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