As someone who is currently receiving biofeedback treatment for pelvic floor dysfunction, I found this recent survey (PDF) by Leiden University Medical Center for Proctology interesting. In particular, the survey's conclusion:

Pelvic floor dyssynergia was found in a large percentage of the patients presenting with anal fissure. We hypothesise that pelvic floor examination and pelvic floor physiotherapy may be important in the treatment of chronic anal fissure.

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I would love to hear whether your pelvic floor PT ultimately helped with fissure. I'm also in PT for pelvic floor issues (mild cystocele, significant weakness) and I've found that my fissure seems to worsen when I'm being diligent with my exercises. My pelvic floor dysfunction stems from chronic tension (I hold tension in the pelvic floor, which makes it difficult to engage the overtaxed muscles when I actually need them) and I suppose that would create fissure issues as well. But the tension created by doing exercises -- even mild ones that include a period of relaxation! -- seems to have resurrected my fissure. Is it just a matter of sticking with the PT?

I have to admit that I didn't get much help from PT - for some reason, the physiotherapist I consulted didn't seem all that keen on getting me to continue the exercises, and although I didn't experience any worsening of my condition from doing them, I didn't notice much improvement, either. The problem is definitely associated with muscular tension, though. At present I'm simply trying to get on with life at a slower pace than before, to work relaxation into my daily schedule without necessarily doing specific exercises, and aiming for a calmer outlook on things altogether. i think that the stress component of a condition like AF is hard to ignore - although physical treatments are available, and may be effective, the real challenge is in trying to make the mind stop torturing the body. I believe that an approach like that of Dr. Ben Kim may perhaps be the best one for me. But I don't know Dr. Kim, and have never visited his practice.

I think that if your condition gets worse, or you notice an increase in pain and discomfort, it's important to let your health professional know, and get your treatment adjusted accordingly. In the end I just discontinued physical treatment altogether, except for an anticonvulsant (pregabalin) and macrogol, but tried to alter my lifestyle and way of thinking. It might work, who knows.

For me, this post sums up the situation with AF as I've experienced it now for several years.

My story in short
- I've had hemorrhoids since 19, they were problematic, but managable, especially since I started squating to defecate. However, once I made a huge mistake and didn't react to constipation on time, because I had my internal hemorrhoids aggrivated. I defecated on the 5th day and felt torn out on the inside. After two weeks of misery and all-day pain, I visited a surgeon who enlightened me that I have an anal fissure. We treated it with Diltiazem cream and it worked like charm, in one month I was pain free. This condition only lasted for two weeks.

After that I've had a retear, I didn't visit a doctor this time. But also something else - nerve pain, that originated somewhere on the inside and was going downwards to my leg. It was very irritating and lasted for more than a month. Somewhere around that time I've started having incomplete defecations and in the end it turned into everyday struggle. I could feel a spam when defecating, I couldn't push out, I felt my muscles weak and blocked, my urge to defecate was weaker.

With the time this spasm almost went away, but the incomplete defecation remained. I tried everything - laxatives, fiber, food regimes, I went to all kinds of specialists, eventhough in my country there are no real specialists on this subject, nothing helped. I figured it out myself - I had pelvic floor dyssinergia.

3 Years passed and I was gathering money and courage to go abroad (to Italy) to get biofeedback treatment. I was planning to do it this spring, but in January I recieved my second fissure. I should note that the first one was more on the inside and I think this is why it was so painful (the pain was lasting ALL day). So it probably affected the nerves. This one is more on the outside and it only hurts when I defecate, after than pretty much nothing. However, even If am now knowledgable on fissure, I wasn't able to cure it. I've been on diltiazem and nifidipine creams for two months, but it doesn't show any signs of healing. Combine it with the inability to defecate completely and the tendency to form a hard tip, and you get the picture.

So, yes, anal fissure can definately be the culprit of pelvic floor dyssinergia.