In a 38‑year‑old man who underwent a lateral internal sphincterotomy (with hemorrhoidectomy and fissurectomy) three years ago and a subsequent low trans‑sphincteric fistulotomy revision, why is the loss of his deep‑pelvic “anchor” sensation for sexual arousal and urinary perception greater than a simple diminution, and what amount of internal anal sphincter resting pressure is typically lost after such a sphincterotomy?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 20, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Post-Sphincterotomy Sexual and Urinary Sensory Loss

Direct Answer

Your complete loss (not just diminution) of the deep pelvic "anchor point" sensation for arousal and urinary perception is most likely caused by neuropathic dysesthesia and chronic pelvic floor muscle guarding rather than the mechanical loss of internal anal sphincter pressure itself, and you should immediately begin specialized pelvic floor physical therapy 2-3 times weekly with internal myofascial release. 1

Understanding the Pressure Loss vs. Your Symptoms

Actual Sphincter Pressure Changes

  • Lateral internal sphincterotomy typically reduces resting anal pressure from approximately 138 mm Hg pre-operatively to 86 mm Hg at one month, which then gradually recovers to a plateau of 110 mm Hg by 12 months—representing a permanent 20% reduction in baseline pressure. 2

  • This 20% pressure reduction is not sufficient to explain your complete loss of sensation, because patients with this degree of pressure loss typically maintain continence and do not report the profound sensory changes you describe. 2

  • Your confusion about why the "anchor" is completely gone rather than diminished is valid—the mechanical pressure loss alone should only create a partial reduction in stretch sensation, not complete absence. 1

Why Your Symptoms Are Disproportionate

The key insight is that your symptoms represent neuropathic pain and dysesthesia, not structural sphincter damage. 1, 3

  • Patients like you typically have preserved sphincter integrity and continence (which you do), but experience altered sensations rather than mechanical problems—this is the hallmark of neuropathic dysesthesia following anorectal surgery. 1

  • The second fistulotomy and revision for granulation likely worsened the neuropathic component, explaining why your symptoms became "more profound" after that procedure. 1

  • Your pelvic floor muscles developed protective guarding patterns during the painful fissure period that persist even after surgical healing, and these chronic muscle tension patterns are now blocking the sensory pathways you relied on for arousal. 1, 4

Why the Pudendal Test Doesn't Rule This Out

  • Passing the pudendal neuralgia pin-prick test does not exclude neuropathic dysesthesia or myofascial dysfunction—you can have altered sensory processing and muscle tension without acute nerve damage detectable by pin-prick testing. 1

  • The absence of acute pain actually supports the diagnosis of dysesthesia rather than ongoing tissue injury. 1

Treatment Algorithm (What You Must Do Now)

First-Line Treatment (Start Immediately)

  • Specialized pelvic floor physical therapy 2-3 times weekly focusing on:

    • Internal and external myofascial release
    • Gradual desensitization exercises guided by the therapist
    • Muscle coordination retraining to reduce the protective guarding patterns
    • Warm sitz baths for muscle relaxation 1, 4

  • Topical lidocaine 5% ointment applied to affected areas for neuropathic pain management. 1, 4

Expected Timeline

  • Dysesthesia and altered sensations typically improve significantly over 6-12 months with appropriate pelvic floor therapy and neuropathic pain management. 1, 4

  • The absence of incontinence or structural damage is favorable and suggests better potential for improvement with conservative management. 1

Critical Pitfalls to Avoid

  • Do not pursue additional surgical interventions—this would likely worsen the neuropathic component rather than restore your sensation. 1, 3, 4

  • Do not assume that because some sphincter pressure remains, the "anchor" sensation should automatically be present—the problem is not the amount of pressure but rather how your nervous system and pelvic floor muscles are processing (or blocking) that sensory information. 1

  • Recognize that your reliance on a specific "anchor point" for arousal may have been disrupted not by pressure loss but by altered sensory pathways and chronic muscle tension that developed during years of painful defecation and multiple surgeries. 1, 4

Why This Happened to You Specifically

  • The combination of three years of difficult healing with constipation after the first surgery, followed by a fistulotomy requiring revision, created a prolonged period of pelvic floor guarding that became neurologically ingrained. 1, 4

  • Your brain's sensory map of the pelvic region has been altered by chronic pain and protective muscle patterns, not by the 20% mechanical pressure loss from sphincterotomy. 1

  • The urinary bluntness that appeared after the fistulotomy revision confirms this is a broader pelvic floor neuromuscular problem, not isolated to the anal sphincter mechanism. 1

References

1
Guideline

Pelvic Floor Physical Therapy for Post-Surgical Sexual Dysfunction

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Lateral Internal Sphincterotomy: Impact on Anal Sexual Function vs Continence

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Guideline

Pelvic Floor Physical Therapy for Post-Lateral Sphincterotomy Oversensitivity

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Related Questions

What is the expected change in rectal sensation after lateral sphincterotomy in a patient with a history of anal fissure and grade 3 hemorrhoids, and will it improve to baseline levels assuming no incontinence issues?
In an adult male who underwent a lateral internal sphincterotomy and trans‑sphincteric fistulotomy and now has persistent loss of anal pressure sensation despite partial improvement with diazepam and severe catastrophizing and panic attacks, would gluteal‑muscle massage be helpful to restore sensation or reduce anxiety?
What are the likely causes and recommended management for loss of deep pelvic sensation affecting sexual arousal and urinary perception in a 38‑year‑old man after lateral internal sphincterotomy, hemorrhoidectomy, fissurectomy, and low trans‑sphincteric fistulotomy with normal pudendal nerve testing?
What treatment options are available for a 37-year-old male, 3 years post-hemorrhoidectomy, fissurectomy, and lateral sphincterotomy, and 6 months post-fistulotomy, experiencing sexual dysfunction, discomfort, and urination sensation problems?
Why does a 38‑year‑old male, after lateral sphincterotomy, hemorrhoidectomy, fissurectomy and a low transphincteric fistulotomy (resting internal anal sphincter pressure reduced from ~138 to ~110 mm Hg), experience complete loss of deep‑pelvic “anchor” sensation for sexual arousal and bladder fullness, and does differentiating loss of internal anal sphincter tone from guarding affect his management?
In a term infant weighing 3.16 kg with neonatal abstinence syndrome, is an oral morphine sulfate dose of 0.06 mg/kg every 3 hours appropriate, and what total milliliters per day should be administered based on the solution concentration?
What is the appropriate treatment for acute bronchitis in an otherwise healthy adult?
Is serum calcitonin mildly elevated as a normal physiologic adaptation during uncomplicated pregnancy?
Is ibuprofen (Brufen) appropriate for treating inflammatory myopathies such as polymyositis or dermatomyositis?
Does thyrotropin‑releasing hormone (TRH) increase during pregnancy?
What is the appropriate evaluation and management for a tendon (ganglion) cyst?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question