A woman in her 30s had undergone several surgeries for an anal fissure.

Although the wound had healed completely, the pain around his anus persisted.

She mentioned that a sacral nerve block provided relief for about a week.

Wondering “why does the pain keep coming back?”, she came across our clinic’s blog and decided to visit.

We have seen many similar cases recently, and I feel it’s important to share what we’ve learned.

Anal Pain Is Transmitted by the Pudendal Nerve

The pudendal nerve is responsible for sensation in the anal area.

It originates from the sacral spinal roots S2–S4, travels through the pelvis via a tunnel called Alcock’s canal, and runs along the obturator internus muscle.

Along its path, it branches to control sensation and muscle function in the anus, urethra, clitoris (or penis), vagina, and perineum.

Why the Pain Persists Even When the Anus Looks Normal

When there is no visible inflammation or wound in the anus but pain continues, the reasons often lie in:

Myofascial compression or irritation along the course of the pudendal nerve Or nerve hypersensitivity or injury itself

In this patient’s case, there was marked tenderness in the right obturator internus and ischiocavernosus muscles.

After a myofascial release, the pain improved temporarily—suggesting that the source of pain was muscle and fascia tension rather than the nerve itself.

What Myofascial Release Reveals

When symptoms improve, even temporarily, after myofascial release, it usually indicates that the surrounding muscles and fascia are provoking the pain rather than the nerve alone.

Identifying the pain structurally is far more effective than continuing uncertain treatments based on vague diagnoses.

Treatment Approach

At our clinic, treatment begins with pelvic floor rehabilitation, and we gradually combine additional therapies depending on the response:

StarFormer® (high-intensity magnetic muscle stimulation) Hydro-release (targeted fascia injection) Low-intensity extracorporeal shockwave therapy (ESWT)

This stepwise approach helps restore healthy neuromuscular balance in the pelvic floor.

From “Removing Pain” to “Preventing Pain”

Of course, everyone wishes the pain could be gone immediately.

However, just as a shoulder massage gives only temporary relief, the pain will return unless posture, sitting habits, and muscle tension patterns are corrected.

“Vaginal stiffness” or “anal stiffness” often arise from prolonged sitting, poor posture, or emotional tension.

Learning how to maintain a relaxed, well-balanced body is the key to a pain-free life in the long term.

Key Takeaways

Most anal pain originates from the pudendal nerve Even when the anus itself is normal, muscle and fascia tension can cause pain Temporary improvement with myofascial release indicates the source Effective treatment combines rehabilitation, StarFormer, hydro-release, and shockwave therapy The goal is not only to relieve pain, but to build a body that doesn’t produce pain

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