Use of Theros® FMS Dilators for Anal Fissures

You can find general information about anal fissures in our guide Anal Fissure.

The exceptional effectiveness of FMS dilators is based on their unique features. You can learn more about them under Unique Features of FMS Dilators.

The use of dilators – often referred to as “anal dilators” – may initially seem contradictory when dealing with a fissure: “Stretching with a fissure?”

No – we are not talking about “stretching”. FMS dilators differ fundamentally from conventional conical silicone dilators. Thanks to their unique shape and friction-free material, their effect – even in cases of fissures – is not based on stretching but on gentle flexibilisation and (re-)activation of hardened, contracted areas.

To treat an anal fissure, you definitely need a suitable dilator set – ideally with finely graduated sizes in 1–2 mm increments so that you can proceed as gently as possible. Choosing the correct starting size is equally important. Dilators that are too small achieve too little, while those that are too large cannot be used. Guidance on selecting the correct size can be found under the right starting size.

The treatment of anal fissures is based on three functions:

• Releasing tension (in cases of muscle spasms)
• Stimulating and massaging (to promote healing)
• Flexibilising and strengthening (for prevention)

Releasing Anal Spasms

Anal fissures are often caused by severe, chronic tension of the sphincter muscle – sometimes progressing to anal spasms. Psychological causes should always be addressed separately. 

The treatment should generally not begin immediately after a fissure has occurred while the injury is still fresh. During this phase, the acute condition makes treatment more difficult. However, in cases of particularly severe spasms, an earlier start may still be beneficial.

At the beginning, you need a dilator that can be inserted without discomfort or with only minimal discomfort. FMS dilators are therefore available from 14 mm onwards and are made of glass – extremely smooth and easy to insert. For even smaller sizes, we offer our innovative Theros® Bougie Dilators. Like our Viball® Kegel Balls, they are made from implant-grade steel and combine the advantages of both product lines.

1) First cover the fissure with a protective, slightly thicker ointment – for example petroleum jelly or a barrier cream for babies.

2) Warm the FMS dilator in a water bath to body temperature. Heat helps release spasms. The lubricant may also be warmed to body temperature. We recommend Vemal Bio Lubricant. If the fissure is fresh, it is best to wait one or two days before beginning treatment so as not to interfere with healing.

3) Dry the dilator so that the lubricant is not diluted. Apply a small amount of lubricant to the sphincter area, the fissure itself and – if possible – carefully into the anal canal to avoid irritation.

4) Insert the dilator using alternating gentle pressure and slight relaxation. If the sphincter does not open painlessly, choose a smaller size.

5) After insertion, relax for a few minutes.

6) Then move the dilator slowly back and forth and gradually increase the movement for a few minutes.

7) Next, withdraw the dilator completely and then reinsert it immediately. Repeat this insertion and withdrawal – opening and closing the sphincter – first slowly and then a little faster, always carefully and mindfully. When you feel that it is enough, stop the treatment. This gently pulsating movement helps release the tension. It is sufficient to move only the head of the dilator.

8) For a more lasting effect, you can later progress to the next size – but only if it is completely pain-free. At this stage, stimulation is what matters, not stretching. Increasing the size too quickly may reopen the fissure and delay healing.

Stimulating Through Massage

Regular, gentle applications improve blood circulation and cellular metabolism – thereby supporting wound healing. At this stage, consistency and gentle stimulation are what matter most, not increasing the size.

Flexibilisation

As healing progresses and after regular massage, you can gradually increase the sizes to improve the flexibility of the sphincter muscle. This helps make the treatment outcome more permanent.

When withdrawing the dilator, try to gently “hold” the head with the sphincter muscle. This interplay between relaxation (during insertion) and contraction (during withdrawal) strengthens the muscle while simultaneously increasing its flexibility.

The so-called “muscle memory” gradually remembers the different levels of muscle tone: relaxation – baseline muscle tone – contraction.

This application using active contractions is only possible because of the unique shape of FMS dilators. Further details can be found in the instructions for use.

Prevention

Once the anal fissure has healed completely, you can massage more intensively and/or increase the sizes for prevention. The principle remains the same: insert while relaxing, hold while contracting. Use your breathing as well, following the rule I-R-I / E-C-E: inhale – relax – insert, exhale – contract – extract.

Beneficial Side Effects

As a beneficial side effect, these exercises have a strong effect on the entire pelvic floor musculature and are particularly helpful in preventing or improving incontinence.

In men, the application also provides stimulation or massage of the prostate, depending on intensity. Of course, men can also use FMS dilators independently of any symptoms to perform a prostate massage in order to prevent or treat prostatitis or erectile dysfunction and strengthen potency.

For Women, Trans People and Couples

FMS dilators are also suitable for treating many vaginal conditions, for example:

• Birth injuries (vaginal tears or perineal tears), vaginismus and incontinence
• Consequences of radiotherapy
• Pain during penetration or sexual intercourse during menopause
• Preparation for penetration or sexual intercourse after a prolonged period of abstinence

FMS dilators are unique worldwide for aftercare and continued treatment of the vagina in trans women following gender-affirming surgery. As a complementary aid, we recommend our Theros® Vagina Stents.

All applications can be found under “All Information About Theros® FMS Dilators (Medical Device)”.