ABSTRACT
CHALLENGING CASE A 38-year-old man presents to your office after receiving an urgent hemorrhoidectomy 1 year previously. He had continued pain and bleeding with bowel movements. He feels his anus is “too tight” and continues to be symptomatic despite attempts at dilatation, daily fiber, and stool softeners. Examination reveals three healed incisions and anal stenosis. The anus will only admit the tip of your finger with discomfort.
