Can pelvic‑floor (Kegel) exercises improve sexual arousal tension and pressure control in a male patient after a fistulotomy that removed the internal anal sphincter?

Can Kegel Exercises Help with Sexual Arousal Tension or Pressure After Fistulotomy?

Yes, pelvic floor (Kegel) exercises can help restore sphincter function and control after fistulotomy that removed the internal anal sphincter, and they should be initiated as soon as the surgical site permits—typically around postoperative day 10.

Evidence for Kegel Exercises After Anal Sphincter Surgery

Proven Efficacy in Post-Fistulotomy Recovery

• Fistulotomy, even for low anal fistulas, causes significant increases in gas and urge incontinence (occurring in 20% of patients), but regular Kegel exercises can restore continence to preoperative levels. 1

• When the internal anal sphincter is partially or completely divided during fistula surgery, incontinence occurs in approximately 31% of patients, with urge incontinence being the most common manifestation (affecting 24-28% of patients). 2

• Regular Kegel exercises performed 50 times daily for one year postoperatively led to complete resolution of incontinence in 50% of affected patients and partial improvement in the remaining 50%. 1

• The mean incontinence scores after sphincter division improved significantly with Kegel exercises (from 1.19 ± 1.96 to 0.26 ± 0.77, P = 0.00001), demonstrating objective measurable benefit. 2

Mechanism of Benefit

• Pelvic floor muscle training addresses multiple male genitourinary issues including stress urinary incontinence, overactive bladder, erectile dysfunction, ejaculation issues, and pelvic pain due to levator muscle spasm. 3

• Exercises performed against resistance (such as the tension/pressure you're experiencing) induce greater muscle fatigue and thus more effective strengthening than exercises without resistance. 4

Specific Exercise Protocol for Your Situation

Timing and Frequency

• Begin Kegel exercises on postoperative day 10 (once initial healing has occurred). 2

• Perform 50 repetitions daily for a minimum of one year to achieve optimal sphincter recovery. 1, 2

• Alternatively, the standard protocol involves contractions held for 6-8 seconds with 6-second rest periods, 15 repetitions per session, twice daily for 15 minutes each session, continued for at least 3 months. 5, 6

Critical Technique Requirements

• You must receive instruction from a trained pelvic floor physiotherapist or healthcare professional to ensure correct technique—this is not optional, as improper technique can worsen symptoms or fail to provide benefit. 5, 6

• Isolate only the pelvic floor muscles without contracting the abdomen, glutes, or thighs. 5

• Maintain normal breathing throughout—never hold your breath or strain to avoid the Valsalva maneuver. 6

Addressing Sexual Arousal Tension/Pressure Specifically

Why This Symptom Occurs

• The removal of your internal anal sphincter has disrupted normal pelvic floor coordination and resting tone, which can manifest as abnormal tension, pressure sensations, or difficulty with arousal-related pelvic sensations. 2

• Urge sensations (the feeling of needing to evacuate or abnormal pressure) are the most common post-sphincterotomy symptom, affecting up to 28% of patients. 2

Expected Improvement Timeline

• Most patients experience significant improvement in urge and pressure symptoms within 6 months of consistent Kegel exercise practice. 1

• Complete restoration of continence and normal sensation typically requires the full one-year exercise protocol. 1, 2

Common Pitfalls to Avoid

• Do not attempt Kegel exercises without professional instruction—up to 50% of patients perform them incorrectly when self-taught, which can worsen pelvic floor dysfunction. 5, 6

• Do not discontinue exercises prematurely—benefits plateau around 3-6 months but continued practice maintains and further improves outcomes. 5

• If you experience worsening pain or new symptoms with exercises, stop immediately and return to your pelvic floor physiotherapist for technique reassessment. 6

When to Seek Additional Help

• If you show no improvement after 6 months of supervised Kegel exercises, you may need referral to a colorectal surgeon for evaluation of additional interventions such as biofeedback therapy or surgical sphincter repair. 6

• Biofeedback therapy using anorectal probes can be added to your Kegel program if home exercises alone are insufficient, achieving success rates exceeding 70% for sphincter dysfunction. 6

• If behavioral or psychiatric factors (anxiety about sexual function, fear of incontinence during arousal) are contributing to your symptoms, concurrent counseling should be addressed. 6