After four years of chronic anal sphincter guarding and recent anorectal surgeries (hemorrhoidectomy, fissurectomy, lateral sphincterotomy, and fistulotomy performed ten months ago), should I have periods of sphincter relaxation, or is continuous tension normal?

Continuous Anal Sphincter Tension After Surgery is Abnormal and Requires Treatment

You should NOT have continuous tension in your anal sphincter—there should be periods of complete relaxation, and your persistent guarding after 10 months post-surgery represents pathological sphincter dysfunction that requires biofeedback therapy. 1

Understanding Normal vs. Abnormal Sphincter Function

In healthy individuals, the internal anal sphincter maintains baseline resting tone but undergoes regular transient relaxations (4-6 per hour) accompanied by rectal pressure changes 2. Your chronic guarding pattern—where you've "forgotten what not being in tension feels like"—represents sustained internal sphincter hypertonia, which is pathological.

What Your Surgery Should Have Accomplished

Your lateral sphincterotomy was specifically designed to reduce internal sphincter hypertonia 2, 3. Research shows that:

• Normal post-sphincterotomy recovery: Resting anal pressure should decrease significantly within 1-3 months and stabilize by 6-12 months 3, 4
• Expected outcome: Internal sphincter relaxations should increase from 1 per hour (pre-surgery) to 4 per hour (post-surgery) 2
• At 10 months post-surgery, your sphincter should have periods of relaxation, not continuous tension

Why You Still Have Continuous Tension

Your persistent guarding likely represents one of two problems:

1. Learned voluntary guarding: Four years of chronic pain created a habitual pattern where you're unconsciously contracting your external anal sphincter and pelvic floor muscles continuously
2. Incomplete resolution of internal sphincter hypertonia: Though less likely after sphincterotomy, some patients maintain elevated baseline tone 3

The fact that you cannot identify periods without tension strongly suggests voluntary/learned guarding behavior overlaying any residual sphincter issues.

Your Treatment Path: Biofeedback Therapy is Essential

Biofeedback therapy is the evidence-based treatment of choice for your situation 1, 5. This is not optional—it's the standard of care for pelvic floor dysfunction and dyssynergic patterns.

What Biofeedback Will Do

• Retrain your awareness: You'll learn to consciously identify and release the chronic guarding pattern
• Restore normal function: 70-80% of patients with dyssynergic defecation achieve significant improvement 1
• Provide real-time feedback: Simultaneous monitoring of abdominal push effort, anal relaxation, and pelvic floor activity helps you relearn normal patterns 1

How to Access This Treatment

1. Request anorectal manometry (ARM): This diagnostic test will objectively measure your sphincter pressures and identify the specific dysfunction pattern 1
2. Get referred to a specialized provider: Look for:
   • Pelvic floor physical therapist with biofeedback equipment
   • Gastroenterologist or colorectal surgeon who performs biofeedback
   • Academic medical centers typically have these services 1
3. Expect 4-6 sessions: Most protocols involve weekly sessions over 1-2 months

Critical Pitfalls to Avoid

• Don't accept "this is normal after surgery": Continuous tension 10 months post-operatively is NOT normal
• Don't delay treatment: Four years of chronic guarding creates deeply ingrained patterns that become harder to reverse over time
• Don't assume you can fix this alone: Conscious relaxation attempts without biofeedback feedback are usually ineffective because you've lost the sensory reference for what "relaxed" feels like

Bottom Line

Your inability to remember what relaxation feels like is a red flag for chronic pelvic floor dysfunction requiring professional intervention. The surgeries addressed the structural/pressure issues, but you need biofeedback therapy to address the learned behavioral component. This is a standard, well-established treatment pathway with high success rates when properly implemented 1, 5.