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Pudendal neuralgia mimicking fissure

Published 13 March 2026 ·Last reviewed 13 March 2026 by the editorial team ·How we create our content

A composite account, drawn from many real anonymised experiences. It is not any one person's story.

Pudendal neuralgia mimicking fissure

What this experience covers

This experience describes what happens when persistent anal or rectal pain turns out to be pudendal neuralgia rather than — or in addition to — an anal fissure. It covers the journey from misattribution to correct diagnosis. This is a composite from many anonymised accounts.

The pattern

When the pain does not match

People typically arrive at a pudendal neuralgia diagnosis after months of pain that does not behave like a fissure should:

  • Pain that persists even when the fissure appears healed
  • Burning or shooting sensations that are not linked to bowel movements
  • Pain that worsens with sitting and improves with standing
  • Discomfort that extends beyond the anal area into the perineum, genitals, or buttocks
  • Pain that does not respond to standard fissure treatments

The diagnostic journey

The path to diagnosis is often long. People describe seeing multiple specialists before pudendal neuralgia is identified:

  • Colorectal surgeon confirms the fissure has healed
  • Pain persists, leading to confusion and frustration
  • Referral to a pelvic floor physiotherapist or pain specialist
  • Assessment identifies nerve involvement rather than ongoing tissue damage

Treatment approaches

People describe treatment for pudendal neuralgia as different from fissure treatment:

  • Pelvic floor physiotherapy — often the first-line approach
  • Nerve blocks — diagnostic and therapeutic injections
  • Medications that target nerve pain
  • Lifestyle modifications — sitting adaptations, cushions, standing desks
  • Gradual, patient progress rather than the quicker timelines of fissure healing

What people wish they had known

  • That pain persisting after fissure healing could be a nerve issue rather than an unhealed fissure
  • That pudendal neuralgia is a recognised condition with established treatment approaches
  • That sitting-related pain that worsens through the day is a characteristic pattern
  • That pelvic floor physiotherapy can be remarkably effective for this condition

When to contact your doctor

Seek medical attention if you experience:

  • Pain that is constant and worsening
  • New neurological symptoms such as numbness or weakness
  • Bowel or bladder control changes
When to seek care Heavy bleeding or feeling faint? Get emergency help now. Emergency: 911

Not sure how urgent it is? Get help today.

  1. Emergency

    Heavy bleeding, black tarry stools, feeling faint, severe pain or trouble breathing.

    Call 911 or go to the ER.

  2. Today

    Fever, pain getting worse, a hot swollen lump, or trouble passing urine.

    Call your doctor or go to urgent care.

  3. Soon

    Bleeding or bowel changes nobody has checked, or anything lasting 3 weeks.

    Book a doctor’s appointment.

Feeling overwhelmed? Call or text 988, any time.

See all the signs

For this topic, get medical advice if you notice:

  • Severe or worsening pain
  • Heavy bleeding
  • Fever
  • Black stools
  • Fainting or dizziness
  • Pus or unusual discharge
  • Inability to pass stool or gas
  • Unexplained weight loss

Recording how you feel is not the same as being checked. These are the signs that need a doctor’s attention.

Call 911 or go to the emergency room now if you have:

  • bleeding that will not stop, a lot of blood (the toilet water turns red, or you pass large clots), or any bleeding with feeling faint or dizzy
  • fainting, a racing heart or trouble breathing
  • confusion or slurred speech, extreme shivering, no urine in a day, or blotchy skin
  • sudden severe belly pain, or a swollen, hard belly with vomiting or not passing stool or gas
  • you cannot pass urine at all, or your bladder feels full and painful and you can’t empty it
  • redness, swelling or severe pain spreading quickly around your anus, genitals or groin, especially with a fever or feeling very ill
  • a fever with a painful swelling near your anus if you have diabetes or a weakened immune system (for example, from chemotherapy or transplant medicines)
  • black, tarry stools

Call your doctor or go to urgent care today (or the ER if you can’t be seen today) if you have:

  • a temperature of 100.4°F (38°C) or higher, chills, vomiting, or feeling generally unwell
  • pain that is getting worse over days, or severe pain that stops you sitting or sleeping
  • a hot, swollen or very tender lump near your anus or at the top of the crease between your buttocks, or foul-smelling discharge
  • trouble urinating
  • bleeding that is getting heavier or more frequent, or blood mixed into your stool
  • feeling much more tired than usual, looking pale, or getting out of breath more easily than you used to
  • not passing stool for several days, or new belly pain

Make an appointment with your doctor if:

  • you have never had these symptoms checked by a doctor or nurse — whatever your age
  • you have had rectal bleeding for more than 3 weeks
  • your bowel movements have been looser, thinner or more frequent than usual for 3 weeks or more, or you have lost weight without trying
  • symptoms have not settled after a week or so, or keep coming back
  • you notice a new lump near your anus, between your buttocks or in your belly, or an itch or discharge that does not clear
  • you have new leakage or trouble controlling your bowels
  • you are 45 or over, or have a family history of bowel cancer or inflammatory bowel disease, and any of these symptoms are new for you

If you are unsure, it is always reasonable to ask. If things feel overwhelming, call or text 988 (Suicide & Crisis Lifeline) or chat at 988lifeline.org, any time. If you don’t feel safe, call 911.

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Discreet symptom tracking

Symptoms that come and go? Keep track, day by day.

For hemorrhoids, fissures, fistulas and other anal and rectal problems. A short, discreet email asks how things have been, and saves each answer, so you can look back at every flare and every good week in your own words. If you haven’t had your symptoms checked, see your doctor first.

  • About ten seconds a check-in. No app, no password.
  • Nothing in the subject or preview says what it’s about.
  • Each Sunday, a link to your week, ready for your next appointment.
Start tracking →

Your notes

Your check-in

Takes about ten seconds.

20:00
Example. Nothing on the lock screen hints at symptoms or conditions.

Explore more

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