Persistent Hypersensitivity Three Years Post-Fissurectomy and Lateral Sphincterotomy
Yes, hypersensitivity three years after fissurectomy and lateral sphincterotomy is a recognized complication, particularly in patients who have not received pelvic floor treatment, and represents neuropathic dysesthesia rather than structural sphincter damage that requires specialized biofeedback therapy rather than additional surgery. 1, 2
Understanding the Clinical Problem
The hypersensitivity you're experiencing is primarily neuropathic pain and dysesthesia, not structural sphincter damage, which explains why it persists despite intact continence 2, 3
Protective guarding patterns that developed during the painful fissure period commonly persist even after surgical healing, creating ongoing pelvic floor muscle tension that manifests as altered sensations 2, 3
The absence of pelvic floor treatment is a critical gap—patients with altered sensations after lateral internal sphincterotomy typically have intact continence and preserved sphincter integrity, but require specific rehabilitation to resolve sensory abnormalities 2
Primary Treatment: Biofeedback Therapy
Biofeedback therapy specifically treats rectal hypersensitivity through sensory adaptation training and represents the most evidence-based approach, with demonstrated effectiveness in 70-80% of patients with anorectal sensory disorders. 1
The American Gastroenterological Association recognizes rectal hypersensitivity as a treatable anorectal sensory disorder that can be addressed through therapeutic interventions such as biofeedback therapy 1
Request referral to a pelvic floor physical therapy center or gastroenterology motility lab that offers anorectal biofeedback therapy 1
Undergo anorectal manometry testing to objectively document sensory abnormalities and establish baseline measurements before starting treatment 1
Adjunctive Pelvic Floor Physical Therapy
Initiate pelvic floor physical therapy 2-3 times weekly with internal and external myofascial release, gradual desensitization exercises, and muscle coordination retraining 2, 3
Warm sitz baths promote muscle relaxation and reduce symptoms 2, 3
The dysesthesia and altered sensations typically improve significantly over 6-12 months with appropriate pelvic floor therapy and neuropathic pain management 2
Pharmacologic Adjuncts
Topical lidocaine 5% ointment can be applied to affected areas for neuropathic pain control 2, 3
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 1
Critical Pitfalls to Avoid
Do not pursue additional surgical interventions—this would likely worsen the neuropathic component rather than improve it. 1, 2, 3
Manual anal dilatation is absolutely contraindicated due to 10-30% permanent incontinence rates 1, 2, 3
Repeat sphincterotomy would likely worsen sensory issues and carries additional incontinence risk 1
The distinction between your symptoms being neuropathic/myofascial rather than mechanical sphincter failure is crucial—this requires physical therapy and biofeedback rather than surgical revision 3
Why This Happens
Lateral internal sphincterotomy has wound-related complications including non-healing wounds in up to 3% of patients, but the sensory complications are often underrecognized 4
Recent research suggests that hypersensitivity of contact receptors and overreaction of the anal-external sphincter continence reflex may contribute to persistent symptoms even after sphincterotomy 5
The external anal sphincter, rather than the internal sphincter, may be responsible for ongoing symptoms through spasm and protective guarding 5