Will pressure-controlled treatment (PCT) restore the empty feeling in my pelvic region to baseline, given my history of anal fistulas and possible sphincter reconstruction?

Understanding Your Pelvic Pressure Symptoms After Anal Fistula Treatment

I need to clarify that "PCT" (pressure-controlled treatment) is not a recognized treatment for anal fistulas or pelvic floor dysfunction. If you underwent fistulotomy with sphincter reconstruction for your anal fistulas, the "empty feeling" in your pelvic region will likely improve over time as the reconstructed sphincter heals and regains function, but this is not related to any "PCT" therapy. 1, 2

What Actually Happens After Sphincter Reconstruction

Expected Recovery Timeline

• Sphincter function typically improves progressively over 3-12 months following fistulotomy with primary sphincter reconstruction 1, 2
• Manometric pressures (which correlate with the sensation of pelvic fullness and control) show significant improvement by 3 months post-operatively and continue improving through 12 months 1
• The "empty" or altered sensation you're experiencing may reflect temporary changes in rectal sensation and sphincter tone during the healing phase 3

What the Evidence Shows About Recovery

• In patients who had fecal incontinence before surgery, 70% showed improvement in continence scores (from 6.75 to 1.88 on the Wexner Scale) after fistulotomy with sphincter reconstruction 1
• Anal manometry demonstrates that maximum resting pressure and squeeze pressure improve significantly in previously incontinent patients, reaching levels comparable to continent patients 2
• The sensation of pelvic control is directly related to pressure receptors in the anal canal and rectum, not volume or weight 4

If You're Experiencing Pelvic Floor Dysfunction

When Biofeedback Therapy (BT) Is Indicated

If your "empty feeling" represents difficulty with rectal evacuation or sensation, biofeedback therapy has a Grade A recommendation and effectively treats 70-80% of patients with pelvic floor dysfunction 3

BT specifically helps by:

• Enhancing rectal sensory perception and increasing anal sphincter tone 3
• Improving rectal sensorimotor coordination, which can address abnormal pelvic sensations 3
• Treating rectal hyposensitivity (the "empty" feeling you describe) in patients with constipation or fecal incontinence 3

Diagnostic Evaluation Needed

You should undergo anorectal manometry (ARM) to determine the specific cause of your symptoms 3:

• ARM measures anal sphincter pressures, rectal sensation thresholds, and coordination during defecation 3
• Rectal sensation testing will identify if you have hyposensitivity (elevated thresholds for feeling rectal fullness) or hypersensitivity 3
• A balloon expulsion test should be performed to rule out dyssynergic defecation 3

Critical Pitfalls to Avoid

Do Not Assume Your Symptoms Are Normal

• Post-operative changes in pelvic sensation warrant evaluation, especially if they persist beyond 6 months 1
• Altered rectal sensation can indicate incomplete sphincter healing, rectal hyposensitivity, or pelvic floor dysfunction—all of which have specific treatments 3

Do Not Delay Seeking Specialized Care

• If you have a history of anal fistulas and possible sphincter reconstruction, you need evaluation by a colorectal surgeon or gastroenterologist with expertise in anorectal physiology 3
• ARM should be performed at specialized centers with standardized protocols 3

Specific Recommendations Based on Your History

If You Had Sphincter Reconstruction

• Expect gradual improvement over 3-12 months, with manometric and clinical assessments at 3 months, 12 months, and every 2 years thereafter 1
• Anal endosonography at 6 months post-operatively can confirm proper sphincter healing 1
• If symptoms persist beyond 12 months, biofeedback therapy should be considered 3

If You Have Rectal Hyposensitivity

• Biofeedback therapy with rectal sensory training can restore normal sensation thresholds 3
• Patients with lower baseline rectal sensation thresholds respond better to biofeedback 3
• Treatment typically requires multiple sessions over 6-8 weeks 3

Bottom line: There is no "PCT" treatment for your condition. Your symptoms require proper diagnostic evaluation with anorectal manometry to determine whether you have sphincter dysfunction, rectal sensory abnormalities, or pelvic floor dysfunction—each of which has evidence-based treatments that can restore function. 3, 1, 2