Bowel movements are a part of our normal routine, but painful bowel movements don’t have to be. A common cause of painful bowel elimination is anal fissures. These tiny tears in the anal canal are quite common and have a significant impact on quality of life. Among patients studied in a 2014 cohort, prevelance of anal fissure was most common in younger females and older males and all patients had significantly higher scores when it came to anxiety, depression, and affect on functionality. Anal fissure pain is typically a sharp, localized anal pain associated with bowel movements followed by bright red blood found on stool, tissue paper, and clothing. The pain can last for hours following a bowel movement causing fear of passing stool and withholding behaviors which can perpetuate a cycle of pain, tension in muscles, and impaired anorectal sensation. The cause of anal fissures is typically the passage of hard stool against high resting tone of the anal sphincters but can vary including underlying functional GI disorders, inflammatory bowel disorders, childbirth, repeated bouts of diarrhea, and prior anal surgery. In 40% of patients, acute anal fissures progress to chronic anal fissures; specialized pelvic floor phsycial therapy is a proven method to treat current anal fissures and reduce recurrence rate.
Anal fissures are typically seen in the posterior midline of the anal canal (6:00 when looking at the pelvic clock) due to decreased blood flow to this sensitive tissue – literally this area receives half the perfusion of the rest of the anal canal. Together with high resting tone of the internal anal sphincter, any increase in pressure or hard stool passing can lead to anal fissure.
Treatment for anal fissure should begin with conservative measures. This includes dietary changes such as adding more fiber and water, stool softeners, sitz baths, topical ointments (either over the counter or compounded prescription medications), and physical therapy. A pelvic health physical therapist can expedite recovery by decreasing tension to the internal anal sphincter and improving blood flow to the affected tissue with manual therapy techniques. These specialized soft tissue techniques reduce tone to the pelvic floor muscles that may be impeding the blood vessles from reaching the fissure. Further, a thorough assessment of the surrounding musculature and pelvic girdle can restore posture, mobility, and function allowing for decreased intraabdomial pressure and easier bowel movements. Education in central nervous system downregulation techniques such as proper breathing and lengthening of the pelvic floor muscles will improve the maintenance of these changes in the pelvis to reduce recurrent episodes of anal fissure. Education in proper breathing and toileting mechanics is also key in preventing chronicity of anal fissure.
Here at Mend, our pelvic health specialist are trained in evaluation and treatment of colorectal disorders such as anal fissures. Click here to schedule in our Boulder or East Boulder County locations!