What causes strictures?

It's scar tissue. I dealt with a  stubborn stricture post takedown at the anastomosis site but luckily after several dilations by my surgeon, it was resolved and the scar tissue hasn't formed again. Sorry, I don't know enough about long term or recurring strictures to answer your questions. 

As far as I know straining cannot cause strictures. Straining can contribute to hemorrhoids, fissures, and pouch prolapse, but strictures are a different beast.

my understanding is unremitted inflammation leads to scarring, leads to scar tissue accumulation, equals stricture.

along those lines, given that crohns penetrates deeper into the intestinal wall, one would suspect that strictures are more common with crohns.

I agree with Scott not so sure that straining per se would help. but I would submit that straining is not a good idea. if you are straining have you thought about a squatty potty or simply mimicking the same with a homemade version? people swear by them.

if I am wrong on the strictures, I would be happy to be corrected, I have two strictures on mid pouch, one less troublesome one above my jpouch. recently had the most hopeful conversation that I have ever had with a Stanford surgeon who said, that newer thinking is maybe they could try a strictureplasty type situation but it would also require a temp ileo in order to allow the surgery site to heal. she stated that it would be new territory and not something that has been widely done but perhaps they would consider it. mind you this was not during an actual consult but merely a question on the side of a CCFA symposium.

I don't have any reason to believe I have a stricture I was just asking. I just had takedown 3 weeks ago and I dealt with bad gas pains and found myself straining and pushing a little much trying to get the gas out. My gas has finally started to subside but re inflamed my hemrhoid from years ago. Just need to try and relax while on the pooper.

As Dewey stated, strictures are scar tissue often due to prolonged inflammation. They are most commonly associated with Crohn's, but absolutely can occur without Crohn's, or without any type of IBD.

The most common stricture for us is at the anastomosis (suture line) of the pouch to the anus/rectal cuff. It is a circular scar that can shrink over time and become fibrosed. Some people are just more prone to this type of scarring than others, just like some people are more prone to adhesion or keloid formation.

Mid pouch and prepouch narrowing and strictures are not associated with a suture line, but more associated with chronic inflammation. This is the type to be more likely associated with Crohn's or even UC.

Treatment can vary depending on the degree of stricturing and the toughness of the tissue. If it cannot be dilated or the dilation will not hold after multiple attempts, surgical repair may be necessary.

Straining does not cause a stricture, but can be a symptom of one. Straining can cause other problems, like prolapse.

Jan

What happens if u have a prolapse? 

Does anyone know if surgical repair of a stricture works? What exactly does that involve-removing the affected area of intestine or is repair done via stricturoplasty? I had a stricturoplasty for a stricture at the pouch inlet about 10 years ago which never resolved my stricture issue. Maybe there is no real answer to this question since so many other factors can affect outcomes with the disease and strictures. 

-Lori

With prolaspe you can have collapse or "telescoping" of the pouch and adjacent intestine. You can also have the pouch prolapse outside of the anus. 

Surgical repair of strictures depend on the location and type. It could be stricturoplasty, or pouch advancement if at the anal anastomosis. 

Jan

so Jan, if surgeon checked morning of takedown and didn't notice any strictures and I don't believe I have a "cuff" due to hand sewn mucousectomy, only 3 weeks from surgery does that mean pretty much no chance of stricture forming that quickly? Reason I ask is cuz things have been going so well besides the big hemrhoid I have from wiping in hospital the first week, I have only been going to bathroom like 5-6 times a day and sleeping through the night. I read a past post by you Jan regarding strictures and you said if you couldn't get finger up the butt you probably have a stricture. Of course I tried and couldn't get more than fingertip up there ?? first 2 weeks I was straining a bit trying to get that painful gas out. Have post op apt in a few weeks so I will have them look.

It is sort of tricky because if you are having sphincter spasms, that will also prevent passage of your finger. Also, if you are inflamed in there, say from hemorrhoids, that also can crowd the passage. Plus, your doctor can get in a better position to fully examine.

That said, strictures can form slowly over time, and that is often the case. Your best bet is to have the doc check it out at your next appointment, like you are planning.

Jan

My hemorrhoid is external, right next to anus, so don't think I have internal. and as far as I know im not having any spasms?? my followup is April 21st so I will have them check it out.