Hi Flo, rectal strictures are among the most problematic complications of Crohn's. I never had one, but had an anal fistula and abscess and now how much stuff hurts down there.
As a far as I understand the treatment options are
A. Regular dilation (surgically through ballon dilation or index finger dilation)
B. Rectal stricturplastly
C. Removal of the rectum
D. Regular (daily) self dilations
In addition to these surgical option, biologic drugs like remicade help with the inflammation that would otherwise lead to even worse scaring.
B. And C. Are options usually preserved as last resorts, which leaves the regular dilations ever few months.
Re D., What I have read about are doctors who recommend that the patient himself or herself does regular dilations which apparently works, especially if the scared part is also regularly cared for with things like aloe vera, mitomycin etc.
Here is that case about "do it at home dilations"
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About 2-3% of Crohn's patients have rectal strictures. Management of these strictures may require endoscopic dilation, stricturoplasty or partial colon resection. Distal rectal and anal strictures pose additional challenges in surgical treatment because of its location. We present 3 patients with distal rectal strictures treated by digital dilation, topical application of mitomycin at stricture site and regular at-home dilation.
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Method:
3 patients, 18, 17, 12 years were diagnosed with Crohn's disease at ages of 10, 15 and 9 years respectively. They had Crohn's disease of the ileum and colon. They were treated with mesalamine, 6-mercaptopurine and infliximab. 2-7 years after the diagnosis, the patients presented with rectal bleeding, difficulty in defecation and passing “ribbon like” stools. The rectal strictures were diagnosed on digital examination or colonoscopy. Gentle 5 days preparation done. Under deep sedation with propofol, colonoscopy was performed, fibrotic 3 mm stricture was noted at 5 cm from the anal verge. Balloon dilatation failed to open the stricture. Following this a digital dilation was done. The index finger was inserted to its base, stricture was opened to a diameter of about 15 mm and topical application of mitomycin (0.3 mg/ml) was done. Abdominal x-ray after dilation showed no evidence of perforation. In the recovery room, patients and parents were taught to do the dilatation with a 14 mm Hegar dilator, which continued at-home daily.
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Result:
Patients tolerated the procedure well. A follow up of 4-18 months showed no relapse of the rectal strictures and the stool caliber was normal.
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Conclusion:
Digital dilatation of rectal strictures is a safe treatment for distal rectal strictures. At-home dilatation by patient or parent is a safe for preventing the recurrence of these strictures. Topical application of mitomycin may have an added benefit in managing these difficult distal rectal strictures.