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
Many people suffer from pelvic pain, urinary problems, or discomfort in the lower body, yet never receive a clear diagnosis. One possible cause that is often overlooked is Myofascial Pelvic Pain Syndrome (MPPS), a type of pain that originates from tight or irritated muscles in the pelvic floor.
But how did we come to understand this condition? Let’s take a quick look at the history behind the diagnosis of MPPS.
1. The Early Days – Understanding Myofascial Pain
The concept of Myofascial Pain Syndrome (MPS) dates back to the early 20th century. Doctors began to notice that certain tight areas in muscles—called “trigger points”—could cause both local and referred pain. At first, this was mostly studied in areas like the shoulders or back, but over time, it became clear that the same thing could happen in the pelvic muscles as well.
2. Recognizing Pelvic Muscles as a Source of Pain
It wasn’t until the second half of the 20th century that researchers began to seriously consider muscles and fascia (the connective tissue around muscles) as potential causes of chronic pelvic pain. In the 1990s, studies started to highlight how some patients with pelvic pain actually had myofascial pain, not infections or inflammation.
3. Defining MPPS as a Distinct Condition
By the early 2000s, the term Myofascial Pelvic Pain Syndrome started gaining ground. Doctors began to look for key features such as:
• Ongoing or recurring pelvic pain
• Tender spots in certain muscles (like the obturator internus or iliococcygeus)
• Pain that spreads from those spots to other parts of the body (called referred pain)
4. New Tools for Diagnosis
Today, imaging tools like ultrasound and MRI are being used to support the diagnosis of MPPS. Still, one of the most important tools remains a skilled physical examination—often done by physiotherapists or doctors trained in pelvic floor care.
5. A Team-Based Approach
MPPS treatment works best when multiple types of care are combined. This might include physical therapy, acupuncture, medication, and even psychological support. This holistic approach offers the best chance for lasting relief.
Why MPPS Is Often Missed
One reason MPPS has gone unrecognized for so long is that the pelvic floor muscles are deep and can’t be felt from the outside. This makes the diagnosis more difficult—especially when symptoms mimic other conditions.
If you or someone you know has been told “your bladder infection won’t go away,” or you’re struggling with unexplained symptoms like urinary urgency, anal or genital discomfort, lower abdominal pain, or even back pain—it may be time to consider whether the pelvic floor muscles are playing a role.
Understanding referred pain from the pelvic floor may be the key to healing and preventing long-term suffering.
“I suddenly feel the urge to urinate and can’t hold it…”
“I’ve tried all the medications for overactive bladder, but nothing works…”
A woman in her late 60s had been struggling with this issue for over 10 years.
Despite trying every available medication for overactive bladder (OAB), she saw little improvement. There were times when her symptoms settled down, but they never truly went away.
So, was her bladder really the problem?
A closer examination revealed some surprising findings.
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