Anal Fissures: Symptoms, Causes, and How Physical Therapy Can Provide Relief

Anal fissures are small tears located in the tissues of the anus, the opening where stool (poop) leaves the body. These fissures can cause pain, bleeding, and discomfort during bowel movements.

They are very common, and can also occur in the lining of the rectum, referred to as rectal fissures. The rectum connects your colon to your anus, so either of these areas may develop fissures due to similar causes.

Anal fissures can cause sharp pain, most often during a bowel movement. This pain is the most common symptom, and it may last for some time after the bowel movement, too. Other symptoms can include bleeding, itching, burning, and muscle spasms.

These symptoms can often make people confuse anal fissures with hemorrhoids. If sharp pain is involved, it is often caused by anal fissures. Hemorrhoids can cause pain as well, but it is not typically the primary symptom.

Anal fissures may go away on their own, but if they last for a long time or happen frequently, it is important to seek professional treatment. Working with a professional who can identify the root cause of your condition will help prevent long-term pain and worsening of the fissures.

Anal fissures are typically caused by straining, stretching, or trauma. The tissues of the anus and rectum can be delicate, so when they are repeatedly exposed to trauma, inflammation, and irritation, fissures can form. They may struggle to heal as they are repeatedly exposed to these factors, too. Let’s take a closer look at the causes and contributors of anal fissures:

Difficult Bowel Movements

Most fissures are caused or worsened by difficult bowel movements. Straining on the toilet—such as when passing hard stool—can cause tears in the anal tissue.

While things like fluid intake and diet can significantly impact your bowel movements, there are other aspects that can make bowel movements difficult. Medications, hormonal changes, psychological factors, and pelvic floor dysfunction can cause symptoms like constipation, which can result in straining.

Pre-Existing Conditions

Some chronic conditions can make people more prone to anal fissures. This typically includes conditions that affect the bowels, such as:

• Chronic diarrhea
• Chronic constipation
• IBD
• Obstructed defecation syndrome

These chronic conditions cause stress and irritation to the anal or rectal tissues. They can also cause chronic pain in the pelvis and other areas, which can contribute to pelvic floor dysfunction.

Pelvic floor physical therapy can significantly reduce the severity of the symptoms associated with chronic conditions. By reducing pain, muscle tightness, and other symptoms associated with these conditions, physical therapy can help reduce the frequency and severity of anal fissures, too.

Pregnancy or Childbirth

Childbirth can affect the anus and may play a role in the formation of anal fissures. Although it is not directly involved with the labor process as the vaginal canal is, the anus is still affected by the straining, stretching, and stress that occurs with the process.

Additionally, the hormonal changes experienced during pregnancy and the changes in bowel habits during postpartum can also contribute to anal fissures.

Due to the increased pressure and other major changes the body experiences during pregnancy, it is common for individuals to experience pelvic floor dysfunction during or after pregnancy. As mentioned briefly before, pelvic floor dysfunction can play a role in anal fissures too, which we’ll discuss more next.

Pelvic Floor Dysfunction

The pelvic floor is a group of muscles located in your pelvis that perform many different functions each and every day. Some of those functions include continence of your bladder and bowels. This means that the health of your pelvic floor is directly related to your bowel movements!

Pelvic floor dysfunction refers to when the pelvic floor is too tight, weak, uncoordinated, inflexible, or a combination of these. When dysfunction is present, the pelvic floor cannot properly perform its functions, including bowel movements. This can lead to symptoms like constipation, pain, incomplete bowel movements, and much more.

These symptoms can contribute to the formation or worsening of anal fissures; therefore pelvic floor therapy may be necessary to allow for easier bowel movements, reduce the frequency of fissures, and prevent worsening of the condition.

Pelvic floor physical therapy can play a large role in managing anal fissures. Having a healthy pelvic floor supports better bowel health—in other words, a healthy pelvic floor requires less straining or difficulties on the toilet. 

Additionally, pelvic floor therapy can significantly help postpartum individuals during their healing period. Pelvic floor physical therapy can help restore their pelvic floor back to good condition and prevent the likelihood of anal fissures, as well as other pelvic floor dysfunction symptoms!

Unfortunately, dysfunction will not just go away on its own, and can worsen with time if left untreated. This can also mean that your anal fissures may stay frequent or even worsen.

While some individuals may find relief from at-home remedies or medications, it is still important to get to the root of the problem for long-term relief. Therefore, when your pelvic floor is experiencing dysfunction, it is very important to seek a professional (like me!).

I’ve helped countless patients with all kinds of conditions, including anal fissures. Everyone’s physical therapy care plan can look different, but the first session always begins with an evaluation. This will allow me to get a better idea of your pelvic floor’s state of health, and possible causes of your dysfunction. 

After getting a clear picture of your pelvic floor’s needs, I’ll create a unique treatment plan just for you! This care plan will blend education, manual therapies, exercises, stretching, and behavioral modifications to reduce tension and restore strength to your pelvic floor.

By engaging in regular pelvic floor physical therapy and staying consistent with your suggested lifestyle changes, you’ll be able to return to pain-free bowel movements and better daily comfort!

To get started, you can book an appointment with me here, or feel free to check out the discovery call if you have more questions.