Can pelvic care therapy provide relief from over sensitivity in a patient with a history of lateral internal anal sphincterotomy (lateral sphincterotomy)?

Pelvic Floor Physical Therapy for Post-Lateral Sphincterotomy Oversensitivity

Yes, specialized pelvic floor physical therapy is the primary recommended treatment for oversensitivity following lateral internal sphincterotomy, as this complication typically represents neuropathic dysesthesia and myofascial tension rather than structural sphincter damage. 1, 2

Understanding the Problem

The oversensitivity you're experiencing is most likely neuropathic pain and dysesthesia, not mechanical sphincter failure. 1 This is a critical distinction because:

• Patients with altered sensations after lateral internal sphincterotomy typically have intact continence and preserved sphincter integrity 2
• The problem stems from pelvic floor muscle tension that commonly develops after anorectal surgery 1, 2
• Protective guarding patterns that developed during the painful fissure period persist even after surgery 1, 2

Treatment Algorithm

First-Line Treatment: Specialized Pelvic Floor Physical Therapy

Initiate pelvic floor physical therapy 2-3 times weekly with the following components: 1, 2

• Internal and external myofascial release targeting pelvic floor muscles 1, 2
• Gradual desensitization exercises guided by a specialized physical therapist 1, 2
• Muscle coordination retraining to reduce protective guarding patterns 1, 2
• Warm sitz baths to promote muscle relaxation 1, 2

Adjunctive Pain Management

• Topical lidocaine 5% ointment applied to affected areas for neuropathic pain control 1, 2

Expected Timeline and Prognosis

The dysesthesia and altered sensations typically improve significantly over 6-12 months with appropriate pelvic floor therapy and neuropathic pain management. 2 The absence of incontinence or structural damage is favorable and suggests better potential for improvement with conservative management. 2

Critical Pitfalls to Avoid

Do not pursue additional surgical interventions, as this would likely worsen the neuropathic component rather than improve it. 1, 2 The problem is not mechanical and cannot be fixed with more surgery.

Avoid manual anal dilatation entirely, as it carries a 30% temporary and 10% permanent incontinence rate. 1

Context: Why This Complication Occurs

While lateral internal sphincterotomy achieves 96% healing rates for chronic anal fissures 3, incontinence or altered sensations occur in up to 45% of patients at some point postoperatively, though most cases are minor and transient. 3 In your case, the oversensitivity without incontinence suggests the neuropathic/myofascial variant rather than sphincter damage, which responds well to physical therapy. 1, 2

Alternative Consideration for Future Patients

For context, botulinum toxin injection represents a safer alternative to lateral internal sphincterotomy, achieving 75-95% cure rates with no risk of permanent incontinence or sexual dysfunction, as it provides temporary rather than permanent sphincter relaxation. 4, 1 However, this information is relevant only for preventing similar complications in other patients, not for treating your current situation.