What treatment options are available for a patient with a history of fissurectomy and lateral sphincterotomy, who 3 years post-surgery, still experiences heightened sensitivity in the affected anal area, to quiet the area, promote normal sensations, or potentially train an adjacent area to achieve the same arousal?

Management of Persistent Heightened Sensitivity Following Fissurectomy and Lateral Sphincterotomy

For persistent heightened sensitivity 3 years post-fissurectomy and lateral sphincterotomy, biofeedback therapy (BT) represents the most evidence-based approach to retrain sensory perception and potentially restore more normal sensations in the affected area. 1

Understanding the Clinical Problem

The persistent heightened sensitivity you're experiencing represents rectal hypersensitivity, a recognized anorectal sensory disorder that can be specifically addressed through therapeutic interventions. 1 This is not simply scar tissue pain—it's an alteration in sensory processing that can be modified through targeted therapy.

Why This Occurs Post-Surgery

• Lateral internal sphincterotomy permanently alters sphincter anatomy and can affect local nerve pathways, potentially creating areas of altered sensation that persist long-term 1
• The surgical site may have developed neuroplastic changes where sensory signals are amplified or misinterpreted by the nervous system 1
• This is distinct from acute post-surgical pain and represents a chronic sensory adaptation that requires specific retraining approaches 1

Primary Treatment Recommendation: Biofeedback Therapy

Biofeedback therapy specifically treats rectal hypersensitivity through sensory adaptation training, which can normalize heightened sensory perception in the affected area. 1

How Biofeedback Works for Your Situation

• BT uses visual or audible feedback to help you consciously modulate sensory perception in the anorectal region 1
• Sensory adaptation training specifically addresses rectal hypersensitivity by gradually desensitizing the area through controlled exposure and retraining 1
• The therapy enhances rectal sensory perception control and can restore more normal sensory thresholds 1
• This represents operant conditioning—you're literally retraining how your nervous system processes signals from that area 1

Expected Outcomes

• BT demonstrates effectiveness in 70-80% of patients with anorectal sensory disorders 1
• Patients with lower baseline sensory thresholds (which you likely have given your heightened sensitivity) are more likely to respond favorably to BT 1
• Treatment typically requires multiple sessions over several weeks to months 1

Accessing Biofeedback Therapy

• Requires referral to a specialized pelvic floor physical therapy center or gastroenterology motility lab that offers anorectal biofeedback 1
• Initial anorectal manometry (ARM) testing may be performed to objectively document your sensory abnormalities and guide therapy 1
• The therapy is instrument-based and requires specialized equipment and trained therapists 1

Adjunctive Pharmacologic Options

While biofeedback addresses the underlying sensory dysfunction, topical agents may provide symptomatic relief:

Topical Anesthetic Application

• Compounded 0.3% nifedipine with 1.5% lidocaine cream applied to the affected area can provide local anesthesia and reduce any residual sphincter hypertonicity that may be contributing to sensitivity 2, 3, 4
• The lidocaine component provides direct sensory nerve blockade while nifedipine promotes local blood flow 3, 4
• Apply three times daily for at least 6 weeks, with pain relief typically occurring after 14 days 2, 3

Important Caveat

• Avoid hydrocortisone beyond 7 days as it causes perianal skin thinning and atrophy, which could worsen your situation 2, 3, 4

Regarding "Training an Adjacent Area"

Your question about training an adjacent area for arousal is clinically astute and aligns with neuroplasticity principles:

• The same biofeedback therapy that addresses hypersensitivity can theoretically be adapted to enhance sensory awareness in adjacent areas 1
• Sensory retraining through BT has been shown to modify rectal sensory perception, and this principle could extend to redistributing sensory focus 1
• However, no specific published protocols exist for intentionally training adjacent erogenous zones in this context—this would require working with a therapist experienced in pelvic floor BT who understands your specific goals 1
• The nervous system demonstrates remarkable plasticity, and conscious sensory retraining through biofeedback represents the most evidence-based approach to achieving this type of neuroplastic change 1

What Will NOT Work

Based on the evidence, avoid these approaches:

• Manual anal dilatation is absolutely contraindicated due to 10-30% permanent incontinence rates 1, 4, 5
• Repeat surgical intervention (another sphincterotomy) would likely worsen sensory issues and carries additional incontinence risk 1
• Simple topical treatments alone (without biofeedback) are unlikely to address the underlying sensory dysfunction after 3 years 1, 2

Critical Next Steps

1. Request referral to a pelvic floor physical therapy center or gastroenterology motility lab that offers anorectal biofeedback therapy 1
2. Undergo anorectal manometry testing to objectively document your sensory abnormalities and establish baseline measurements 1
3. Initiate structured biofeedback therapy with a therapist experienced in treating anorectal sensory disorders 1
4. Consider trial of compounded nifedipine/lidocaine cream for symptomatic relief during the biofeedback therapy course 2, 3, 4

The key insight is that your persistent heightened sensitivity represents a treatable sensory disorder, not permanent structural damage, and biofeedback therapy offers the most evidence-based approach to sensory retraining and potential restoration of more normal sensations.