
The anal sphincter is made up of two rings of muscle: the internal sphincter, which is involuntary and cannot be consciously controlled, and the external sphincter, which is a voluntary muscle that can be controlled and closed. The external sphincter can be strengthened through exercises to help control bowel movements and prevent or treat incontinence. These exercises, such as Kegels, can be done at any time and in any position and involve squeezing the muscles as hard as you can and then relaxing. If you are experiencing leakage, it is important to consult a healthcare professional to rule out any underlying medical conditions.
How to Control the Sphincter Muscle
| Characteristics | Values |
|---|---|
| Type of Muscle | Voluntary (external anal sphincter) or involuntary (internal anal sphincter) |
| Control | The external anal sphincter can be controlled consciously |
| Exercises | Pelvic floor muscle exercises, also known as Kegel exercises, can be done to strengthen the muscles |
| How to Exercise | Squeeze the muscles as hard as you can, then relax. Repeat this up to 10 times, 3 times a day |
| Additional Information | It takes 6-12 weeks to notice a change |
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What You'll Learn

Pelvic floor muscle exercises
To identify the correct muscles, try to stop the flow of urine the next time you are about to pass water. The muscles that you tighten to stop the flow are the front parts of the pelvic floor. Alternatively, you can insert a finger into your vagina or rectum and squeeze the muscles around it as if you are trying to hold in your urine. These are the muscles you would use to prevent yourself from passing gas.
Once you have identified the correct muscles, you can perform pelvic floor exercises by slowly tightening and pulling up the pelvic floor muscles from the back towards the front. Hold the squeeze for as long as you can, up to 10 seconds, and then relax the muscles. Relax for 3 to 4 seconds before trying another pull-up. Start with 5 repetitions and gradually increase to 8 to 12. You can also try doing fast pull-ups, where you pull up the muscles quickly and tightly and then relax them immediately. Start with 5 repetitions and gradually increase to 10.
It is important to keep your breathing regular and avoid tightening your abdominal and buttock muscles during the exercises. You should also avoid making it a habit to do the exercises while urinating. Most people notice some improvement after 4 to 6 weeks, but it may take up to 3 months to see a major change. If you are not seeing improvement, you may be doing the exercises incorrectly or may have an underlying medical condition, so it is recommended to consult a healthcare professional or physical therapist.
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Anal sphincter exercises
The back passage or anus has two rings of muscle around it: the internal sphincter and the external sphincter. The internal sphincter is an involuntary muscle that stays shut at all times until you need to empty your bowels, at which point it should open automatically. The external sphincter, on the other hand, is the outer ring of muscle that you can squeeze more tightly when you need to, for example, when you have urgency or diarrhoea.
The external sphincter muscle can be exercised and strengthened to make it thicker and stronger, providing more support and potentially compressing the internal muscles to prevent leakage. To perform anal sphincter exercises:
- Squeeze the external sphincter muscles as hard as you can, then relax.
- Repeat this up to 10 times, for a total of 3 sets per day.
- If you find the exercises too difficult, start with fewer repetitions and build them up over time.
- Consistency is key; make sure to practice these exercises regularly to improve and maintain bowel control.
These exercises are particularly beneficial for individuals with faecal incontinence, those who experience leakage during strenuous activities or when lifting heavy weights, and patients preparing for a colostomy or ileostomy (stoma) reversal operation. Remember, with regular exercise, you can improve the strength and responsiveness of your external sphincter muscle, just like any other muscle in the body.
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How to identify the correct muscles
There are over 50 types of sphincter muscles in the human body, with a variety of functions. Some of the most well-known sphincters are the anal and urethral sphincters, which are responsible for regulating defecation and urination, respectively. The anal sphincter, for example, has both inner and outer muscles: the inner sphincter is involuntary and prevents stool leakage, while the outer sphincter is under conscious control and allows you to pass or hold stool.
To identify the correct muscles, it is important to understand the role and location of the specific sphincter. For instance, the anal sphincter is located at the opening of the rectum at the end of the digestive tract. The urethral sphincter, on the other hand, is found in the urinary tract and controls urine flow through the urethra.
The iris sphincter, or pupillary sphincter, is an involuntary muscle that regulates the constriction of the pupil in response to changes in light. It is composed of two sets of muscles: the iris sphincter muscles, which cause constriction, and the iris dilator muscles, which cause dilation. This sphincter is responsible for maintaining clear vision and preventing light sensitivity.
Precapillary sphincters are another type of involuntary sphincter that regulates blood flow into capillaries, the tiny blood vessels in our bodies. These microscopic sphincters ensure consistent blood flow and pressure, preventing fluid buildup and leakage that can lead to edema.
To identify the correct sphincter muscles, consider their function and location in the body. While some sphincters are easily identifiable, such as the anal and urethral sphincters, others like the precapillary sphincters are more challenging to pinpoint due to their microscopic nature. Specialized tests, such as defecography, anorectal manometry, and electromyography, can also help diagnose issues and identify the specific sphincter muscles involved.
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When to seek medical advice
If you are experiencing issues with controlling your bowel movements, you should not delay seeking medical advice. Fecal incontinence can be caused by constipation, diarrhea, muscle damage, or nerve damage, and treatment will depend on the underlying cause.
Your doctor will ask you questions about your symptoms and perform a physical and rectal exam. They may also recommend further tests to determine the cause of fecal incontinence, including:
- Anorectal manometry to study the strength of your anal sphincter muscles and their coordination with your rectum.
- Balloon expulsion test to assess how well your anal sphincter and rectum work to pass stool.
- Endorectal ultrasound or MRI to check the structure of your anal sphincter muscles and surrounding tissue.
- Pudendal nerve terminal motor latency test to measure how well the nerve that controls your anal sphincter is working.
- Anal sphincter electromyography (EMG) to determine if nerve damage is the reason your anal sphincter muscles aren't functioning properly.
- Defecography to take X-ray or MRI images of how your organs and muscles work when holding and releasing stool.
- Endoscopy to check for abnormalities in your lower digestive system that may be causing fecal incontinence.
Based on the results of these tests, your doctor will be able to recommend an appropriate treatment plan. Simple treatments such as diet changes, medicines, bowel training, and exercises to strengthen your pelvic floor muscles can improve symptoms by about 60%. In more severe cases, surgery may be recommended.
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Biofeedback techniques
Biofeedback therapy is an instrument-based learning process centred on operant conditioning. It is a conservative therapy that aims to teach people who have lost the normal automatic control of a bodily function to relearn awareness and control of that function. The goal of biofeedback therapy in defecatory disorders is to strengthen the pelvic floor muscles, retrain rectal sensation, and coordinate pelvic floor movement.
Biofeedback therapy for dyssynergic defecation consists of improving the abdominal push effort together with biofeedback technique-guided pelvic floor relaxation followed by simulated defecation and/or sensory training. This includes breathing exercises for whole-body relaxation, exercising pelvic floor muscles and the anal sphincter for strengthening and relaxing these muscles, and modifying rectal sensitivity. Biofeedback can also be used to treat conditions such as urinary incontinence, IBS, or faecal incontinence.
Biofeedback gives live feedback on the effectiveness of muscle control. A probe is inserted into the vagina or rectum to measure the effectiveness of muscle movements while the patient performs actions such as coughing, pushing, and squeezing. This live feedback can then enable the patient to improve the way they perform strengthening exercises to make them more effective. The procedure is non-invasive with a low risk of complications and is often tried before considering surgical procedures.
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Frequently asked questions
Kegel exercises, also known as pelvic floor muscle exercises, are done to strengthen the muscles that support the rectum. These exercises can be done at any time and in any position.
To do Kegel exercises, tighten the muscles of the sphincter and feel them contracting. Squeeze the muscles as hard as you can, then relax. Hold for a count of ten and then relax for a count of ten. Repeat this exercise ten times to equal one set and complete 8 to 10 sets per day.
To identify and squeeze the correct group of muscles, you can sit on the toilet and insert your well-lubricated finger into the rectum. You should also make sure not to contract your abdominal, thigh, or buttocks muscles while performing the exercise.
If you are struggling with leakage of gas or stool, it's important to talk to your healthcare provider. They can evaluate your symptoms and recommend treatments such as physical therapy or biofeedback.











































