At a glance
Your fissure healed. Your doctor confirmed it. But the pain did not stop. If this is where you are, you are not imagining it — and you are not alone. This is one of the most discussed experiences in online colorectal communities, with thousands of people describing the same bewildering pattern: healed but still in pain.
There are real, identifiable reasons why pain persists after a fissure has closed. This guide covers the most common causes people and clinicians report, what tends to help, and when it is worth pushing for further investigation.
What people describe
The phrase that comes up again and again is “healed but still pain.” People use remarkably similar language to describe what they are experiencing:
- “Two colorectal surgeons said the fissure is healed, but why the burning?”
- “No visible fissure, but I still have pain when sitting for more than twenty minutes”
- “The sharp pain is gone, but there is this constant residual tenderness”
- “It does not feel like the fissure pain any more — it is duller, wider, harder to point to”
- “Scar tissue causing spasms — that is what my physio thinks”
- “If the fissure is healed, why so much pain?”
The pain often changes character after the fissure closes. People commonly describe it shifting from sharp and localised to dull, diffuse, and harder to pin down. It may spread beyond the original site — into the buttocks, the perineum, or deeper in the pelvis. It may worsen with sitting and ease with standing or gentle movement.
This shift in pain quality is itself a clue. It suggests the source of pain has changed, even if the location has not.
Why pain can persist after healing
There is rarely a single cause. For many people, several of these factors overlap.
Muscle memory and spasm habit
This is the most commonly reported cause. During weeks or months of fissure pain, the internal anal sphincter and surrounding pelvic floor muscles tightened protectively. This is a normal response — the body guards an injured area.
The problem is that the muscles can get stuck in this tightened state. Even after the tissue heals, the muscles continue to guard. They have learned a pattern of tension and they do not automatically unlearn it when the reason for it disappears.
This ongoing spasm reduces blood flow to the area, produces its own pain, and can make bowel movements uncomfortable despite the absence of a tear. People often describe it as the muscles “forgetting how to relax.”
Scar tissue
When a fissure heals, it leaves scar tissue. This scar tissue is less elastic than the surrounding skin and can cause:
- A pulling or catching sensation during bowel movements
- Localised tenderness at the healed site
- Restriction of the normal stretch of the anal canal, which triggers spasm
- A small firm area that a doctor can sometimes feel on examination
Not everyone with scar tissue has symptoms from it. But for some people, particularly those who had deep or chronic fissures, the scar itself becomes a source of ongoing discomfort.
Pelvic floor dysfunction
Pelvic floor dysfunction is closely related to muscle guarding but involves a broader set of muscles. The pelvic floor — the group of muscles that stretches across the base of the pelvis — can become chronically tight, uncoordinated, or locked in a protective pattern.
People with pelvic floor dysfunction after a fissure commonly describe:
- Pain that has spread beyond the original fissure site
- A constant dull ache or pressure in the rectum or pelvis
- Pain that worsens significantly with prolonged sitting
- A sense that the muscles around the anus are always clenched
- Difficulty fully relaxing during bowel movements
- Discomfort that radiates to the tailbone, sit bones, hips, or thighs
Pelvic floor dysfunction is one of the most underdiagnosed contributors to post-fissure pain. It does not show up on a colonoscopy, an MRI, or a standard visual examination. It requires specific assessment — usually by a pelvic floor physiotherapist — to identify. For a deeper look at this, see our pelvic floor and chronic anal pain guide.
Levator ani syndrome
Levator ani syndrome is a specific presentation of pelvic floor dysfunction involving the levator ani muscles. People describe a persistent dull ache, pressure, or heaviness in the rectum that can last for hours. It is often worse with sitting and better when standing or lying down.
Some people develop levator ani syndrome as a consequence of prolonged fissure-related muscle tension. It can coexist with other causes on this list. See our levator ani syndrome guide for more detail.
Undetected fissure
Sometimes the fissure has not fully healed, or a new fissure has formed that is difficult to see. This is worth considering if:
- The pain pattern still feels like the original fissure — sharp during bowel movements, burning afterward
- You have not had a thorough examination recently
- Previous examinations were visual only (some fissures are easier to detect with anoscopy or examination under anaesthesia)
- There is a skin tag or scar tissue that could be obscuring a small tear
People describe being told no fissure is visible on one examination, only for a more detailed assessment to find one. This is not because earlier examinations were careless — some fissures are genuinely difficult to detect.
If your pain pattern matches a fissure and you have been told the area looks healed, it is reasonable to ask about a more thorough examination.
Nerve sensitisation
After months of pain signals from the same area, the nervous system can become sensitised. The nerves in and around the healed site begin to amplify signals — sensations that would not normally register as painful start to hurt. This is called peripheral or central sensitisation, and it is a well-documented pattern after many types of injury.
People describe this as:
- The area feeling “raw” even though it looks normal
- Normal activities like sitting or walking causing discomfort that seems disproportionate
- A heightened awareness of the area that makes everything feel more intense
- Symptoms that fluctuate with stress, fatigue, or emotional state
Nerve sensitisation is real and physical. It is not anxiety, though anxiety can amplify it. It tends to improve with time and with treatment that addresses the underlying muscle tension and retrains the nervous system’s response.
When to push for further investigation
If your fissure has been confirmed healed but your pain persists, the following are reasonable steps that people commonly describe taking:
- Ask specifically about pelvic floor assessment. This is the single most commonly recommended step. Many colorectal specialists do not routinely assess the pelvic floor, so you may need to raise it yourself.
- Request a referral to a pelvic floor physiotherapist. Specify that you need someone experienced in hypertonic (too tight) pelvic floor conditions, not just incontinence-related weakness.
- Consider a second opinion if you feel your concerns are not being taken seriously. People frequently describe the difference between a clinician who dismisses persistent pain and one who investigates it.
- Ask about a more thorough examination if there is any possibility the fissure has not fully healed or a new one has formed.
- Keep a record of your pain — when it occurs, what makes it worse, what eases it. This information is valuable for any clinician assessing you.
You are not being difficult by asking questions. You are advocating for your own care.
What people find helps
Pelvic floor physiotherapy
This is the most frequently described turning point for people with persistent pain after fissure healing. A pelvic floor physiotherapist assesses the muscles, identifies areas of tension and guarding, and works to release them through manual therapy, biofeedback, breathing techniques, and a home exercise programme.
People commonly describe:
- Learning that they were holding significant tension without realising it
- Gradual reduction in pain over weeks to months
- Improved ability to sit, work, and have bowel movements comfortably
- A sense of finally understanding what was causing the pain
Progress is typically slow but real. Most people describe meaningful improvement over six to twelve weeks of consistent therapy. See our pelvic floor and chronic anal pain guide for a detailed look at what this involves.
Biofeedback
Biofeedback uses sensors to show pelvic floor muscle activity in real time on a screen. For people who have been unconsciously clenching for months, seeing the muscle tension — and learning to reduce it — can be a powerful experience. Many people describe being shocked at how tense their “relaxed” state actually was.
Biofeedback is usually part of a broader pelvic floor physiotherapy programme rather than a standalone treatment.
Sphincter and pelvic floor relaxation techniques
Between professional sessions, people describe daily self-care as important for progress:
- Warm sitz baths — 15 to 20 minutes in comfortably warm water, particularly after bowel movements
- Diaphragmatic breathing — slow, deep breaths that expand the belly and naturally encourage the pelvic floor to relax
- Gentle stretching — child’s pose, happy baby, deep squats, and hip-opening stretches
- Positioning changes — avoiding prolonged sitting, using a cushion, taking regular breaks
For more detail on these techniques, see our sphincter relaxation techniques guide.
Muscle relaxants and prescription treatments
Some people describe being prescribed medications to help reduce sphincter or pelvic floor tension. These are decisions to make with a doctor based on your specific situation. They are typically used alongside physiotherapy rather than as a replacement for it.
Time and patience
This is not the answer anyone wants, but it is honest. Nerve sensitisation and deeply ingrained muscle tension patterns take time to resolve. People who have been through this consistently describe recovery as a process of weeks to months, not days. The pain does not disappear overnight — it fades gradually, with setbacks along the way.
The emotional toll of invisible pain
Being in pain while being told nothing is wrong is one of the most difficult aspects of this experience. People describe:
- Self-doubt. When examinations are normal, it is natural to wonder whether you are imagining things or being dramatic. You are not.
- Frustration with the medical system. Being told “it is healed, it should not hurt” — sometimes repeatedly — is exhausting. Many people describe feeling dismissed, minimised, or not believed.
- Grief for the expected recovery. You went through months of treatment with the understanding that healing would mean the end of pain. When it does not, there is a genuine sense of loss.
- Isolation. This is already a condition most people do not discuss openly. Adding the complexity of “the thing healed but I still hurt” makes it even harder to explain to others.
- Relief when finally heard. People consistently describe the moment someone — whether a pelvic floor physiotherapist, a second-opinion specialist, or even a forum post — validates their experience as profoundly meaningful. Being believed matters.
These feelings are common and they are valid. If chronic pain is affecting your mental health, that is worth addressing directly with a GP or therapist. Pain and emotional wellbeing are deeply interconnected.
Being believed matters
Perhaps the most important thing to take from this guide: if your fissure has healed but your pain has not stopped, there is almost certainly a reason. The most common explanations — pelvic floor dysfunction, muscle guarding, scar tissue, nerve sensitisation — are real, physical, and treatable.
You are not imagining it. The pain is not in your head. It may just require a different kind of assessment to find the cause — one that looks beyond the healed tissue to the muscles, nerves, and patterns surrounding it.
Thousands of people have been where you are and found their way through. The path usually starts with the right person asking the right questions about your pelvic floor.