Anal stenosis and megarectum in the elderly

Anal stenosis, an often unrecognized condition causing acute colonic obstruction in the elderly, is described with reference to three cases. Initial management should include: 1) digital dilatation and rectal examination; 2) sigmoidoscopy; 3) insertion of a rectal tube; 4) correction of fluid and electrolyte imbalance. Sufficient experience is not available to predict the results of sphincterotomy or anoplasty, both of which may result in incontinence, and conservative measures may suffice in most cases. Prevention of this condition may be achieved by adequate intake of dietary fiber or regular bulk laxatives in these debilitated patients.