When a Squatty Potty isn't Enough: How Pelvic Floor Physical Therapy for Hemorrhoids and Anal Fissures Can Help

Anal fissures and hemorrhoids are some of the most common causes of severe rectal pain in adults. An anal fissure is a tear near the rectum that can cause severe difficulty when defecating. Often you might see bright red blood when wiping, experience soreness around the area, and/or pain that lasts well after having a bowel movement. 

Hemorrhoids are small swollen veins around the rectum and anus that can occur both internally and externally. Hemorrhoids can be either painful or painless and most often have symptoms of itching, swelling, pain and bleeding. 

So, how can pelvic floor physical therapy help with hemorrhoids?

Many patients with chronic anal fissures and hemorrhoids also experience an over tightening or even spasm of their pelvic floor muscles that help with defecation. Specifically, the puborectalis muscle which forms a U-shaped sling around the rectum is in charge of relaxing in order for stool to pass.

However, if this muscle contracts instead, this will stop the passing of stool and is referred to as pelvic floor dyssynergia (imagine a kink in a hose - nothing will pass through!). Symptoms of pelvic floor dyssynergia include: prolonged straining, multiple attempts at evacuation and an inability to fully feel empty.

How do hemorrhoids happen?  

Many factors affect our bowel function and despite taking fiber supplements, eating fruits and vegetables, drinking enough water, and putting our feet on a step stool (or squatty potty), we can still find ourselves constipated or straining! This is often very frustrating and yet another reason to see one of our pelvic floor physical therapists. In the clinic, we find our patients can combat this frustration by learning the proper strategies of pooping and by becoming more aware of their pelvic floor muscles. 

Poor habits that lead to pelvic floor muscle tightness:

• Holding your breath
• Not using your abdominal muscles to push 
• Using your phone while sitting on the toilet 

Pelvic Floor Physical Therapy for Hemorrhoids and Anal Fissures

Here at Fusion Wellness, our licensed pelvic floor physical therapists are specialized in the assessment and treatment of the pelvic floor muscles to improve coordination, relaxation and length to ease having bowel movements (defecation) and prevent hemorrhoids and other painful conditions.

Studies have found that treatments including myofascial release to address trigger points in pelvic floor muscles to improve flexibility, release muscle tension and improve circulation will help symptoms from anal fissures and hemorrhoids. Manual techniques are used to gain awareness of how to contract and relax the PF muscles and are taught how to incorporate this in daily life. Breathing and pelvic floor muscle exercises can also be combined with surface EMG biofeedback to further improve relaxing during defecation.

Lastly, after a full body assessment and thorough evaluation, the therapist will help you develop lifelong strategies to have a bowel movement without straining or pain.  Contact our office today to schedule an appointment!

References: 

Nelson RL, Thomas K, Morgan J, Jones A. Non surgical therapy for anal fissure. Cochrane Database Syst Rev. 2012;2:CD003431. [PMC free article] [PubMed] [Google Scholar]

Kendra L Harrington , Esther M Haskvitz, Managing a Patient's Constipation With Physical Therapy, Physical Therapy, Volume 86, Issue 11, 1 November 2006, Pages 1511–1519, https://doi.org/10.2522/ptj.20050347

van Reijn-Baggen, D. A., Elzevier, H. W., Putter, H., Pelger, R. C. M., & Han-Geurts, I. J. M. (2022). Pelvic floor physical therapy in patients with chronic anal fissure: a randomized controlled trial. Techniques in coloproctology, 26(7), 571–582. https://doi.org/10.1007/s10151-022-02618-9