Getting Started

A few key ideas, quotes, and insights helped me start developing my protocol:

Eliminating waste should be comfortable. Research fissure pain and you’ll find the phrase “comfortable bowel movement” appearing in popular and professional articles alike. It seems simple, but if you’ve been ignoring or struggling with anorectal pain for a long time, a consistently comfortable movement may seem elusive. So there might be a personal mystery still to solve.

Don’t pummel your peripherals. I’ve seen plenty of people express computer rage in keyboard-smacking, mouse-pounding futility. Since fissures can cause similar anguish, I found it helpful to remember that areas on our own periphery—the anoderm, anal verge, and perianal skin, for example—are highly sensitive for good reasons (more on this later). So while they may be the current source of pain, your peripherals are likely not the ongoing cause. The less inflammation here the better, so gentler self-care may be needed.

The body needs to heal itself. Almost all medical texts I reviewed emphasized a clear path to fissure resolution: diet and lifestyle changes, spasm reduction measures (like warm baths), medicinal options, and finally some surgical alternatives if needed. But they all made the same basic point: healing comes by relaxing the internal and external anal sphincters, which allows increased blood flow and the body’s natural healing system to proceed unimpeded.

In other words, though professional intervention can help, it’s up to you and your body to heal. Since fissure sufferers tend to be high-functioning people, this may mean getting out of your own way. For instance, carefully analyze your response to this simple logic statement:

If you’re too busy to heal, then you’re too busy.

The results of your analysis could point the way forward.

Think long-term. Most medical references I read stated that anal fissures can recur rather easily. This was a red flag for me, and also an important clue. If even surgical options don’t always provide permanent protection, then it’s practical to produce a path to prevention, or at least set up steps that can promote a faster fix in case of future fissures.

Seek truth. Fissures can have many causes, and they can seem similar to other GI tract issues. You may know the exact situation that caused a fissure, and you may know its specific location. But if the cause is unclear, if positive fissure identification is not easy to make, or if one or more fissures occurs in other locations, your best route to truth may come from visiting a medical professional for an examination.

You need the right mental model. My career in high tech has taught me that many things work very differently than we assume. For lots of products, that’s okay, even preferred. But the wrong mental model of fecal expulsion can cause real problems. Notice this quote from Encyclopædia Britannica:

“As feces exit, the anus is drawn up over the passing mass by muscles of the pelvic diaphragm….”

Did you know that? The right movement is about pulling over, not pushing through. The pushing is done by peristaltic waves (more on these later). Here’s a corroborating quote I found from Brown University Health Services:

“Straining is not recommended because it can cause a tightening of muscles that should actually be relaxed during a comfortable bowel movement.”

You see the issue. If your mental model is to expel waste the way you squeeze toothpaste from a tube, it’s possible that you’re using the wrong muscles, movements, or technique. If your fissure has gone chronic, or if you’re experiencing other maladies (like hemorrhoidal inflammation) could it be that you’ve adopted the wrong mental model?

With that in mind, I’m suggesting a product that I found helpful. It’s an app called Essential Anatomy, by 3D4Medical.

Using its 3D capability helped me both gain a better view of what’s really going on and have more illuminating conversations with doctors and physical therapists. I purchased the iPhone version, and for the clarity it gave, I found the cost well worth it.

I’ll refer to the app in several places. If it isn’t available to you or to your liking, I do show a few basic sketches on subsequent pages, but to see accurate visual renderings you’ll need access to an illustrated medical reference.

You may need the right angle. A quirky video available on WebMD.com supported what I suspected: the standard household toilet might hinder improvement. The video relates a comment from 1924 about the common commode that resounds to this day: “Dr. William Welles…wrote, ‘it would have been better if the contraption had killed its inventor before he launched it under humanity’s buttocks.’” The concept of an ideal expulsion angle is still being debated, but while it has adherents on both sides, I found that heeding it hastened my healing (I’ll say more about this later).

You need the right goal. The preceding thoughts were to help you arrive here: the right goal.

All treatments have the same basic aim of relaxing the internal and external anal sphincters so your body can heal itself. This might seem daunting, though, since medical references say that only the external anal sphincter is under conscious control, and its tension accounts for a lower percentage (less than 45%) of total tone. So what to do?

The quote that helped everything click—and that ultimately motivated me to make a protocol—was a short phrase in a longer sentence. It simply said: “Learn to relax the muscles of the anus.” That one point helped me crystallize three crucial concepts into a single goal: muscular relaxation is necessary, it can be learned, and I needed to learn it.

Everything else about my protocol—diet, exercise, other changes—were all in service to that goal. And as you’ll soon see, setting that goal unlocked a series of steps that proved to be powerfully, even surprisingly, effective.

Next up, a rather odd topic for such a personal issue: Other People.

Last updated: June 2019