Anal Fissures: Why They Hurt, Why They Linger, and Why Healing Requires a Full-System Approach
If you’ve ever felt like you were being “ripped open” during a bowel movement, you’re not being dramatic — you may be dealing with an anal fissure.
Anal fissures are small tears in the lining of the anal canal, and they can be unbelievably painful. But what many people don’t realize is that fissures don’t persist because of one single issue. They linger because several systems are feeding the problem at the same time.
True healing only happens when we treat the fissure from every angle.
What is an anal fissure?
An anal fissure is a tear in the thin tissue just inside the anal opening. Because this area has a dense nerve supply and a powerful internal sphincter muscle, fissures often cause:
Sharp, glass-like pain with bowel movements
Burning or stinging that can last hours afterward
Bright red blood on the toilet paper
Anxiety around going to the bathroom, which ironically worsens the problem
Why fissures become chronic
Most fissures begin with constipation, hard stool, straining, or poor toileting mechanics. But once pain enters the picture, your body responds protectively:
Pain → muscle tightening → reduced blood flow → delayed healing → more pain.
This cycle can persist even when stool softeners or creams are used in isolation.
Healing an anal fissure requires a full-system approach
This is the part most people never get told.
Fissures are multifactorial, meaning they don’t heal unless all contributing systems are supported together.
From years of treating patients (and personal experience), lasting healing requires attention to:
1. Stool consistency support
Even perfect pelvic floor mechanics can’t overcome hard stool.
This may include:
Adequate hydration
Individualized fiber strategies
Magnesium supplementation when appropriate to soften stool and calm sphincter tone
Creating regular, pressure-free bowel habits
2. Pain control to interrupt the guarding reflex
Pain teaches the body to clench — and clenching prevents healing.
Short-term symptom relief is sometimes essential:
Topical lidocaine or compounded fissure creams from your provider
Sitz baths or gentle warmth to improve blood flow
Education to break the pain–fear–tension loop
3. Pelvic floor down-training and mechanics
This is where pelvic floor physical therapy becomes part of the conversation:
Diaphragmatic breathing to regulate the nervous system
Pelvic floor relaxation and coordination during bowel movements
Postural and toileting training to avoid bearing down
Manual techniques to restore muscle length and circulation when appropriate
4. Nervous system regulation
Chronic fissure pain doesn’t stay in the tissue — it becomes a neural pattern.
Calming the nervous system:
Reduces involuntary guarding
Restores blood flow
Speeds healing
Why this approach works
You can’t cream your way out of a fissure.
You can’t breathe your way out of hard stool.
And you can’t fiber your way out of pelvic floor spasm.
Real healing only happens when all angles are addressed together.
You’re not broken. Your body is protecting you
Anal fissures are deeply painful, but they are also highly treatable when approached correctly.
If you’ve been stuck in the cycle of pain, fear, and frustration, pelvic floor physical therapy combined with full-system care can be the turning point toward true healing, not just temporary relief.
