Can Pelvic Floor Therapy Restore Sexual Sensation After Sphincter Surgery?
Yes, specialized pelvic floor physical therapy can significantly improve sensory dysregulation and restore sexual function after lateral sphincterotomy and fistulotomy, with expected improvement over 6-12 months. 1, 2
Understanding Your Specific Problem
Your loss of pelvic sensation and sexual arousal stems from neuropathic dysesthesia and myofascial dysfunction rather than permanent structural sphincter damage. 1, 3 This is a critical distinction because:
- You have preserved continence, indicating intact sphincter integrity 1, 2
- The problem is altered sensations rather than mechanical failure 1, 3
- Pelvic floor muscle tension developed after surgery and contributes to the sensory changes 1, 2
- Protective guarding patterns from the painful pre-surgical period persist even after healing 1, 2
Why Pelvic Floor Therapy Works for This
Pelvic floor physical therapy is the primary recommended treatment because it directly addresses the neuropathic and myofascial components causing your sensory problems. 1 The therapy works through:
- Internal and external myofascial release to reduce muscle tension 1, 2
- Gradual desensitization exercises that retrain sensory pathways 1, 2
- Muscle coordination retraining to eliminate protective guarding 1, 2
- Biofeedback therapy that enhances rectal sensory perception and restores normal function 4
Your Treatment Protocol
Start immediately with this specific regimen:
- Specialized pelvic floor physical therapy 2-3 times weekly focusing on internal and external myofascial release 1, 2
- Topical lidocaine 5% ointment to affected areas for neuropathic pain control 1, 2
- Gradual desensitization exercises guided by your physical therapist 1, 2
- Warm sitz baths to promote muscle relaxation 1, 2
- Home exercises integrated between sessions 5
The physical therapist must use anorectal probe placement with a rectal balloon to provide feedback regarding dynamic changes during simulated activities. 4 This is essential for retraining sensory pathways relevant to sexual function.
Expected Timeline and Prognosis
Your dysesthesia and altered sensations typically improve significantly over 6-12 months with appropriate pelvic floor therapy and neuropathic pain management. 1, 2 The absence of incontinence or structural damage is favorable and suggests better potential for improvement with conservative management. 1
Success rates for pelvic floor rehabilitation in similar conditions range from 50-80%. 6, 7 Biofeedback therapy improves symptoms in more than 70% of patients with pelvic floor dysfunction. 4
Critical Mistakes to Avoid
Do not pursue additional surgical interventions - this would likely worsen the neuropathic component rather than improve it. 1, 2, 3 Your problem requires physical therapy, not surgical revision, because the dysfunction is neuropathic/myofascial rather than mechanical sphincter failure. 3
Avoid manual anal dilatation entirely - it carries a 30% temporary and 10% permanent incontinence rate. 2, 3
Finding the Right Provider
Seek a pelvic floor physical therapist specifically trained in anorectal disorders, not just urinary dysfunction. 4 The therapist must have equipment that provides feedback regarding changes in abdominal and rectal push effort simultaneously with changes in anal and pelvic floor relaxation. 4
The success depends on provider competency and your commitment to completing all sessions. 4 Most protocols involve 8-10 sessions at one-week intervals with integration of home exercises. 5
Additional Supportive Measures
Behavioral modifications and lifestyle adjustments are important adjuncts. 5 Pelvic floor rehabilitation can improve sexual dysfunction, dyspareunia, and pelvic floor myofascial pain when combined with supplemental modalities. 8
Rectal sensory training using serial balloon inflation can enhance sensory perception. 4 This directly addresses your complaint of missing sensation by retraining sensory pathways through operant conditioning principles. 4