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Anal dilatation for chronic fissure

Published 13 March 2026 ·Last reviewed 13 March 2026 by the editorial team ·How we create our content

At a glance

Anal dilatation for chronic fissures is an approach that some people discover after years of dealing with a fissure that resists conventional treatment. The principle is straightforward: gently and gradually stretching the internal sphincter to reduce the chronic spasm that prevents healing.

This is not a mainstream first-line treatment, but it is discussed in the colorectal health community and some people describe finding benefit from it. This guide covers what is known and what to consider.

The theory

Chronic anal fissure is driven in part by sphincter spasm. The internal sphincter muscle is tighter than it should be, reducing blood flow to the anal lining and preventing the tear from healing. All effective fissure treatments work by addressing this spasm — whether through topical relaxants (GTN, diltiazem), botox injection, or surgery (LIS).

Graduated dilatation works on the same principle: gently stretching the muscle to reduce its resting tone. The approach is more gradual than surgical intervention and does not involve cutting muscle tissue.

Historical context

Manual dilatation of the anus (Lord’s procedure) was historically performed under general anaesthesia as a fissure treatment. It involved forceful stretching of the sphincter and was associated with significant rates of incontinence. This procedure has largely been abandoned.

Modern graduated self-dilatation is a very different approach — controlled, gradual, and performed by the individual at their own pace. The two should not be confused.

What people describe

People who have tried graduated dilatation for chronic fissures commonly describe:

  • Starting with the smallest size and progressing very slowly over weeks
  • Using the devices with lubricant after a warm sitz bath when the sphincter is most relaxed
  • Gradual reduction in the sense of sphincter tightness
  • Some improvement in fissure symptoms over time
  • The approach requiring significant patience and consistency

Important considerations

  • This should be discussed with a clinician before starting — particularly to ensure there are no contraindications
  • Gradual progression is essential — forcing or rushing can cause injury
  • It is not a guaranteed treatment — the evidence is limited
  • It works alongside other care — stool management, sitz baths, and topical treatments should continue
  • It does not replace surgery when surgery is appropriate — but it may be an option for people who prefer to avoid surgical intervention

Where to start

If you are interested in exploring this approach:

  1. Discuss it with your colorectal specialist or GP
  2. If appropriate, they may recommend specific graduated dilators
  3. Begin slowly and follow any guidance provided
  4. Continue all other aspects of your fissure care
  5. Monitor symptoms and report to your clinician at follow-up

Common questions

What is anal dilatation for fissures?

Anal dilatation involves gradually stretching the internal sphincter muscle to reduce its resting tone. The theory is similar to what LIS achieves surgically — reduced sphincter spasm allows better blood flow and conditions for healing. People describe using graduated dilators or similar devices under medical guidance.

Is there evidence for anal dilatation?

Manual dilatation of the anus under anaesthesia was historically used for fissures but fell out of favour due to uncontrolled sphincter stretching and incontinence risk. Graduated self-dilatation at home is a different approach — more controlled and gradual. The evidence base is limited, and this is generally not a first-line treatment. Some specialists include it as part of a comprehensive approach.

Is it safe?

When done gradually with appropriate devices and ideally under the guidance of a clinician or physiotherapist, controlled dilatation is generally considered low-risk. The key is gradual progression — forcing or rushing can cause injury. Anyone considering this approach should discuss it with their clinician first.

Should I try this instead of surgery?

Dilatation is not a direct substitute for surgery. It may be helpful as a complementary approach or for people who are not candidates for or have declined surgical options. The decision should be made in consultation with your clinician, who can assess whether it is appropriate for your specific situation.

When to seek care Heavy bleeding or feeling faint? Get emergency help now. Emergency: 911

Not sure how urgent it is? Get help today.

  1. Emergency

    Heavy bleeding, black tarry stools, feeling faint, severe pain or trouble breathing.

    Call 911 or go to the ER.

  2. Today

    Fever, pain getting worse, a hot swollen lump, or trouble passing urine.

    Call your doctor or go to urgent care.

  3. Soon

    Bleeding or bowel changes nobody has checked, or anything lasting 3 weeks.

    Book a doctor’s appointment.

Feeling overwhelmed? Call or text 988, any time.

See all the signs

For this topic, get medical advice if you notice:

  • Heavy or persistent bleeding that does not settle
  • Severe pain that is getting worse rather than better
  • Fever or signs of infection
  • Symptoms that have not improved after 4 to 6 weeks of self-care

Recording how you feel is not the same as being checked. These are the signs that need a doctor’s attention.

Call 911 or go to the emergency room now if you have:

  • bleeding that will not stop, a lot of blood (the toilet water turns red, or you pass large clots), or any bleeding with feeling faint or dizzy
  • fainting, a racing heart or trouble breathing
  • confusion or slurred speech, extreme shivering, no urine in a day, or blotchy skin
  • sudden severe belly pain, or a swollen, hard belly with vomiting or not passing stool or gas
  • you cannot pass urine at all, or your bladder feels full and painful and you can’t empty it
  • redness, swelling or severe pain spreading quickly around your anus, genitals or groin, especially with a fever or feeling very ill
  • a fever with a painful swelling near your anus if you have diabetes or a weakened immune system (for example, from chemotherapy or transplant medicines)
  • black, tarry stools

Call your doctor or go to urgent care today (or the ER if you can’t be seen today) if you have:

  • a temperature of 100.4°F (38°C) or higher, chills, vomiting, or feeling generally unwell
  • pain that is getting worse over days, or severe pain that stops you sitting or sleeping
  • a hot, swollen or very tender lump near your anus or at the top of the crease between your buttocks, or foul-smelling discharge
  • trouble urinating
  • bleeding that is getting heavier or more frequent, or blood mixed into your stool
  • feeling much more tired than usual, looking pale, or getting out of breath more easily than you used to
  • not passing stool for several days, or new belly pain

Make an appointment with your doctor if:

  • you have never had these symptoms checked by a doctor or nurse — whatever your age
  • you have had rectal bleeding for more than 3 weeks
  • your bowel movements have been looser, thinner or more frequent than usual for 3 weeks or more, or you have lost weight without trying
  • symptoms have not settled after a week or so, or keep coming back
  • you notice a new lump near your anus, between your buttocks or in your belly, or an itch or discharge that does not clear
  • you have new leakage or trouble controlling your bowels
  • you are 45 or over, or have a family history of bowel cancer or inflammatory bowel disease, and any of these symptoms are new for you

If you are unsure, it is always reasonable to ask. If things feel overwhelming, call or text 988 (Suicide & Crisis Lifeline) or chat at 988lifeline.org, any time. If you don’t feel safe, call 911.

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Related symptoms

BleedingPain during bowel movementsPain after bowel movementsSpasm or crampingConstipation

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For hemorrhoids, fissures, fistulas and other anal and rectal problems. A short, discreet email asks how things have been, and saves each answer, so you can look back at every flare and every good week in your own words. If you haven’t had your symptoms checked, see your doctor first.

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