Transcription
Physiotherapy treatment for anal fissure can promote anal fissure healing and also help relieve anal fissure pain, especially with bowel movements. Hi, I'm Michelle, and today I'm guiding you through some of the physiotherapy treatments that we use to help if you've been diagnosed with an anal fissure by your doctor.
Now, in particular, we're going through two things, and these are both really important things that often aren't well recognized. The first thing is bowel emptying because, when you empty your bowel, you stretch your skin around the anal fissure. So it's really important that you use the correct technique. Now secondly, just as important, is getting the stool consistency right at home. Both these things you can do at home, and I'm going to guide you through both, and both are equally important. So make sure you stay with me for the stool softening because that obviously helps the bowel emptying.
You can see a fissure looks like this; it's a little split in the skin in the soft skin inside the anus. The skin basically splits apart like that, and it can often happen with an intense bowel movement and also with diarrhea. There are also some other causes as well. Now, if you feel that you've got an anal fissure, it feels like a tearing, a splitting sensation when you use your bowels, which is why it's so intensely painful because the fissure is actually causing the skin to split apart, and the bowel movement is going over that. With a chronic fissure, you get muscle spasm around the area as well, which can make the pain even worse.
So we're going to talk about ways to actually empty your bowel, how to do that properly without opening up that fissure repeatedly, and allowing the skin and the tissue to heal over that area. The first thing is our bowel techniques. We'll go through that, and as I said, make sure you stay with me for the stool softening because that's just as important so that this bowel technique works really well.
Now, let's talk about how to empty your bowels or correct bowel emptying with an anal fissure to reduce pain and to help stop the splitting of that anal fissure. The first thing to do is to go to the bathroom when you feel the first appropriate urge. Take a seat on the toilet, and this is how you sit. I'm going to come back and sit side on so that you can actually see what I'm doing here. Now, you can't see my feet, but they're flat, and my hips are apart, so my knees are apart. In that position, this is the optimal emptying position for the bowel. You lean forward so that you have the inward curve in the lower back there; the spine is straight, and your chest is lifted. You can either use your hands on your thighs, or if it feels more comfortable, your elbows down your thighs as well. So, that's your emptying position.
Now, in that position, as soon as you get there, take five deep breaths into your belly. By doing this, you relax the anal sphincter, you start to relax the pelvic floor muscles, and you start to open up the anal sphincter when you actually take your deep breath. The inclination with a sphincter is to hold on, and when you anticipate the discomfort, that tightens everything up, which actually makes the condition worse because you're tightening and pushing down against a closed anal sphincter. We need to try to open that up during emptying, so this is the part of the process we go through.
Five deep breaths into your belly, and as you breathe, you breathe so that the air goes into your lower belly, expanding forward with the in-breath and back. You can do five of those deep breaths just before you start. You might find that you even start to empty during those deep breaths. The second thing to do is to push but never strain. When you push, you push by making your sides, the waist, wide by saying "mmmm." So when you use your hands here, you can feel "mmmm…" you can feel your side muscles engaging. These are the muscles to use for emptying, not pushing down using the strong front muscles and internally pushing down through the anal sphincter. What that does is actually close off the anal sphincter, and it'll worsen the condition.
So we need to open that up by saying "mmmm." So pushing from here, but when you say "ooo" at the same time, bulging your lower belly forward. So "ooo," you're going into like a barrel shape, and you can feel it now if you say "ooo." Can you feel what happens through your anus, through the back passage? "Ooo," you'll feel it open up. So that is key to actually getting this patterning right: "mmmm" to push, "ooo" to open, and then "mmmm" if you need to push again.
Now, at the end of that, if you obviously need to wipe, try to avoid using harsh, abrasive toilet paper. If you can use a moist towelette, that's great. If you can wash with warm water, even better. Also, some of the research recommends having a sitz bath; warm baths are really great for pain relief after using your bowels, and they can also help with the warmth, which can promote circulation to the area and some more muscle relaxation too. So, a warm bath afterward is really important to get that bowel technique right.
Now, we need to go through the stool softening because if your stool isn't soft, it's not going to empty well using just that technique that I just showed you. So let's now talk a little bit more about how to get the right stool consistency so that that technique works really well at home. What we're looking for is to get a soft, well-formed stool, as you can see here. Ideally, you're looking at about a type four on the Bristol stool scale.
Now, there are two really important ways to get this stool soft, and this is vital because if the stool is too hard, or if it's too runny, if it's too hard, it's going to stretch out and open the anal fissure like I showed you before. If it's too soft, you'll have an aggressive bowel movement as well, and then you also might need to strain to empty, and again, this can cause ongoing problems with the fissure.
To soften the stool, if the stool is too hard, go to the pharmacist; there are some stool softeners that you can access, a number of them. Either Coloxyl (not Coloxyl with senna, just the Coloxyl), paraffin, Agarol, or also the osmotic laxatives such as Polyethylene Glycol, Miralax, or Movicol. Speak with your pharmacist about those.
Now, when you're taking a softener, you need to take it for the entire duration that you've got the fissure and also a little bit of time afterward because that newly formed tissue that's repaired the fissure can stretch and split again. So you want to make sure that the tissue is really well healed before you stop your softeners. So that's the first part: stool softening, aiming for that type 4 stool.
The second thing is your diet. Your diet is a really important part of this. If you have too much fiber in your diet and too much insoluble fiber when you're constipated, that will actually make constipation worse; it will cause bloating, and it will cause the stool to become hard and really lumpy. What will happen is a whole lot of gas will form behind the stool as well, so that will make the fissure worse when you're passing it.
You need to relieve the constipation first of all, and you do that by using perhaps your Polyethylene Glycol. Speak to your doctor or pharmacist about that so that you actually get a movement happening. When you've done that, try not to increase your insoluble fiber. Now, your insoluble fiber is things like the skin. So if we have a kiwi fruit or you think of an apple, the outside part, the skin part, is the part that doesn't dissolve well in the bowel.
What happens is that goes through the bowel, and it actually bulks the stool, making it larger to pass. You really don't want to be passing a large stool if you're suffering from an anal fissure. We want to make the stool soft, well-formed, obviously, but soft and a reasonable size. The way you do that is by gradually increasing your soluble fiber, and I mean gradually.
Soluble fiber is fiber that dissolves well in the bowel. Foods like oatmeal are great with soluble fiber. Fruits that have the skin off, like pears and apples, even some of the inside of the kiwi (not the seeds so much; the inside of the kiwi has two-thirds of the insoluble fiber, while two-thirds of the fiber that is soluble is on the inside).
There are plenty of lists on the internet, or you can refer to my stool softening video above for foods that will actually help you to soften the stool. But it's really important that you get that balance and look for foods that have both insoluble and soluble fibers, but look for the foods with a high content of soluble fiber so that it dissolves well in the bowel and makes the stool softer and easier to pass, not bulky and hard and lumpy.
So, those are the two really important aspects of stool softening: one, stool softeners, and second, your diet. Oh, and by the way, you need to be having enough fluid too if you are having extra fiber to make sure that you keep that stool nice and soft and well-formed too.
We've gone through quite a bit of information here, haven't we? We've talked about the correct technique to use so that you're not straining to empty your bowel, promoting anal fissure healing. We've also talked about the correct stool technique or the correct way to get a good stool using your medications as prescribed by your pharmacist or your doctor, and also attending to your diet, increasing your intake of soluble fiber at first. After that, once you're healed, you might like to increase your insoluble fibers too.
I really hope that this information is helpful for you in resolving your anal fissure and preventing it from becoming a chronic and ongoing problem. If the video helped you, as always, I'd really be grateful if you could give it a like below, and I look forward to seeing you in the next video. Goodbye for now.