At a glance
For people with anal fissures, the internal anal sphincter is often at the centre of the problem. High resting pressure or spasm in this muscle reduces blood flow to the fissure, prevents healing, and causes the intense post-bowel-movement pain that defines the condition.
While the internal sphincter is not under direct voluntary control, there are natural approaches that help it relax. This guide covers the techniques people most commonly describe as helpful, how they work, and how to make them part of a daily routine.
Understanding the sphincter
The anal sphincter is actually two muscles:
- External sphincter — the muscle you can consciously squeeze and release. This is under voluntary control.
- Internal sphincter — a smooth muscle that maintains a constant resting tone without conscious input. This is the one that causes problems with fissures.
When people talk about needing to “relax the sphincter” for fissure healing, they are primarily talking about the internal sphincter. Because it operates automatically, the approach has to be indirect — creating conditions that encourage relaxation rather than trying to command it.
Warm water immersion
This is the most consistently recommended and most effective natural approach to sphincter relaxation.
How it works
Warm water relaxes smooth muscle. When the perianal area is immersed in comfortably warm water, the internal sphincter responds by reducing its resting tone. Blood flow to the area increases. Pain reduces. The spasm cycle is temporarily interrupted.
The practice
- Sitz baths — sitting in a basin of warm water for ten to fifteen minutes
- Warm baths — a full bath works equally well, though is less practical for multiple daily sessions
- Timing — after bowel movements is the most important time, as this is when the sphincter is most likely to be in spasm
- Temperature — comfortably warm, not hot. Too hot can cause discomfort. Too cool is ineffective.
- Frequency — two to three times daily during active symptoms. Once daily as maintenance.
Breathing techniques
Diaphragmatic breathing — slow, deep belly breathing — is the second most commonly described natural relaxation technique for the sphincter.
How it works
Deep breathing activates the parasympathetic nervous system (the “rest and digest” system), which promotes muscle relaxation throughout the body including the pelvic floor. It also directly counteracts the fight-or-flight response that causes clenching.
The practice
- Sit or recline in a comfortable position
- Place one hand on your chest and one on your belly
- Breathe in slowly through your nose — the belly should rise while the chest stays relatively still
- Breathe out slowly through your mouth
- Each breath cycle should take six to eight seconds
- Continue for five to ten minutes
When to use it
- Before bowel movements — starting the breathing several minutes before helps reduce anticipatory clenching
- During bowel movements — continuing to breathe deeply rather than holding breath or bearing down
- During pain episodes — slow breathing will not eliminate spasm pain but can reduce the intensity
- At bedtime — if sphincter tension is disrupting sleep
Positioning
Body position affects sphincter tension. The positions people describe as most helpful:
During bowel movements
- Squatting position — using a footstool to raise the knees above hip level while sitting on the toilet. This straightens the anorectal angle and reduces the effort needed to pass stool.
- Leaning forward — resting forearms on the thighs with a slight lean opens the angle
- Relaxed posture — actively avoiding hunching, gripping, or tensing the body
During the day
- Avoiding prolonged sitting — sitting increases pressure on the perineal area and can maintain sphincter tension. Regular standing or walking breaks help.
- Lying on the side — this position naturally reduces sphincter pressure and is often described as the most comfortable resting position during flares
Gentle movement
Light physical activity — particularly walking — is consistently described as helpful for overall pelvic floor relaxation. The mechanism is both physical (gentle movement promotes blood flow and reduces muscle tension) and psychological (activity reduces the anxiety that contributes to clenching).
What people describe as helpful:
- Walking — ten to twenty minutes of gentle walking, particularly after meals
- Gentle stretching — basic stretches that target the hips and lower back can indirectly help pelvic floor tension
- Avoiding high-impact exercise — during active flares, intense exercise can worsen sphincter spasm
Stress and anxiety management
The connection between emotional state and sphincter tension is well-documented and widely described by people with fissures. Stress tightens muscles. Fear of pain causes anticipatory clenching. The cycle between anxiety and sphincter spasm is real and bidirectional.
Approaches people describe:
- Recognising the connection — simply understanding that anxiety tightens the sphincter can help people consciously counteract it
- Pre-bowel-movement rituals — creating a calm, unhurried environment for bowel movements rather than rushing
- Reducing overall stress — easier said than done, but many people describe their fissure symptoms improving during periods of lower stress
- Addressing fissure-specific anxiety — the fear of bowel movements is itself a major driver of sphincter tension
Dietary factors
While diet primarily affects stool consistency, it also indirectly influences sphincter behaviour:
- Adequate fibre — soft, well-formed stools require less effort to pass, reducing the strain on the sphincter
- Sufficient water — dehydration makes stools harder and bowel movements more difficult
- Warm drinks — some people describe warm water or herbal tea before bowel movements as helping to relax the sphincter and stimulate gentle motility
- Avoiding known triggers — caffeine and spicy foods can increase sphincter tone for some people
When natural approaches are not enough
Natural sphincter relaxation techniques are an important foundation, but for some people — particularly those with high resting sphincter pressure or chronic fissures — they may not be sufficient on their own. If consistent self-care is not producing improvement after several weeks, discussing additional options with a clinician is reasonable. Prescribed topical treatments, botox, and surgical options all work by addressing sphincter tension through different mechanisms.
The natural approaches described here remain valuable alongside any medical treatment. They support healing, improve comfort, and give you practical tools for managing symptoms day to day.