Management of Post-Sphincterotomy Sensory and Sexual Dysfunction
Direct Answer
Your symptoms represent pelvic floor muscle dysfunction with neuropathic hypersensitivity following sphincter surgery, and the primary treatment is specialized pelvic floor physical therapy combined with neuropathic pain management—not additional surgery. 1
Understanding Your Condition
Your constellation of symptoms—loss of deep pelvic anchoring sensation, diminished arousal without direct stimulation, and reduced urinary awareness—stems from two mechanisms:
- Protective muscle guarding patterns that developed during your original anal fissure pain and persisted after surgery, creating chronic pelvic floor tension 1, 2
- Altered sensory processing from the surgical disruption of the internal anal sphincter, which sits in close proximity to pelvic autonomic nerve pathways 2
The internal anal sphincter is anatomically distinct from deep pelvic autonomic nerves and is confined to the superficial anal canal level 2. However, the protective guarding that develops during painful defecation creates widespread pelvic floor dysfunction that persists even after the acute problem resolves 1, 2.
Primary Treatment Protocol
Initiate pelvic floor physical therapy 2-3 times weekly with the following components 1:
- Internal and external myofascial release to address muscle tension
- Gradual desensitization exercises to retrain sensory processing
- Muscle coordination retraining to restore normal pelvic floor function
- Warm sitz baths to promote relaxation
Add topical lidocaine 5% ointment to affected areas for neuropathic pain control 1
Expected Timeline
The dysesthesia and altered sensations typically improve significantly over 6-12 months with appropriate pelvic floor therapy and neuropathic pain management 1. This is not a quick fix, but the prognosis for meaningful improvement is good with consistent therapy.
Critical Warnings
Do not pursue additional surgical interventions. Further surgery would likely worsen the neuropathic component rather than improve it 1. The surgical damage is done, and the path forward is rehabilitation, not revision.
Manual anal dilatation is absolutely contraindicated due to unacceptably high incontinence rates (30% temporary, 10% permanent) 3, 2.
Context on Your Surgery
Lateral internal sphincterotomy, while effective for fissure healing (96% success rate), carries a 45% risk of some degree of fecal incontinence at some point postoperatively, though most episodes are minor and transient 4. Your specific symptoms of altered sexual and urinary sensation are less commonly reported but represent a recognized complication pattern 1.
The low transphincteric fistulotomy adds complexity, as it involves the external sphincter and can contribute to altered pelvic floor mechanics 5.
Sexual Function Considerations
Sexual dysfunction after pelvic surgery relates to both anatomical changes and psychoemotional factors 5. Your difficulty with arousal without direct stimulation suggests altered sensory processing rather than complete nerve damage, which is why rehabilitation therapy targeting sensory retraining is appropriate 1.
Specialist Referral
Seek evaluation by a pelvic floor physical therapist experienced in post-surgical male pelvic dysfunction and consider consultation with a colorectal surgeon or pelvic floor specialist if symptoms do not improve after 6-8 weeks of appropriate therapy 3. These specialists can assess for structural complications and coordinate multidisciplinary care.
Alternative for Future Reference
For others considering fissure treatment: 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 1, 2. This information comes too late for your situation but is important for informed decision-making in similar cases.