This allows a clear passage from the mid rectum to the anal opening so stool can pass without any increase in pressure from straining.
   
   Because the anal sphincter is thinner and weaker in the front and back, stretching should be concentrated on the sides. Manual dilation of the anal sphincter should also be done gradually to avoid damaging the muscles or tearing the tissues.

After the procedure is completed, a soft sponge can be inserted to minimize the possibility of a hematoma or blood clot formation. However, the removal of the sponge is often the most unpleasant part for the patient.

Care During the Recovery Period

After the patient recovers from the anesthetic and any sponge is removed, the patient can be sent home.

For the first few weeks, defecation may feel very different – straining should not be necessary to push stool out – instead, it should be effortless and may come quickly without warning. Because of this, fecal incontinence or anal leakage may occur in the first few days, especially on sneezing as well as physical exertion or straining. A pad or adult diaper may be necessary during the recovery period.

Involuntary passing of flatus gas or fart can also occur for several months after the procedure. This should go away within two or three months of sphincter tightening exercise.

To ease the pain during recovery, the doctor may also prescribe pain killers. As usual, the patient should be advised to increase his or her fiber and water intake to help create well-formed stool that is easy to pass, and to avoid straining or other bad bathroom habits such as reading on the toilet.

Minor side effects such as prolapsing tissue or itchy skin tags can sometimes occur. If so, these tissues can be cut out with only local anesthesia.

Side Effects and Complications

Unlike surgical removal of hemorrhoids or hemorrhoidectomy, there is no post-operative bleeding, inability to pass urine, fecal impaction, or anal stenosis (narrowing of the anal canal).

However, anal dilation can result in the following side effects:

1. Fecal incontinence or anal leakage
   
   If too much force is used, sphincter disruption with keyhole anal deformity can occur.
   
   
2. Perforation of the rectum
   
   Forceful pulling of the hooked index finger against the rectal wall can cause tearing of the rectal tissue.
   
   
3. Minor hematomata or blood clots
   
   These small blood clots do occur in many cases. However, they should not require special treatment other than hot baths and application of creams. Bruises and small tears should heal by themselves within a few days.

Contraindications

Anal dilation is not a procedure for all cases of hemorrhoids. It should NOT be used for the following cases:

1. First- and second-degree hemorrhoids
   
   These should be used by other methods, such as rubber band ligation, injection theraphy.
   
   
2. Hemorrhoids with no symptoms
   
   
3. Large, symptomatic but non-painful hemorrhoids
   
   
   Hemorrhoids with mucosal prolapse or those that are itchy because of mucus leakage should not be treated with anal dilation because it may worsen the symptoms.
   
   
4. Patients with weak sphincter muscle
   
   Patients with weak sphincter muscle, especially elderly patients, should not be treated with anal dilation, due to the potential side effects of fecal incontinence or anal leakage.