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FASTR

The Goal

My wife and I had driven up to the wintry Sierra Nevada mountains for a day of cross-country skiing. Now it was late afternoon. The gray skies were lowering, snow was falling, the temperature dropping. An icy wind worked its way through our winter clothes, raking an arctic chill across our skin. As our trail through thick forest darkened into shapeless shadows, we stopped to gather strength for a final push through dense trees to the far side of a long, windswept meadow. We were hungry, thirsty, and tired, and our fingers and toes were burning with cold. I realized then and there, in the deepening freeze and failing light, that I had to take action.

It was time for a smooch. And a rather romantic one at that.

What happened next was so astonishing that we couldn’t help but express our mutual surprise. Radiant warmth instantly flooded our fingers and toes with welcome heat, while a surge of strength flattened our fatigue and provided a pulse of power to help us reach the trail’s end.

What made this experience so astounding was not the power of a kiss—that we already knew—but that such a small action could so completely override prevailing conditions to produce such amazing internal effects.

I share this experience for a reason. Except for a small smile of skin between our nose and jaw, we were wrapped in skiwear, but we were still quite cold. And despite eating energy bars along the way, we were quite tired. If someone had asked me at that moment to mobilize some inner force that could heat my fingers and toes, warm my entire body, and build a buoyant burst of energy, I’d say they were asking the impossible. And yet, with a single, simple, elegant act—along with some positive underlying emotions—I was able to use a tiny fraction of my dermal surface to create a memorable and pervasive cascade that led to whole-body benefits.

So…the goal?

Remember the focus of my protocol: muscular relaxation is necessary, it can be learned, and I needed to learn it.

Up to this point, I’ve presented the steps I took to promote positive actions and reduce distractions across a range of daily activities. Crucial for sure, but not enough. I still needed to learn targeted muscle relaxation.

To do that, I noticed my network and focused on feedback to locate and then release tension from specific muscles. But I also discovered that targeted did not always mean direct. As I experienced it, the successful sensation was partially direct, like pointing an index finger or raising a big toe, and partially indirect, like taking an action in one place and feeling the results elsewhere, similar to the snowy kiss.

To help demonstrate what I mean, I created the following steps and exercises as a loose translation of my wordless internal communication, so you might want to view them as a starter template which you can customize for your own style and circumstances. I’ll describe steps to the goal under two situations: relaxation at any time, and specifically during waste elimination. But first, it’s important to understand what my use of the term “relaxation” actually means.

What Relaxation Means

For my protocol, I defined relaxation in two ways. One way is that relaxation means releasing excess tension. Here’s why making this obvious point is key:

Defecation starts with an automatic reflex. As described in Our Amazing Design, the puborectalis muscle, which is wrapped like a sling around the rectum, relaxes automatically in response to activity farther up the GI tract. That relaxation causes the rectal angle to widen, which drops stool into the upper portion of the anal canal, which causes stretch sensors to activate, which relaxes the internal anal sphincter and produces an urge to defecate. That urge, in turn, automatically causes the external anal sphincter—already in a near-perpetual state of tension—to tighten a little more. Under normal circumstances, the automation pauses there—your body has transmitted its hint that it’s ready for release, but will wait until you provide a voluntary signal to move forward. If you signal the go-ahead, the external sphincter relaxes and the process proceeds.

So while my protocol goal is about relaxation, too much relaxation might be interpreted as a nudge, communicating an “It’s okay to go” signal usually only used for defecation. Moreover, if your brain interprets any conscious attempt at relaxation as a risky mixed message—“Are you asking me to go, or not?”—then it might keep sphincteric tension higher than needed. Calling out excess tension, then, is just a reminder that relaxation isn’t an on or off state like a light switch, but is a matter of degree, like a thermostat. If you think about it that way, ideal relaxation becomes a simple matter of finding the right place on the dial.

The second definition of relaxation means being able to calm the neighbors. Imagine that you awoke one morning to find your neighbors frantically preparing to evacuate their homes. How would you react? You might rush to prepare as well, no questions asked, or you might first try to find out what’s going on. But in either case, my guess is that you’d tense up. How does this relate to fixing a fissure?

Recall that the internal anal sphincter is not under conscious control, yet can account for about 55–85% of sphincteric tension. But its neighbors—the external sphincter and other muscles of the pelvic region—can be consciously controlled, and that’s where you have a calming opportunity. If you can get a few of the neighbors to relax, then maybe the whole neighborhood will calm down.

In my experience, success came from creating a calming effect within the entire pelvic region. Some sensations felt direct, and some felt indirect. But the overall effect feels like a muscular drop and release, similar to the way a tense neck and shoulders might loosen and droop with relief after a danger has passed. And it’s not the same sensation as a “time to go” signal.

Here’s a very simple exercise that demonstrates the concept of combined drop-and-release without introducing too much relaxation:

  1. Stand and let your arms hang straight at your sides.
  2. Clench one of your hands firmly, but not tightly, into a gentle fist. Your hand should feel comfortably tight. Spend a moment absorbing that sensation.
  3. Now clench that same hand harder so that you have a very tight fist.
  4. While maintaining your tightly clenched fist, bend that same arm at the elbow and flex your arm muscles, as if you were showing off your arm like a bodybuilder.
  5. Hold that pose for a moment. Notice the multiple tension points: clenched fist and flexed arm. If you’re giving it your all, your arm might transmit some pain signals and/or start to shake slightly.
  6. Now, without unclenching your fist, relax your flexed arm muscles and let your arm hang straight at your side again. Notice that you have gained some relief.
  7. Now return your fist to its comfortably firm state.

See the idea? If you tightly squeezed everything, your various flexed muscles created a lot of painful tension. Relaxing and dropping your arm provided half the solution—that’s the drop; releasing the excess tension in your fist resolved the rest—that’s the release. And at no time did you need to completely relax your fist to gain relief.

Here’s one way to achieve that two-part relaxation at any time:

Relaxation at Any Time

When you think about it, the act of cross-country skiing—strapping on slippery skis and sharp poles so you can slide your way through a freezing forest—might seem a bit silly. But it’s also enjoyable, and usually rewarding.

Likewise, the following steps might seem a bit odd, but they can help you learn to relax the pelvic floor and reduce sphincteric tension at any time. I found that practicing these steps while standing is easiest and most informative:

Step 1 - Establish a good mental model.

The GI tract’s beginning and end have specialized skin, musculature, and other features. To establish a good mental model of your goal, start at the beginning:

  1. Mentally focus on your mouth. It may help to be in front of a mirror. If you are, take a moment to notice the different skin types and their attributes as you gaze from chin to lip to mouth.
  2. Purse your lips to the point that they form the shape of an exaggerated cartoon kiss. This mouth configuration, similar to that used by musicians who play brass or woodwind instruments, is sometimes referred to as embouchure.
  3. Fill your cheeks with a bubble of air, as if you were ready to play a trumpet. Tighten your lips so that no air can escape from your mouth. Continue to breathe through your nose.
  4. If the trapped bubble of air is toward the back of your throat or mid-mouth, push it forward until it causes pressure against the inner surface of your cheeks and pursed lips. Do not let any air escape.
  5. Feel the sensation and hold. After a few seconds, you may begin to feel slight pain in your expanded cheeks or pursed lips. Keep holding that position. If you’re in front of a mirror, you may see how the pursed folds of your lips begin to pale or redden with tension and exertion. You are modeling for yourself the pain-producing result of clenched GI tract muscles.
  6. Next, make various slight adjustments to the muscles of your mouth, cheeks, and jaw to see how micro-movements change the sensations of tightness, pressure, and pain. You can also try slightly maneuvering your muscles to adjust the trapped bubble of air. Experiment a bit, and note the effects. You are modeling the potentially positive effects of micro-movements that relieve pressure.
  7. Now, expel most—but not all—of the trapped bubble of air a little at a time by forcefully pushing it through your clenched and pursed lips. Your lips should part a minimal amount, and the escaping air might make a funny and familiar sound for a reason; the noise of exiting flatus (gas) is influenced by a similar anal embouchure. You are modeling for yourself the painful effects of working at cross-purposes—trying to expel something under pressure through tightly clenched muscles that only allow a tiny opening.
  8. You should have some air left over in your mouth cavity. Keep your lips pursed and try to expel as much of it as possible. You may feel your cheeks tighten and register slight pain as you use your muscles to move them inward and collapse the inner volume of your mouth. You are modeling the potentially painful process of bearing down on muscles inside a cavity to eject residual material.
  9. With the trapped air gone, un-purse your lips and breathe through your nose. If you had some pain from the earlier steps, it should dissipate. Close your mouth if it’s open, and then let some time pass. From my observation, most people don’t live with their mouths hanging open or perpetually clenched and pursed, so you are modeling your normal state—a gentle, helpful tension that keeps your alimentary entrance closed while still feeling relaxed.
  10. Re-fill your cheeks with air and purse your lips in the same way you did in instructions 2 and 3.
  11. Now, simply relax your mouth and lips and release the trapped bubble of air through your mouth by opening it gently. You are modeling the ease of release without excessive tension.
  12. Again re-fill your cheeks with air, but this time don’t purse your lips so tightly; just hold your mouth closed normally, or with a very slight increase in tension.
  13. Now, just smile as broadly as you can by using your mouth and cheek muscles to pull the corners of your mouth back toward your ears. Do not try to hold your upper and lower lips together, but let them separate and pull over your teeth. Do not clench your teeth either, but let your mouth open freely if that’s your natural way of smiling. As you no doubt noticed, the bubble of trapped air escaped easily and almost instantaneously. You are modeling the sensation of pulling muscles up and over an exiting substance rather than pushing a substance through a clenched and tightened opening.
  14. Repeat instructions 10 through 13 to really understand what’s happening, and anchor those aspects of your mental model firmly in mind.

Step 2 - Get a sense for drop-and-release.

Using the easily controllable trapezius muscle group (the group of muscles around your neck and upper back), this next step helps you practice the feeling of dropping and simultaneously releasing tension from specific muscles.

  1. Isolate and tense your trapezius muscles (often called your “traps”).
  2. Move your tensed traps straight up along your spinal column toward your ears. You should feel easy and obvious vertical movement. Other parts, such as your shoulders and collarbones (clavicles), may come along for the ride.
  3. Now, in a single action, release the tension in your traps and drop them straight down along your spine. Your other parts (shoulders, etc.) should drop easily and automatically.
  4. Repeat instructions 1–3 several times. The key effect you’re trying to detect is the muscular sensation of simultaneous drop-and-release. When you apply this technique to your pelvic floor, the actual muscle movement might feel quite different than relaxing your traps, so for now, just focus on the act of simultaneous drop-and-release.

Step 3 - Build trust in your other senses.

Humans have far more senses than the traditional five (sight, smell, taste, touch, and hearing). For example, we can sense balance, acceleration, temperature, pain, and the passage of time. We also have proprioception, or kinesthetic sense, which allows us to detect the movement and relative position of our various body parts, and interoception, which relates to stimuli produced internally, such as in our GI tract. From my experience, noticing your network and focusing on feedback involves tuning in to these other senses. An easy way to start is by building trust and appreciation for your kinesthetic sense:

  1. Close your eyes.
  2. Extend an arm sideways, and then point the index finger of your raised hand.
  3. With eyes still closed, bend your arm and try to touch the tip of your nose with your index finger. You will probably exactly touch or get very close to your target.
  4. Keep your eyes closed and target other areas: earlobes, eyebrows, navel, big toe, kneecap, etc. Your accuracy may vary depending on your target.
  5. Repeat instructions 1 through 4, and this time try to sense even the smallest internal changes. You might feel a slight tingling as your index finger almost touches your nose, or you might notice how each involved part will tense, flex, or relax. This is all simple network feedback that probably goes unnoticed during your typical routine, but is important for the goal of targeted tension release.

As an option, you can try tuning in to other senses to prepare for the next step, where you will use a simulated combination of proprioception (position of parts), interoception (inner sensations), and thermoception (heat differences) to map your internal network.

Step 4 - Trace your route.

This step is important and can provide great benefits now and in the future. To get started, one of two analogies might help:

If you own a desktop or laptop computer, your system probably includes a version of traceroute (tracert on Windows), a tiny program that helps you detect how data packets travel along a network to reach a particular destination.

If roads are more your speed, consider how easy it is to route motor vehicles (you might think of them as “passenger packets”) to Silicon Valley using the U.S. Interstate network: From anywhere in the U.S., make your way to Interstate 80. Travel west to California. When you reach the San Francisco Bay Area, take any of I-80’s spurs to get to I-280. Once on 280, many of Silicon Valley’s most famous companies are easily accessible.

Using a similar routing concept, this step helps you map your own neural network by sending data along internal routes that might normally get ignored. This is a simulation, so whether nerve impulses are actual or imagined is not important; the objective is to sense how to access specific muscles:

  1. Imagine a sphere of warmth forming and growing comfortably in your chest.
  2. From the sphere of warmth, imagine that you can send smaller packets of warmth to any destination on your internal network. You can send the smaller packets of warmth as a pulse, a wave, or an uninterrupted stream. In this simulation, the sphere of warmth replenishes itself each time a packet is sent, so you can send as many packets as you want.
  3. Send packets of warmth toward one of your extremities, such as a hand, foot, finger, or toe. Imagine that destination warming up as each packet reaches its target. Try this for a while until—real or imagined—you really begin to sense the route to your target destination. Take your time, and keep at it…you might find that it takes a while to establish a good network connection.
  4. Now, redirect the packets of warmth toward your pelvic floor. Do this for a while. Again, don’t rush. Take your time.
  5. Next, recall that the muscles of your pelvic floor are shaped like a diamond, so as each packet of warmth reaches your pelvic floor, route it to one of the facets of the diamond. Try this for a while. Don’t worry if you can’t sense an exact match between the packets of warmth and a specific muscle. I’ll explain why a little later. For now, just try to get as close as you can.
  6. Once you feel like you’re starting to sense the muscles of your pelvic floor, begin to route all new packets of warmth to the approximate fissure site.
  7. Imagine each packet being able to move expertly so as to reach an optimal destination. For example, if you’re trying to fix a fissure in the posterior midline position (toward the back), you might imagine each packet of warmth nestling inside the curvature of your sacrum and coccyx (your “tailbone”).
  8. As you continue sending warmth to your target, imagine the warmth increasing comfortably at your destination site.

Step 5 - Drop and release.

This is it—the important relaxation step. I know this technique works for two reasons, which I need to briefly discuss:

  1. I used it to successfully resolve a persistent and pernicious anal fissure, and
  2. I was able to view real-time biofeedback provided by an electromyograph machine (sometimes called an EMG sensor), which measures and reports muscular tension (or more technically, the sum of motor unit action potential) as a simple number.

In my case, the EMG included a set of sensor nodes that were placed throughout my pelvic floor by a licensed physical therapist during a physical therapy session. Those nodes were then connected to a handheld device with a digital display. Using biofeedback data generated from my body and detected by the sensors, the EMG reported a number on the display, and I could watch the number change instantly as I made small muscular movements that raised or lowered tension.

For me, obtaining biofeedback with assistance from a qualified medical professional was very helpful, and I discuss my experience further in Medicine and Other Modalities. For now, though, I need to share some important learnings and observations from my biofeedback experience before we cover this step’s instructions:

So let’s put everything together. Here’s the final step:

  1. Using your mental model, sense a point of pain or tension, such as the fissure site. Set that point as your specific target destination.
  2. Using the network connections you established during your simulated combination of internal sensations, trace your route to the target destination. If it helps, imagine your target filling with comfortable warmth.
  3. Now, notice your network, focus on feedback, and mentally expand your target area to include a slightly larger region. For example, you might include the entire diamond of your pelvic floor, or perhaps the back half of the diamond plus all the other muscles around your tailbone.
  4. Prepare to do a simultaneous drop and release. Remember that your anal canal includes both powerful muscles and delicate features. Do not squeeze or clench your target area. Do not increase anal embouchure (recall the pain that comes from keeping your lips tightly pursed). Do not press the anal muscles downward as if extruding toothpaste from a tube. Do not bear down by increasing anal, rectal, or abdominal pressure as you might do during defecation. Do not crush the muscular anorectal region inward on itself. Simply verify mentally that you have expanded your target destination to a small region.
  5. Now, simultaneously allow any tense or tightly held muscles to drop softly into a relaxed state AND release excess tension from all the muscles in your target region. While some muscles may be under direct control, others may feel just out of reach, so for those, try to release tension indirectly, such as when you experience a relaxing wave of full-body warmth or relief.
  6. Keep practicing. It may help to remember that you are fixing—not fighting—a fissure, so don’t allow frustration to derail your efforts; it can take time to establish a good network connection.

That’s the technique. That’s how I started to achieve my protocol goal.

With practice, I was soon able to release muscular tension quickly with just a little concentrated effort. But then I’d move on to something else, and often within a few minutes, if I took the time to notice, I’d find that pelvic tension had returned. No problem—a few more seconds of concentration and I’d re-achieve a relaxed state. Over time, relaxation lasted longer between patches of concentration.

Relaxation During Waste Elimination

The way we expel digestive gases, liquids, and solids can dramatically affect overall repair results, and a real challenge can arise if our systems work at cross-purposes. How so?

As mentioned in Our Amazing Design, a fissure is a breach of the body’s protective shielding in a hard-to-see location, so from a design perspective, a fissure should cause attention-getting stimuli, such as pain. It also makes design sense that the sphincter muscles seize up to prevent imminent injury or to safeguard an already injured area. But protective tightening creates a conflict when it’s time to release waste material, since this “safe mode" opposes easy relaxation. How can this be solved?

We’ve already discussed several assistive remedies, such as following an ingesting strategy that yields soft stools with sufficient mass, postures and products that favor natural body mechanics, and personal care options that soothe rather than scour sensitive skin. These can all turn the pain dial down.

And we’ve done more: in the previous steps, we modeled the difference between painful elimination by pushing a substance through a small opening versus easy elimination by pulling relaxed muscles up and over an exiting substance.

But as I discovered, even more gains come from cooperating with our amazing design. Here’s how:

Wave goodbye. It’s important to recognize that defecation is the last voluntary step (some say semi-voluntary) of a mostly involuntary process. After food is swallowed past teeth and tongue, it’s moved along by automatic activities, such as peristalsis, a rhythmic constriction and relaxation of GI tract muscles that produce a one-way wavelike movement, and a larger wave motion called a mass movement, which a few times each day transports digestive waste material from the large intestine (specifically the transverse and descending colon) to the “straight intestine,” or rectum. The rectum, basically a funnel-shaped holding tank, then stores the waste material until the body signals a need to empty it, and, if at all possible, will leave it to you to decide when to do that. Once you agree that stool should leave your body and you initiate defecation, peristaltic waves again help move material outward.

Any voluntary control, then, should not oppose that last natural wave motion, since doing so could create increased pressure, pain, and damage. Relaxing means allowing the body’s automated waves to help finish the job.

Kindly administer your perimeter. Like the passenger doors on a jet plane, anorectal features serve as a well-designed exit portal and perimeter guard. Under normal conditions, these features work together to allow or deny passage of material in and out of the body without a lot of fuss. If you bring them under conscious control, kindly administering your perimeter means two things:

First, if the plane has landed, the seat belt signs are off, and the passengers are lined up in the aisle, kind administration means that you don’t keep the door locked or blocked—you allow it to open completely and then get out of the way. Digestively, this means that you don’t try to save yourself from last-inch pain by clamping down on anorectal features during an exit procedure. True, some painful jostling may occur, but not nearly as much as would come if you make each passenger squeeze through a barely open door.

Second, just as any airline would go bankrupt if its policy was to push passengers from the plane upon arrival, kind administration means that you avoid pushing stool from your body, but instead let material disembark freely and naturally. If nothing seems quite ready to move, you might limit your influence to a gentle nudge toward the door. And since angry impatience rarely empties a plane faster, kind self-administration likewise includes a measure of relaxed patience.

Don’t force the issue. Since a fissure can bring time-consuming symptoms (bleeding, pain, slower exit, longer clean-up, etc.), it may be tempting to pass stools on a preferred schedule rather than waiting for a natural need. However, forcing a bowel movement by voluntarily straining, crushing, or overusing sphincter and pelvic floor muscles can damage the anal canal’s more delicate features and lead to long-term problems with related parts, such as the important pudendal nerve. What’s more, a habit of conscious control could confuse or disrupt natural coordination, leading to muscles that stay tight—or tighten further—when they should relax. So though it might mean some temporary adjustment and inconvenience, not forcing the issue means switching from commanding control to responsible response.

Seek sleek technique. Like watching an accomplished dancer flow effortlessly through a stunning routine, the seemingly easy act of elimination conceals a complex coordination of sophisticated steps. When things are functioning normally, virtuoso performance is almost assured in each of us by design. Unfortunately, being stricken with a fissure is bad enough…it’s like trying to tango with a badly stubbed toe. But adding irritation is worse…it’s like purposely putting a rock in your shoe.

Our bodies have built-in sensors, chronometers, communicators, pushers, pullers, openers, and closers that all move in well-coordinated fashion. Stalling, rushing, or impeding the process through optional actions—bathroom reading, impatient pushing, or deliberate clenching, for example—can introduce missteps that throw us off our rhythm. So seeking sleek technique simply means doing everything possible to keep egestion graceful, smooth, and soothing.

Keep it together. You might be wondering whether your protocol can focus on just the goal of relaxation without involving other aspects of your daily routine. For me, the answer was no, at least not at first—there were just too many variables that influenced the final egestive act, and it’s easy to get discouraged if positive results from one activity are canceled out by negative results from another. In my case, I found that success came faster when I worked on things together.

In fact, setting the goal of muscle relaxation doesn’t exclude other repair modes, and as I discovered, can actually complement them very well. I’ll explain how in Medicine & Other Modalities.

Last updated: June 2019