Quick Guide

• Breath: Exhale during any effort; avoid holding your breath.
• Pain scale: Aim to keep discomfort during bowel movements ≤4/10; sharp pain should improve within 2–4 weeks.
• Success signs: Pain and bleeding reduce steadily; bowel movements become smooth and strain-free.

Step 1 — Stool Softening Protocol (Daily)
Goal: Prevent trauma during bowel movements

1. Hydration: 1.5–2.5 litres of water daily, spaced evenly. Avoid large chugs; steady intake is easier on digestion.
2. Fibre: Add soluble fibre (e.g., psyllium husk) gradually. Start with 1 tsp in water per day, increasing to 1–2 tbsp as tolerated.
3. Diet: Include soft, moist foods — ripe bananas, stewed apples or pears, cooked vegetables, porridge oats.
4. Healthy fats: Add 1–2 tbsp olive oil or flaxseed oil daily to meals to help lubricate stool.

Success: Bristol Stool Chart type 3–4 consistently, no “hard edges.”

Step 2 — Zero-Strain Toilet Technique (1–2 minutes per attempt)
Goal: Avoid stretching the fissure and triggering pain

1. Use a small footstool so your knees are above your hips.
2. Lean forward with your elbows on your knees; keep spine straight.
3. Take 3 slow nasal breaths: inhale into belly, exhale long and gently, consciously relaxing the anal sphincter with each exhale (imagine the anus softening and opening like a flower).
4. If no movement within 3–5 breaths, get up, walk for 2–3 minutes, and try again later.

Success: Stool passes with minimal or no sharp tearing sensation.

Step 3 — Warm Sitz Bath (10–15 minutes, 1–2×/day)
Goal: Relax sphincter muscle, improve blood flow, reduce pain

1. Fill a shallow basin or bathtub with warm (not hot) water — enough to immerse the anal area.
2. Sit comfortably with knees apart; shoulders and jaw relaxed.
3. Breathe slowly: inhale through your nose 4–5 seconds, exhale gently through your mouth 6–8 seconds, allowing pelvic floor to drop.
4. Stay still; avoid tensing the buttocks.

Success: Anal area feels less tight and sore after soaking; bowel movements later are easier.

Step 4 — Pelvic Floor Drop Drill (2–3 minutes)
Goal: Stop unconscious clenching that delays healing

1. Lie on your back, knees bent, feet flat on the floor.
2. Inhale into your belly and lower ribs.
3. On each exhale, imagine your tailbone sliding away from your head and your anus releasing downward.
4. Visualise the fissure softening and “closing without effort” as blood flow nourishes the tissue.

Success: A noticeable release of tension in the anal area after 1–2 minutes.

Step 5 — Post-Bowel Movement Soothe (Immediate)
Goal: Reduce irritation and protect healing tissue

1. Gently clean with lukewarm water (handheld shower head or bidet) or use fragrance-free wipes.
2. Pat dry — avoid rubbing.
3. Optionally, apply a thin layer of a barrier ointment (e.g., zinc oxide or medical-grade petroleum jelly) to keep tissue moist and reduce friction.

Success: Minimal post-toilet burning; comfort lasts between movements.