Rectal strictures

Rectal strictures are chronic narrowings of the rectum that obstruct normal intestinal movement. They occur in 2–30% of patients following surgery for colorectal cancer. Other causes include inflammatory bowel disease (IBD), infections (e.g., lymphogranuloma venereum, tuberculosis), and radiation therapy. Bowel obstruction, constipation, overflow diarrhea, tenesmus, and urgency to void are typical clinical features. Diagnosis involves imaging such as CT enterography or MR enterography to evaluate the stricture and assess for underlying conditions or complications, followed by endoscopy and biopsy. Treatment options vary and may include rectal dilation (digital or instrumental), endoscopic therapies (e.g., balloon dilation, incision, or stenting), and surgical interventions such as stricture resection or stricturoplasty.

Chronic rectal narrowing causing: ^[1]

• Obstruction of normal intestinal movement, leading to clinical features of bowel obstruction
• Inability to insert a 12-mm endoscope through the rectal lumen (anatomical definition)

• Following surgery for colorectal cancer: occurs in 2–30% of patients ^[2]

Epidemiological data refers to the US, unless otherwise specified.

• Postoperative: following colorectal anastomosis for colorectal cancer
• IBD (e.g., ulcerative colitis)
• Colorectal cancer
• Infections, e.g.:
  • Lymphogranuloma venereum
  • Tuberculosis
• Iatrogenic
  • Radiation therapy
  • Long-term use of NSAID suppositories
  • Intrauterine contraceptive devices

• Symptoms of bowel obstruction
• Constipation
• Diarrhea
• Tenesmus
• Urgency

Patients may also experience hematochezia and/or discharge depending on the underlying cause (e.g., inflammatory bowel disease). ^[3]

See also "Diagnostics for colorectal cancer" and "Diagnosis of ulcerative colitis."

• Imaging ^[4]
  • Evaluate for:
    • Underlying conditions (e.g., cancer recurrence)
    • Stricture number, severity, type, and length: guides treatment approach
    • Complications (e.g., fistulas, abscesses)
  • Modalities: CT enterography or MR enterography
• Endoscopy and biopsy: to rule out malignancy ^[5]
  • Multiple endoscopic biopsies
  • Cytological brushings

Treatment is guided by severity and clinical suspicion for other conditions, such as cancer. Options include the following: ^[1]

• Rectal dilation
  • Digital dilation: for distal strictures that are accessible by finger.
  • Instrumental dilation ^[2]
• Endoscopic therapy
  • Endoscopic balloon dilation (first-line): often requires several sessions ^[4]
  • Endoscopic incision
  • Endoscopic stenting
• Surgical therapy: for strictures refractory to other treatments ^[5]
  • Stricture resection
  • Stricturoplasty