Dominic Stone
The anal sphincter is made up of two muscles: the internal and external anal sphincter. While the internal sphincter is an involuntary muscle that stays shut, the external sphincter is a voluntary muscle that can be controlled and consciously closed more firmly. Anal incontinence, which is the release of rectal contents against one's wishes, can be treated or prevented by performing exercises that strengthen the external anal sphincter and the pelvic floor muscles.
Characteristics of Controlling Anal Muscles
| Characteristics | Values |
|---|---|
| Internal anal sphincter | An inner ring of muscle that cannot be controlled consciously |
| External anal sphincter | A voluntary muscle that can be controlled and closed firmly |
| Pelvic floor muscles | A group of muscles supporting the organs in the lower pelvis |
| Fecal incontinence | The release of rectal contents against one's wishes |
| Treatment for fecal incontinence | Sphincter repair surgery, pelvic muscle retraining, rectal sensation training, stool softeners, and fiber |
| Sphincter exercises | Squeezing and relaxing the muscles up to 10 times, 3 times a day |
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What You'll Learn
The difference between the internal and external anal sphincter
The internal and external anal sphincters have different nerve supplies, which results in different functions. The internal anal sphincter is an inner ring of muscle and is an involuntary muscle, meaning it is not under conscious control. It is composed of concentric layers of circular smooth muscle tissue and is programmed to stay shut. This is why most adults do not leak stool while they sleep.
The external anal sphincter, on the other hand, is a voluntary muscle that you can control and close more firmly. It is a short tube of skeletal muscle surrounding the inferior portion of the anal canal and is part of the pelvic floor muscles. The external sphincter is a layer of striated muscle encircling the outside wall of the anal canal and can be exercised and strengthened to help control bowel movements.
The internal anal sphincter is part of the inner surface of the anal canal, while the external anal sphincter is part of the pelvic floor muscles and is related to some muscles of the perineum. The external anal sphincter is comprised of three parts: the upper or deep part, the middle or superficial part, and the lower or subcutaneous part. The subcutaneous part surrounds the anal verge, with its most inferior fibres extending past the internal anal sphincter.
The two sphincters work together to control defecation. When the rectum is full, nerves trigger the urge to have a bowel movement, and the internal anal sphincter relaxes automatically. The external sphincter is then relaxed voluntarily to allow the passage of faeces.
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How to exercise your anal muscles
The anal sphincter is made up of two rings of muscles: the internal anal sphincter and the external anal sphincter. The internal sphincter is an involuntary muscle, meaning it functions without conscious thought, similar to the heart and diaphragm. The external sphincter, on the other hand, is a voluntary muscle that you can control and strengthen through exercise.
Exercising the anal sphincter can help treat or prevent faecal incontinence and reduce the chance of leaking stool or gas. These exercises are particularly useful for those who struggle with bowel control, a surprisingly common issue affecting 36% of adults in the United States.
To perform these exercises, find a comfortable position, either sitting, standing, or lying down, with your legs slightly apart. Squeeze the muscles of your external anal sphincter for up to 10 seconds, then relax. Repeat this up to 10 times, and then squeeze as hard as you can and relax. Do this set of exercises 3 times a day, and adjust the number of repetitions as needed.
If you are experiencing fecal incontinence due to an underlying medical condition, simply performing these exercises may not be effective. It is important to consult a healthcare provider to address any health issues and receive proper treatment. They may refer you to a physical therapist, especially if you are not seeing improvements in anal sphincter strength.
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How to know if you need medical attention
Anal muscles, also known as the anal sphincter muscles, help control bowel movements. These muscles are surrounded by two circular muscles that aid in passing stool.
Anal Fissures
Anal fissures are tears in the anal lining that can be caused by trauma, such as stretching and straining, or pre-existing conditions. They are very common, especially in infants, pregnant women, and people under 40. Symptoms include sharp pain, burning or itching, fresh blood in your stool, anal muscle spasms, and a lump on the skin near the tear. While some fissures heal quickly, others may take several weeks or months. If you suspect you have an anal fissure, it is important to seek medical advice, especially if the pain is severe or the fissure does not heal within a few weeks.
Rectal Prolapse
Rectal prolapse occurs when the rectum falls down into the anus. It is usually a gradual process due to muscle deterioration. While it is not a medical emergency, it can be upsetting. If you experience rectal prolapse, you may need to manually push your rectum back inside. Over time, the prolapse will worsen and can lead to complications such as fecal incontinence. If you are experiencing rectal prolapse, it is important to consult a healthcare provider to discuss treatment options, which may include surgery.
Fecal Incontinence
Fecal incontinence is the inability to control bowel movements and gas. It can be caused by weak anal sphincter muscles, which can occur after childbirth or with increasing age. If you are experiencing fecal incontinence, you should seek medical advice. Treatment options include natural vegetable powder, pelvic muscle retraining exercises, and in some cases, surgery.
Constipation
Constipation can be caused by the tightening of the anal sphincter muscles instead of relaxing during bowel movements. It can also be caused by hard stool in the rectum, which puts pressure on the sphincters. If you are experiencing ongoing problems with constipation, you may benefit from anorectal manometry, a test that evaluates the function of the anal sphincter muscles. Treatment options include glycerin suppositories, stool softeners, and rectal sensation training.
Hemorrhoids
Hemorrhoids are a common condition that can cause pain in the anus during sex or bowel movements. Over-the-counter treatments are usually adequate, but in some cases, surgery may be required.
Skin Irritation
The use of harsh soaps, scented towelettes, alcohol, or other disinfectants on the anal area can cause skin irritation and damage. If you experience pain or itching, it is important to seek medical attention and avoid using these products.
It is important to prioritize anal health and seek medical attention if you are experiencing any of the above symptoms or if you have concerns about your anal muscle control.
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The link between anal muscle control and incontinence
The anal sphincter is made up of two parts: the internal sphincter, which is an involuntary muscle, and the external sphincter, which is a voluntary muscle that can be controlled and closed firmly. The external sphincter is responsible for about 20% of resting anal pressure, while the internal sphincter contributes to the remaining 80%. This internal sphincter is programmed to stay shut, preventing stool leakage during sleep.
Incontinence can occur when there is a reduction in resting anal pressure. This can be caused by unilateral nerve injury, which weakens the external anal sphincter, leading to mild episodes of incontinence. More severe symptoms may result from bilateral pudendal neuropathy. Progressive muscle fibre atrophy and replacement fibrosis can occur when large areas of denervation are not compensated by re-innervation.
To prevent and treat incontinence, exercises can be performed to strengthen the anal sphincter and pelvic floor muscles. These muscles work together to help control bowel movements and prevent gas and stool leaks. Supervised pelvic floor muscle training with a physical therapist has been shown to be more effective than performing the exercises alone. Biofeedback therapy is another treatment option for minor incontinence, while major incontinence may require anal sphincter repair surgery.
It is important to consult a healthcare provider to evaluate any new health issues related to incontinence. They can perform a physical exam, assess symptoms, and recommend the appropriate course of action, which may include exercises, therapy, or surgical options.
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The pudendal nerve and its role in anal muscle control
The pudendal nerve is a mixed nerve, meaning it has both motor (control of muscles) and sensory functions. It carries sensation from the external genitalia of both sexes, the skin around the anus and perineum, and also conveys sympathetic autonomic fibres.
The pudendal nerve is the main nerve of the perineum and is responsible for supplying sensation to the penis and clitoris, as well as the anal canal and anus. It is involved in controlling somatic muscles, including the external anal sphincter, which is a voluntary muscle that can be controlled and closed firmly. This muscle can be exercised and strengthened to help control bowel movements and prevent incontinence.
The nerve branches into three parts: the inferior rectal nerve, the perineal nerve, and the dorsal nerve. The inferior rectal nerve controls the anal sphincter muscle and sends sensory information to the anal sphincter and anal canal. The perineal nerve controls the pelvic floor muscles and the urethral sphincter, providing sensory information to the perineum, labia, and scrotum. The dorsal nerve sends sensory information about touch, pleasure, pain, and temperature to the skin of the penis or clitoris, allowing for sexual pleasure and assisting in erections.
Damage to the pudendal nerve can lead to pain and affect one's ability to control bowel movements and enjoy sex. This damage can be caused by compression, stretching, or childbirth, resulting in temporary or permanent neuropathy. Pudendal nerve entrapment syndrome, also known as Alcock canal syndrome, is a rare type of nerve compression syndrome that causes severe, chronic, and disabling pain called pudendal neuralgia.
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Frequently asked questions
The anal muscles, or anal sphincters, are made up of two muscles: the internal anal sphincter and the external anal sphincter. The internal sphincter is an involuntary muscle that stays shut, preventing leaks during rest and sleep, while the external sphincter is a voluntary muscle that can be controlled and strengthened through exercise.
Controlling and strengthening the anal muscles, particularly the external sphincter, can help prevent fecal incontinence, which is the involuntary release of rectal contents. It can also help manage constipation and rectal or pelvic pain.
You can strengthen your anal muscles by performing specific exercises, such as squeezing the muscles as hard as you can and then relaxing. It is recommended to repeat this up to 10 times, 3 times a day.
The time it takes to see results may vary, but it is important to consistently practice the exercises and ensure you are performing them correctly. If you are not seeing improvement, consider seeking guidance from a healthcare professional or physical therapist with experience in pelvic floor muscle dysfunction.
In addition to exercises, biofeedback techniques can be used to help individuals learn to control their body functions. This involves electrical sensors that provide information to the healthcare provider, who can then coach the patient during exercises. In more severe cases, sphincter repair surgery may be recommended, but this depends on the health of the pudendal nerve.
