An anal fissure is a tear in the mucosa that hurts sharply during a bowel movement and for a long time afterwards. The mechanism that keeps it going is well understood: pain triggers a reflex spasm of the sphincter, the spasm limits blood supply to the wound, the wound has nothing to heal with, and the next bowel movement tears it open again.
That is why in a fissure physiotherapy targets one specific link in that chain - excessive sphincter tension. Learning to release it, manual work around the anus and a change in how you empty your bowel give the wound conditions in which it can heal. I run this therapy alongside the treatment prescribed by a proctologist, not instead of it.
An anal fistula is a different matter and requires surgery - physiotherapy will not close it and it should not be delayed. My role here is before and after the procedure: preparing the pelvic floor, working with the scar, and rebuilding continence of gas and stool if the surgery affected the sphincter.
Therapy
- History and assessment of how you empty your bowel
- Examination of resting sphincter tone
- Learning to release the anal sphincter
- Manual therapy and tissue work around the anus
- Learning to empty the bowel without straining
- Care after surgery - the scar and the return to full function
- A home programme