At a glance
Bladder changes are not the first thing people link to a fissure. But many anonymised accounts describe them: needing to pee far more often, a stream that starts slowly, a feeling of not quite emptying, dribbling after finishing, or a sting as urine passes near the tear.
Several people only found their fissure after going to the doctor for what they thought was a bladder problem. Others went through repeated urine tests that came back clear.
The usual explanation people are given is pelvic floor guarding. But bladder symptoms can also have their own causes. This guide covers both, and when to get checked.
What people describe
The patterns repeat across many accounts:
- Frequency that tracks the pain. The urge to pee is strongest when the fissure is most painful, often in the hours after a bowel movement.
- Hesitancy and a weak stream. Some describe struggling to start, or a stream that stops and starts.
- Not emptying fully. The last push needed to finish peeing tightens the same muscles that hurt, so people stop short.
- Dribbling afterwards. Men in particular describe a few drops escaping once they have dressed.
- Stinging near the fissure. More often described by women, when urine runs backwards.
- A rush to pee right after a bowel movement, sometimes producing only a little.
Some people say the bladder symptoms bothered them more than the fissure itself.
Why it may happen
The anal sphincter, the pelvic floor and the muscles around the bladder outlet sit close together and share nerve supply. When a fissure causes pain and spasm, the whole pelvic floor can tighten and stay tight. Clinicians often call this guarding.
A tight pelvic floor can make it harder to relax enough to start peeing or to empty fully. It can also send mixed signals that the bladder needs emptying when it does not.
Other things can add to it:
- Drinking more water to keep stools soft naturally means more trips to the toilet.
- Caffeine, fizzy drinks and artificial sweeteners irritate the bladder for some people.
- Fear of pain makes people hold tension without noticing.
- After surgery, anaesthetic, pain, swelling and pain relief can all make it harder to pee for a short while.
When it is something else
Guarding is the most common explanation people are given, but it is not the only one. Bladder symptoms deserve their own check, especially if they are new.
Urine infection (UTI). Burning, cloudy or strong-smelling urine, blood in the urine, fever, or pain in the back or side point towards infection. A simple urine test can check. Several people in the accounts were treated for infections that later tested negative, which is why it helps to describe the fissure to whoever you see.
Prostate problems. In men, a weak stream, getting up at night to pee, or dribbling that continues after the fissure settles can relate to the prostate. Some men were diagnosed with prostatitis. Others felt the symptoms were muscle-related and settled when the fissure healed. A GP can examine and test.
Medication. If a bladder change started after a new cream or tablet, mention it to the prescriber.
Weak rather than tight muscles. Leaking with a cough or laugh is usually a different issue from guarding. It is worth raising separately.
Nerve problems. Numbness around the bottom or genitals, leg weakness, or a sudden change in bladder or bowel control are not guarding and need urgent assessment.
Other bladder conditions. Symptoms that continue after the fissure has healed may need a urologist or urogynaecologist to look further.
What people commonly try
These are things people describe trying. They are not a treatment plan, and your GP or clinician can tell you what is right for you.
- Sitting to pee and leaning forward, or using a footstool so the knees sit higher than the hips. Many find this helps the pelvic floor let go.
- Taking time. Breathing slowly and not pushing, then waiting a moment before getting up.
- Warm baths or sitz baths, which people say ease spasm in the whole area.
- Cutting back on bladder irritants such as caffeine, fizzy drinks and artificial sweeteners, while keeping fluids up for stool softness.
- Pelvic floor physiotherapy. People who saw a specialist pelvic health physiotherapist often describe it as the thing that finally explained the link between bowel and bladder.
- Treating the fissure itself. The most consistent pattern is that urinary symptoms eased as fissure pain and spasm eased, whether through creams, Botox or surgery.
For some people the bladder symptoms faded within weeks. For others it took months, even after the fissure healed.
When to seek care
Get urgent help (go to A&E or an emergency department, or call 999 in the UK or 911 in the US) if you have:
- Inability to pass urine at all, or a full, painful bladder you cannot empty
- Fever with burning, back or side pain, or shivering
- Heavy bleeding from the bottom that does not stop
- Severe pain that is getting worse rather than better
- New numbness or tingling around the bottom, genitals or inner thighs, weakness or numbness in the legs, or new loss of bladder or bowel control, especially with back pain
See your GP or clinician if:
- You have burning, cloudy or bloody urine, or think you might have an infection
- You are getting up several times a night to pee, or your stream has become weak
- You have new leaking of urine or stool (if this comes with numbness around the bottom or genitals or weak legs, get urgent help instead)
- Bladder symptoms continue after the fissure has settled
- You have had anal surgery and peeing is getting harder rather than easier