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?

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.

Gluteal Massage for Post-Sphincterotomy Sensory Loss and Anxiety

Gluteal massage alone will not restore anal sensation, but comprehensive pelvic floor physical therapy—including both internal anal work and external gluteal myofascial release—combined with continued anxiolytic support represents the evidence-based treatment for your post-surgical sensory changes and catastrophizing. 1

Understanding Your Sensory Problem

  • The altered sensations you're experiencing after lateral internal sphincterotomy and fistulotomy are primarily neuropathic dysesthesia and pelvic floor muscle tension, not structural sphincter damage, since your continence remains intact 1, 2
  • Protective guarding patterns that developed during your painful fissure period persist even after surgery, creating ongoing muscle tension that interferes with normal sensation 1
  • Your partial response to diazepam confirms that muscle tension is a significant contributor—the medication relaxes the external anal sphincter and pelvic floor muscles, temporarily improving sensation 1

Why Gluteal Massage Alone Is Insufficient

  • Internal anal sphincter dysfunction and impaired rectal sensory feedback cannot be adequately treated with external pelvic-floor techniques alone; internal therapy is required 1
  • While gluteal muscle tension contributes to the problem, the primary issue involves the internal anal canal structures that cannot be reached by external massage 1
  • Biofeedback therapy specifically targets rectal sensation, tolerance of rectal distention, and coordination of the internal sphincter, which necessitates internal assessment and treatment 1

Evidence-Based Treatment Algorithm

First-Line: Specialized Pelvic Floor Physical Therapy

  • Initiate pelvic floor physical therapy 2-3 times weekly with a therapist experienced in post-anorectal surgery rehabilitation 1, 2
  • The therapy must include both internal and external components: 1
    • Internal myofascial release of the anal sphincter complex
    • External myofascial release of the gluteal muscles (this addresses your massage idea)
    • Gradual desensitization exercises
    • Muscle coordination retraining
    • Biofeedback using electronic devices to improve pelvic-floor sensation and contraction 1

Adjunctive Measures

  • Continue warm sitz baths several times daily to promote muscle relaxation 1, 2
  • Apply topical lidocaine 5% ointment to affected areas for neuropathic pain control 1, 2
  • Continue diazepam or similar anxiolytic as prescribed by your physician, since it's providing partial benefit and addresses both the muscle tension and catastrophizing 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
  • Improvement is gradual, not immediate—this timeline is important for managing your catastrophizing tendencies 1

Critical Pitfalls to Avoid

  • Do not pursue additional surgical interventions, as this would likely worsen the neuropathic component rather than improve it 1, 2
  • Avoid manual anal dilatation entirely, as it carries a 30% temporary and 10% permanent incontinence rate 1, 3
  • Do not rely on external massage alone—you must have internal pelvic floor work to address the root cause 1
  • Do not stop therapy prematurely—sensory recovery takes 6-12 months, and stopping at 2-3 months will leave you with persistent symptoms 1

Managing Your Catastrophizing

  • Your severe catastrophizing and panic attacks are both a consequence of the sensory changes and a barrier to recovery 1
  • The combination of physical therapy (which provides tangible improvement) and continued anxiolytic medication addresses both the physical and psychological components 1
  • Consider adding cognitive-behavioral therapy specifically for health anxiety if catastrophizing persists despite physical improvement 1

Why This Happened

  • Lateral internal sphincterotomy causes a permanent reduction in resting anal sphincter pressure—your pressure dropped from approximately 138 mmHg pre-surgery to around 110 mmHg at one year, which remains higher than normal controls (73 mmHg) but lower than your baseline 4
  • The sensory changes you're experiencing are common but underrecognized complications of sphincterotomy, affecting up to 45% of patients at some point post-operatively, though most cases are transient 5
  • Your fistulotomy added additional trauma to the sphincter complex, compounding the sensory disruption 6

Bottom Line

Schedule an appointment with a pelvic floor physical therapist who has experience with post-anorectal surgery patients—this is non-negotiable for your recovery. 1 The gluteal massage you're considering should be incorporated as the external component of a comprehensive program that must include internal anal work. Continue your diazepam as prescribed, and prepare for a 6-12 month recovery timeline. 1

References

1
Guideline

Pelvic Floor Physical Therapy for Post-Lateral Sphincterotomy Oversensitivity

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Lateral Internal Sphincterotomy: Impact on Anal Sexual Function vs Continence

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Anal Fissure Treatment Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Related Questions

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?
In a 38‑year‑old male who underwent a 1 cm lateral internal sphincterotomy (with hemorrhoidectomy and fissurectomy) and later a low transphincteric fistulotomy, how much resting internal anal sphincter pressure is typically lost, explaining the loss of the deep pelvic “anchor‑point” sensation during sexual arousal?
In a 38‑year‑old man who underwent a lateral internal anal sphincterotomy (with hemorrhoidectomy, fissurectomy and low trans‑sphincteric fistulotomy) and now reports loss of deep‑pelvic “anchor” sensation and blunted urinary sensation, how much resting internal anal sphincter pressure is typically lost, and does this loss represent loss of passive IAS tone rather than a guarding contraction?
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?
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?
In an asymptomatic adult aged 40‑75 with intermediate 10‑year atherosclerotic cardiovascular disease (ASCVD) risk (5‑20%), is it recommended to obtain a coronary calcium (CAC) score every few years as routine screening?
Which artery is most commonly occluded in a patient presenting with unilateral facial asymmetry and weakness of the arm and leg?
What dose of intravenous sodium bicarbonate should be given to a 70‑kg adult with severe metabolic acidosis (arterial pH < 7.1, bicarbonate < 10 mmol/L) and how should repeat dosing and monitoring be performed?
Are routine blood tests automatically performed on every emergency department patient regardless of presentation?
What is the recommended acute and long‑term treatment plan for gout, including medication choices, dosing, and lifestyle measures?
Which medications should be started or avoided for a patient with a moderately enlarged prostate (~4 cm, volume ~39 cc) showing intraparenchymal calcification and no focal lesion?

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