Anal fissure treatment for anal fissure healing and relieving anal pain with bowel movements presented by Pelvic Floor Physiotherapist Michelle Kenway.

Watch this video and read on below to learn:

• Correct bowel emptying technique for anal fissure treatment at home

• Stool softening methods to promote anal fissure healing (stool softener medication and dietary fiber)

Anal Fissure Treatment Video Timestamps

1:00 Anal fissure picture
1:02 What is anal fissure
1:08 Anal fissure causes
1:18 Anal fissure symptoms
2:08 Bowel emptying position for fissure
2:55 Bowel emptying technique for anal fissure
6:05 Stool softeners for anal fissure
7:21 Diet for anal fissure
9:58 Summary anal fissure treatment

Pelvic Pain and Pelvic Relaxation Physiotherapy (Audio Download)

What is an Anal Fissure?

An anal fissure is a split in the soft tissue that lines inside the anus (shown below).

Anal Fissure Causes

There are a number of common causes of anal fissure including overstretching the anal skin:

• Straining with constipation or diarrhea
• Childbirth
• Anal intercourse

Muscle spasm can develop along with an anal fissure which slows the blood supply to the fissure, delaying healing and contributing to chronic anal fissure.

Anal Fissure Symptoms

Anal fissure symptoms can include:

• Intense anal pain with bowel movements
• Anal pain up to 2 hours after bowel emptying
• Sensation of splitting or burning with bowel emptying
• Bright red blood on toilet paper after bowel emptying

Seek medical advice if you experience any of these symptoms rather than self diagnosing an anal fissure.

1. Bowel Emptying for Anal Fissure Treatment

Using the correct bowel emptying position and technique is an important aspect of anal fissure treatment.

The split anal skin (anal fissure) can stretch open with bowel emptying especially with hard lumpy stools and straining with constipation. This is why incorrect bowel emptying technique and stool consistency may delay fissure healing and cause anal fissure pain.

Bowel Empyting Position for Anal Fissure

The correct position for bowel emptying with an anal fissure is shown below

• Sit on the toilet with feet flat on the ground
• Spread knees and hips apart
• Lean forward at the hips
• Keep the spine straight and maintain the inward curve in the low back
• Rest hands or elbows on thighs

Bowel Emptying Technique for Anal Fissure

Using the correct bowel emptying technique is an important part of anal fissure treatment to reduce straining and relax the anal sphincter during defaecation.

It’s important to avoid straining or pushing down through the anus during bowel emptying to minimise stretching the anal tissues and fissure.

Correct technique for bowel emptying:

• Go to the bathroom with the appropriate urge to empty the bowel
• Start with 5 deep belly breaths to promote pelvic floor muscle relaxation

• Gently wash with water or use moist towelette after emptying
• Warm baths or sitz baths can relieve anal pain after bowel movements

2. Stool Softening Anal Fissure Treatment

Correct Stool Consistency for Anal Fissure Treatment

Anal fissure healing is promoted by having a soft, smooth well formed stool.

• Ideal stool consistency is represented as Type 4 on the Bristol Stool Chart (shown below).
• Hard and lumpy stool (Type 1-2) is likely to cause constipation and straining with bowel emptying.
• A stool that is too soft and runny (Type 5-7) can cause diarrhea, aggressive bowel movements and straining to empty the bowel.

Stool Softener Medication

Stool softeners are mild laxatives are that usually available over the counter from the pharmacy.

Check with the pharmacist prior to taking stool softener medications and for the appropriate duration to take them for. Stool softeners are often indicated for continued use until the anal fissure has fully healed.

Stool softeners include:

• Docusate (e.g. Coloxyl, Colace)
• Paraffin
• Agarol
• Osmotic laxatives – polyethylene glycol (e.g. Movicol or Miralax)

Diet for Anal Fissure

Diet for anal fissure treatment aims to achieve a soft well-formed stool that is not bulky and avoids constipation.

A commonly made mistake is to increase general fiber consumption with an anal fissure. Some research suggests that reducing the intake of dietary fiber reduces idiopathic constipation (unknown cause)¹.

Most plant-derived foods contain 2 types of fiber; insoluble (non dissolving in water) and soluble (dissolves in water). Avoid foods that contain high quantities of insoluble fiber for anal fissure healing.

Decrease Insoluble Fiber

Insoluble fiber increases the bulk or size of the stool making it larger to pass, therefore stretching the anal tissues during bowel emptying. Insoluble fiber can also contribute to increased gas and bloating with constipation. Foods high in insoluble fiber include wholegrains, nuts, wheat bran, green beans and include the skins of fruits and vegetables.

Increase Soluble Fiber

Choose foods with high soluble (dissolvable) fibre content. This type of fiber will avoid bulking the stool and soften the stool to help promote anal fissure healing. Examples of foods with high soluble fibre content include oats, pear, apple and carrots (without skins).

More video information on stool softener foods that avoid constipation.

References

Image anal fissure Bernardo Gui, Public domain, via Wikimedia Commons
https://upload.wikimedia.org/wikipedia/commons/9/9e/Anal_fissure_2.jpg

1. Ho, K. S., Tan, C. Y., Mohd Daud, M. A., & Seow-Choen, F. (2012). Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World journal of gastroenterology, 18(33), 4593–4596. https://doi.org/10.3748/wjg.v18.i33.4593