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Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Operative

Anal Dilation (for Fissure / Stenosis)

A gentle, measured stretch of the anal canal done under brief anesthesia — used mostly for narrowing (stenosis) from scar tissue, and for selected fissures.

Request a consultationSurgery is arranged with a coordinator by phone.
Setting
Operative
Anesthesia
Usually a brief anesthetic in the operating room, so the muscle is fully relaxed
Back to work
Most patients are back to normal daily activities within a few days
Pain relief
Warm sitz baths, stool softeners, and over-the-counter pain relievers for a few days
Success rate
70-90%
Recurrence
10-25%

What it is

What is Anal Dilation?

Anal dilation is a procedure performed to gently stretch the anal canal and the internal anal sphincter muscle. It is used to treat two distinct conditions: chronic anal fissures and anal stenosis (narrowing). For anal fissures, the goal of dilation is to gently stretch the hypertonic (overly tight) internal anal sphincter, which improves blood flow and allows the fissure to heal. This is considered a form of controlled sphincterotomy. For anal stenosis, which is a fibrous, inelastic narrowing of the anal canal typically resulting from prior surgery, the goal of dilation is to physically stretch or break the scar tissue to restore the normal caliber and pliability of the anus. The procedure can be performed in an office setting, but is more commonly performed under anesthesia to ensure complete muscle relaxation and patient comfort.

Am I a candidate?

Who is a Good Candidate for Anal Dilation?

Anal dilation is a therapeutic option for several conditions:

  • Chronic Anal Fissure: It is considered for patients with chronic anal fissures who have failed conservative medical management (e.g., topical nitrates or calcium channel blockers) and who wish to avoid a surgical lateral internal sphincterotomy.
  • Anal Stenosis: It is the primary treatment for patients with mild to moderate symptomatic anal stenosis, which causes difficult or painful bowel movements and incomplete evacuation.
  • Post-Hemorrhoidectomy Spasm: It is occasionally used for patients experiencing significant internal sphincter spasm after anorectal surgery.

The procedure should be used with caution in patients with pre-existing incontinence or known sphincter weakness.

How it's done

  1. 1This is not the old 'anal stretch.' Forceful, uncontrolled manual dilation was abandoned because it injured the sphincter — modern dilation is measured, gradual, and deliberate.
  2. 2A brief anesthetic lets the muscle relax completely, which is what makes a controlled, gentle stretch possible.
  3. 3The canal is widened step by step with calibrated dilators or a balloon, to a measured size — never a forceful stretch.
  4. 4For stenosis, the goal is to stretch the ring of scar tissue back toward a normal caliber; for a fissure, to relieve the muscle spasm so it can heal.
  5. 5The procedure takes minutes, and you go home the same day.

What to expect

  1. Same day

    Home shortly after the procedure.

  2. First few days

    Some soreness, a feeling of pressure, and light spotting are normal. Sitz baths and stool softeners keep things comfortable.

  3. A few days

    Most people are back to work and normal activities.

  4. If treated for stenosis

    You may be given a short program of gentle self-dilation at home to hold the new caliber while the tissue settles — your surgeon will walk you through it.

  5. Follow-up

    A visit to check healing and, for stenosis, confirm the canal is staying open.

Risks & considerations

What are the Risks?

While generally safe when performed carefully, anal dilation has potential risks, including:

  • Pain: Significant discomfort and pain can occur, particularly if the dilation is performed too aggressively.
  • Bleeding: Minor bleeding or spotting is common. More significant bleeding can occur if the anoderm or mucosa is torn.
  • Fecal Incontinence: There is a risk of temporary or, rarely, permanent incontinence to flatus or stool. The risk is higher with more aggressive or uncontrolled dilation, which can overstretch or tear the sphincter muscles.
  • Fissure Recurrence or Incomplete Healing: The underlying fissure may not heal completely or may recur over time.
  • Restenosis: In cases of anal stenosis, the scar tissue may reform, requiring repeat dilation or more definitive surgical anoplasty.

Sources

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