The Backside of Things…

We often see patients with anal pain, irritation, and itching.  Many times, they will have seen their providers and been prescribed a medication for their symptoms and given a diagnosis of hemorrhoids or anal fissures.  The medication can help with the symptoms but does not always take care of the underlying problem.  Our job as pelvic floor PT is to figure out why the pain or irritation is happening in the first place.  

First off, if there is new blood in your stool, you should see your provider for an assessment.  New blood in your stool can be a first sign of colon or colorectal cancer.  Please have this checked out. 

Often, we will have patients with diagnoses with anal fissure or hemorrhoids.  It is important to understand the difference, though treatment with PT will most likely be similar for both. 

A hemorrhoid is a swollen vein that is similar to a varicose vein that you can get in your lower leg.  The hemorrhoid can be internal or external.  Internal hemorrhoids are inside your rectum and do not usually cause pain unless they push out of the anus.  External hemorrhoids are on the skin around the anus.  This skin can easily get irritated and can be red or break down.  When stool moves through the anal canal, the vein can become irritated and cause blood to be on the stool.  This will usually be bright red blood. 

An anal fissure is a tear in tissue that lines the thin tissue of the anal canal.  Anal fissures can cause pain with and after bowel movements that can last several hours, bright red blood in the stools, and a lump or skin tag on the skin.   Anal fissures can commonly recur or have delayed healing if the underlying issues that caused the fissure in the first place aren’t treated. 

There are common causes of hemorrhoids and anal fissures:
– constipation
– straining to have a bowel movement
– straining with lifting
– limited physical activity,
– pregnancy and childbirth,
– anal intercourse
– limited water
– not enough fiber intake

With pelvic floor PT, our goal is to take the strain off the pelvic floor muscles and tissues of the anal canal to heal the fissure or hemorrhoid.  This will often include education on toileting techniques for decreased straining, improving pelvic floor muscle coordination so that stool can pass through more easily, and improving lifting mechanics for improved deep core activation and decreased pressure on the pelvic floor.   

Pelvic floor PT plays an important role in preventing and healing hemorrhoids and anal fissures.  We would like to work hand in hand with your providers to help decrease the risk of a non-healing fissure or recurrent hemorrhoids.