In January 2017, after a short bout of harder-than-normal BMs, I got a superficial fissure, internal hemorrhoids, and some bizarre pain that would radiate into my left butt cheek and down my left leg. My first CRS successfully treated the fissure with nifedipine, but my pain didn’t improve. He figured that I had a hidden fissure and recommended Botox, but I didn’t agree with the recommendation (or like him much, for that matter) so I got a new CRS.

The new CRS treated my internal hemorrhoids with infrared coagulation, but was puzzled as to why I still had pains because he could see that they had shrunk somewhat. I could direct him to the exact location of pain in my anus, but he said there was nothing there. He figured it was a muscle problem and sent me to PT for biofeedback.

My PT decided that my problem was due to hip misalignment and tight pelvic muscles and recommende exercises, self-dilation, and sphincter muscle stretching. This has helped reduce the radiating pain, but not the pain during or after BMs. I also developed an intense stinging or burning pain in my anus after BMs that could last anywhere from minutes to 8 hours.

I was still bleeding, so my CRS treated the hemorrhoids a second time (a few weeks ago). I no longer bleed or have pain during a BM, but the intense stinging or burning pain is still there.

After reading about pudendal nerve problems, I’m convinced that that is the main source of my pain. Some urinary changes that I’ve had also seem to be possibly associated with that nerve. I also noticed that the radiating pain seemed to be associated with the posterior femoral cutaneous nerve, and that the two nerves are close to each other and can interact.

Does anyone have experience with this? I’m planning to bring this up to my CRS this week.

You are on to something. I have similar symptoms, including urinary problems....specialist don't see anything yet I suffer greatly.

Problem is, how does pudendal nerve get diagnosed. And, what can help? Not easy answers but I agree that nerve problems are likely, once other things are ruled out.

I had the same internal hemorrhoids infrared and the same butt cheek pain as you describe( right butt cheek). Though it did subside after the infrared session I do feel a little sensation the past 2 days, 6 weeks after infrared. Curious it may be the sitz baths in the tub and my boney a$$ due to the loss of weight Cause of this hemorrhoid/ fissure fiasco. Hope you heal. Did you say you went for a second lazer? and was it worth it?

The second round of IC definitely helped, but didn't solve the problem. A third round on the biggest hemorrhoid has also helped.