At a glance
One of the most confusing and demoralising experiences in the fissure world is this: the fissure heals, the examination confirms it, your surgeon says everything looks fine — but the pain is still there. Not the same pain as the acute fissure, but an aching, burning, or pressure that will not go away.
This is more common than most people realise, and it has a name — or several names. This guide explores what may be happening and what can be done about it.
What people describe
People living with chronic pain after a healed fissure describe symptoms with remarkable consistency:
- A deep ache in the rectal area, particularly when sitting
- Burning or pressure that is not tied to bowel movements
- Spasm-like episodes — sudden cramping that comes and goes
- Pain that is worse with stress and eases with relaxation or lying down
- Discomfort during or after bowel movements that does not match what a healed fissure should cause
The pain often has a different character from the original fissure pain. It is less sharp, more diffuse, and less clearly connected to specific events.
Why the pain persists
Pelvic floor dysfunction
The most common explanation is that the pelvic floor muscles — which include the muscles around the anus and rectum — learned to guard and clench during the months of fissure pain. This clenching was a protective response: the body tried to prevent painful bowel movements by tightening everything.
When the fissure heals, the structural cause of pain is gone. But the muscles have developed a pattern of tension that does not automatically resolve. The muscles remain hypertonic (too tight), and this tension itself causes pain, reduced blood flow, and spasm.
Levator ani syndrome
Levator ani syndrome is chronic pain caused by tension in the levator ani muscles — the main muscles of the pelvic floor. People describe it as a constant or near-constant ache deep in the rectum, often worse when sitting. It is directly related to pelvic floor dysfunction and is treatable.
Proctalgia fugax
Some people develop episodes of sudden, intense rectal pain lasting seconds to minutes. This is proctalgia fugax — a spasm of the internal anal sphincter or pelvic floor muscles. It can begin or worsen after a period of chronic fissure pain and may persist after the fissure heals.
Central sensitisation
When pain persists for months, the nervous system can become sensitised — the volume on pain signals gets turned up. This means that sensations which should be mild or neutral are experienced as painful. The fissure may have healed, but the nervous system is still in a heightened state.
A fissure that is not visible
In some cases, a very small or internal fissure may not be visible on standard examination but is still causing symptoms. If there is any uncertainty, an examination under anaesthesia (EUA) can provide a more thorough assessment.
What can help
Pelvic floor physiotherapy
This is the most commonly described effective intervention for chronic pain after a healed fissure. A specialist pelvic floor physiotherapist can:
- Assess whether the pelvic floor muscles are in spasm
- Teach relaxation techniques specific to those muscles
- Guide you through stretches and exercises that retrain the muscle pattern
- Help you understand the connection between stress, muscle tension, and pain
People who pursue pelvic floor physiotherapy commonly describe significant improvement, though it takes time — weeks to months of consistent practice.
Addressing the nervous system
For pain that involves central sensitisation, approaches that work on the nervous system can be helpful:
- Graduated exposure — slowly reintroducing activities that trigger pain anxiety
- Mindfulness and relaxation practices — to reduce the stress-pain feedback loop
- Cognitive behavioural therapy (CBT) — specifically for chronic pain management
- Medication — in some cases, low-dose medications used for chronic pain conditions may be appropriate
Self-care measures
- Sitz baths — warm water relaxes the pelvic floor muscles
- Diaphragmatic breathing — breathing into the belly (not the chest) helps relax the pelvic floor
- Avoiding prolonged sitting — take regular breaks to stand and move
- Managing stress — the connection between stress and pelvic floor tension is well established
- Gentle exercise — walking, swimming, and yoga are commonly described as helpful
The path forward
Chronic pain after a healed fissure is not something you have to live with. It is treatable, though the treatment is different from fissure treatment. The shift is from treating damaged tissue to retraining muscles and nerves that have been affected by months of pain.
If you are in this situation, the right steps are:
- Confirm with your clinician that the fissure has genuinely healed
- Ask about pelvic floor assessment
- Request a referral to a pelvic floor physiotherapist
- Be patient with the process — muscle retraining takes time
- Address the emotional component — chronic pain affects mental health, and that deserves attention too