Anal fissures are small tears in the lining of the anus, the opening where stool (poop) exits the body. They make bowel movements very painful and can cause bleeding, which will appear bright red on the stool, in the toilet, or on the toilet paper. These fissures may cause other symptoms such as itching, irritation, and general discomfort.

Similarly, rectal fissures can occur and cause the same symptoms. Rectal fissures are tears are found in the lining of the rectum, which is the canal that connects your colon to your anus.

Rectal or anal fissures should not be confused with hemorrhoids, although they can have similar symptoms. Hemorrhoids are usually caused by excessive straining, consistently sitting on the toilet longer than 10 minutes, chronic constipation or chronic diarrhea.

Anal fissures, on the other hand, are commonly caused by hard, dry stool or diarrhea, which causes skin breakdown and tearing that does not heal. Anal fissures also typically cause more severe and longer-lasting pain than hemorrhoids. However, there are a variety of potential causes or conditions that can contribute to anal fissures.

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As mentioned before, anal fissures are commonly caused by damage or injury to the rectal/anal lining, such as passing difficult stool. Difficult stool can include large, hard, or dry stool that can stretch and tear the lining of the rectum.

Similarly to hemorrhoids, factors such as chronic constipation, diarrhea, and excessive straining can increase the likelihood of anal or rectal fissures. Some other causes of these fissures include:

• Vaginal childbirth
• Trauma from anal intercourse or insertion of other objects
• Inflammatory bowel disease (IBD)
• Tight anal sphincter muscle
• Radiation in this area for cancer treatment

Physical therapy is an essential and beneficial form of preventative treatment and management for those who experience anal fissures. In fact, pelvic floor physical therapy can play an important role in supporting overall bowel health and reducing the likelihood of future fissures.

Even if your fissures heal, they can scab or leave scars—creating weakened areas of tissue that can retear. With physical therapy, those problematic areas can be better managed and the root cause of your anal fissures can be properly discovered and addressed.

This is especially true considering the fact that anal fissures are often caused by difficulty passing stool, straining, or anal trauma. Understanding your pelvic floor muscles and how they affect your bowel movements is incredibly important.

Oftentimes, constipation and other bowel conditions are tied to tight or uncoordinated pelvic floor muscles. A pelvic floor physical therapist can help you become more aware of your muscles and get them back to optimal health—promoting smoother bowel movements and less straining on the toilet.

In addition to addressing tight or uncoordinated pelvic floor muscles, pelvic floor therapists can help teach better bathroom habits and posture, as well as relieve pain or stress in the pelvic area.

If necessary, they can teach patients how to perform manual therapy at home, such as how to use wands or dilators. Lastly, physical therapists are skilled in teaching relaxation techniques that can calm tense muscles in the pelvic floor, which can encourage healing of anal fissures.

As you can see, there are a lot of ways that physical therapy treatment can support healthy bowels and prevent the formation of fissures. Our physical therapists at Hive Therapy and Wellness often use the following treatment techniques to help their patients manage fissures:

• Biofeedback
• Therapeutic Modalities
• Electrical Stimulation
• Behavioral Modification
• Therapeutic Modalities
• Manual Therapy 
• Neuromuscular Re-education