Anal dilatation for chronic fissure

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