At a glance
Weightlifting with a fissure is possible for many people, but it requires modification. The main concern is intra-abdominal pressure — the bearing down that happens during heavy compound lifts. This guide covers what to modify and how to keep training safely.
The concern: pressure
Heavy lifting increases pressure in the abdominal and pelvic areas. This is the same pressure that occurs during straining on the toilet — and straining is one of the main aggravators of anal fissures. The exercises that create the most pressure:
- Squats — particularly heavy, deep squats
- Deadlifts — conventional deadlifts create significant intra-abdominal pressure
- Leg press — combines heavy weight with a compressed position
- Heavy overhead press — requires bracing
What to modify
Reduce weight, maintain form
The most practical approach: reduce the weight on compound lifts to a level where you can breathe through the movement rather than holding your breath and bracing. This typically means working at 50 to 70% of normal loads during active fissure symptoms.
Exercise substitutions
- Squats — replace with leg extensions, hip thrusts (if comfortable), or goblet squats at lighter weight
- Deadlifts — replace with hip hinge variations at lighter weight, or focus on upper body pulling (rows, pulldowns)
- Leg press — replace with single-leg work at moderate weight (lunges, step-ups)
Upper body training
Upper body work is generally well tolerated by people with fissures. Bench press, rows, pulldowns, shoulder work, and arm training can usually continue at normal or near-normal intensity, provided you are breathing through the movements rather than straining.
Core training
Intense core work (planks, heavy carries, hanging leg raises) creates abdominal pressure. Lighter core work and breathing-focused exercises are better tolerated.
Breathing matters
Learning to exhale on effort rather than holding your breath is the single most important modification. The Valsalva manoeuvre (breath holding under load) is what creates the problematic pressure. Exhaling during the concentric (lifting) phase reduces this pressure significantly.
This may mean lifting less weight. That is a worthwhile trade-off during recovery.
Practical gym strategies
- Train at a time when fissure symptoms are lowest
- Use a cushion on seats and benches if needed
- Keep training sessions shorter during active symptoms
- Have a post-gym routine: shower, clean the area, apply any topical treatment
- Monitor how the fissure responds in the 24 hours after training and adjust accordingly