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 really aren't often 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. So 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.
So, you can see a fissure looks like this and it's a little split in the skin in the
soft skin inside the anus and so the skin basically splits apart like that,
and it can often happen with an intense bowel movement and also too with diarrhea then there's
also some other causes as well. Now if you feel that you've got an anal fissure, it feels like um
a tearing, a splitting sensation when you use your bowels, which is why it's so intensely painful
because the fish is actually doing that the skin is actually splitting apart and
the bowel movement is actually going over that, and with a chronic fissure you get muscle spasm
around the area as well which make things makes the pain or can make it 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.
So 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.
Now, 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 and 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, and 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, and you can either use your hands on your thighs,
or 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,
and by doing this you relax the anal sphincter you start to relax the pelvic floor muscles,
and start to open up the anal sphincter when you actually take your deep breath. The inclination
with a sphincter is to hold on and you're anticipating the discomfort when you do that,
that tightens everything up, and it actually makes the condition worse because you're tightening,
you're 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 here,
and as you breathe, you breathe and so that the air goes into your lower belly so that it expands
forward, with the in-breath and back, and 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 closes 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 by bulging your lower belly forward. So “ooo” so 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 a 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 you 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, and also too some of the research recommends having a sitz bath,
warm baths are really great at for pain relief after using your bowels as well
and they can also to help with the warmth can also to help promote circulation to the area
and some more muscle relaxation too. So, warm bath afterwards.
So that first part's really important but 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 that 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 that I've just shown you works
really well at home. Now, what we're looking for is to get it to get a soft, well-formed stool. As
you can see here. So ideally you're looking at with a fissure about a type four on the bristol
stool scale. Now there's two really important ways to getting 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 like that. 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. So, to soften the stool,
if the stool is too hard, go to the pharmacist there's some stool softeners that you can access,
a number of them. Either Coloxyl not Coloxyl with sinner just the Coloxyl,
Paraffin, Agarol, or also to the Osmotic laxatives such as the 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 afterwards because that newly formed tissue that's repaired that fissure can
stretch and split again. So you want to make sure that the tissue is really well healed
before you stop your softness. So that's the first part stool softening aiming for that type 4 stool.
The second thing is your diet. Now 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 and what will happen is a whole lot of gas will be formed will form behind the stool
as well so that will make the fissure worse when you're passing it. So, you need to relieve
the constipation first of all and you do that by using perhaps your Polyethylene Glycol, speak to
your doctor speak to your 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 so this
skin part is the part that doesn't dissolve well in the bowel. So what happens is that
goes through the bowel and it actually bulks the stool, and it actually makes it larger to pass,
and you really don't want to be passing a large stool if you're suffering from an anal fissure.
We want to make the soft the stool well-formed. Obviously but soft and a reasonable size and the
way you do that is by gradually increasing your soluble fiber and I mean gradually. So 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 pear, are apple, even some of the inside of the kiwi not
the seeds so much here the inside of the kiwi two-thirds of the insoluble fiber or two-thirds
of the fiber that insoluble fiber on the outside. The soluble fiber that dissolves is on the inside.
There's 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 looking for foods and foods 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 it makes the stool softer and easier to pass and not bulky and hard and lumpy.
So they're 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.
So, 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, so that you promote
anal fissure healing, and also too we've 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 to attending to your diet, increasing your intake of soluble fiber at first,
then after that, after you're healed then you might like to increase your insoluble fibers too.
So, 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 videos 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.