At a glance
Some people are told to use anal dilators after fissure surgery. Others are told not to touch the area at all. Many are never told anything either way. That inconsistency is the first thing people notice.
This guide looks at dilatation after a procedure: lateral internal sphincterotomy (LIS), fissurectomy, Botox, flap surgery or anoplasty. It draws on many anonymised accounts. For self-dilatation as a treatment instead of surgery, see our self-dilatation guide. For dilatation done by a surgeon under anaesthetic, see anal dilatation for fissure.
One point comes before everything else. Dilating after surgery should only happen if your surgeon or a pelvic floor physiotherapist has recommended it and shown you what to do. A healing wound tears easily. Pain, bleeding or anything new means stop and get checked.
This page does not explain how to dilate. That is deliberate. The right plan depends on what was done, how it is healing and what your surgeon found.
Why it comes up after surgery
People describe a few different reasons they were given.
- To stop the canal narrowing. Scar tissue contracts as it heals. After fissurectomy, flap surgery, anoplasty or extensive haemorrhoid surgery, some surgeons want the canal kept gently open while that happens. People treated for narrowing (stenosis) are the group most often told this.
- To ease spasm while healing. Some people still feel a tight, gripping muscle after LIS or Botox. A few are told that gentle, guided stretching may help the muscle settle.
- To keep the area used to normal stretching. Some people are told that very soft, small stools for months can leave the canal less flexible. Gentle stretching is offered as one way to address that.
- As follow-on care after a surgical dilatation. People who had a dilatation under anaesthetic are sometimes told to continue at home for a period afterwards.
Just as many describe the opposite. Some surgeons say stretching an area that is still healing only aggravates it. One recurring pattern is a surgeon telling someone to stop a routine they had started on their own advice.
What people describe
The first reaction
Disbelief is common. People describe thinking their surgeon must be joking, or feeling a cramp at the very thought of it. Several describe putting it off for days, or only managing it a couple of times before stopping out of fear.
The early weeks
Those who were told to start soon after surgery often say it hurt at first and felt wrong. Many say it became easier over the following weeks, and that the fear was usually worse than the experience. Some notice light blood on the dilator during the healing phase. The people who did best stopped and rang their surgeon before carrying on. Some were then told it was part of slow healing, but that was a judgement their surgeon made after asking questions, not a rule you can apply yourself.
When it seems to help
People who feel it helped describe:
- bowel movements that felt less narrow and less forced
- fewer spasms after going to the toilet
- a sense of control at a time when recovery felt out of their hands
- reassurance that scar tissue was not closing things up
When it does not
Others describe soreness that lingered for hours, a new tear, or no change at all after weeks of effort. A smaller group find their pain after healing comes from the pelvic floor rather than the sphincter. They are often redirected to a pelvic floor physiotherapist.
The worries people raise
“Will I re-tear it?” This is the biggest fear, and it is a real risk. People who report new tears often link them to pushing ahead too quickly, or to starting before the wound had closed. Starting point and pace are your surgical team’s call.
“Am I damaging my continence?” After LIS especially, people are anxious about adding more stretch to a muscle that has already been cut. Any new leakage of stool or wind means stop dilating and contact your surgeon the same day. Do not wait to see if it settles. In the accounts where this was checked, people were often told the muscle was working normally, which is reassuring, but only an examination can tell you that.
“Is something else going on?” Narrow stools, tightness or bleeding after surgery are not always about tight muscle. Sometimes there is a new fissure, a haemorrhoid, a skin tag or something that needs looking at. Dilating can mask a problem that needs assessment, which is one reason people are told not to go it alone.
“Where do I even get these?” Many people struggle to find suitable dilators and feel embarrassed buying them. Products not designed for anal use can be the wrong shape or length. If your surgeon recommends dilators, ask them or the clinic where to get the right ones.
“Nobody told me how often or for how long.” This is one of the most frequent complaints. People are given the idea but not a plan. If that is you, ring the clinic and ask for specific instructions before you begin.
When people stop
People describe stopping for different reasons:
- Their surgeon set an end point. Often a period of time after all symptoms, including bleeding, had settled.
- Healing was confirmed at a follow-up and they were told it was no longer needed.
- It was making things worse. Soreness, bleeding or new tears led them to stop and get reviewed.
- Fatigue with the routine. Some simply got tired of it. A few describe a flare after stopping abruptly and wish they had agreed a plan with their surgeon first.
- It turned into a longer-term habit. People who had surgery for narrowing sometimes describe being told it may continue for months or longer.
A common regret is drifting back into constipation once things felt healed, then re-tearing. Keeping stools soft and avoiding straining remains part of most recovery plans, whatever else is used.
Questions to take to your follow-up
- Do you recommend dilatation after my procedure, and why?
- If yes, who will show me what to do, and what exactly should I use?
- When should I start, and when should I stop?
- What should make me stop straight away and call you?
- If you do not recommend it, what should I do if things feel tight?
- Would a pelvic floor physiotherapist be useful for me?
When to seek care
Stop using any dilator and contact your surgical team, GP or urgent care if you notice:
- heavy or persistent bleeding that does not settle
- severe pain, or pain that is getting worse rather than better
- sharp pain, fresh bleeding or a new tear during or after dilating
- fever, swelling, pus or discharge that could mean infection
- new leakage of stool or wind, or any change in bowel control
- narrowing, tightness or difficulty passing stool that is getting worse
If you feel faint, are bleeding heavily, or have fever with severe pain, seek urgent care straight away. If you are unsure whether something is part of normal healing, it is always reasonable to ring the clinic and ask.