Dominic Stone
The anal sphincter is a band of muscles that surrounds the entrance of the anus and controls bowel movements. It is divided into two rings of muscles: the internal anal sphincter, which is involuntary and stays shut to hold stool in the body, and the external anal sphincter, a voluntary muscle that can be consciously controlled and closed more firmly. Weakness in these muscles can lead to faecal incontinence or leakage, which is a common problem affecting 36% of adults in the United States. Strengthening the anal sphincter muscles through specific exercises like Kegels can help treat incontinence and reduce the chance of leaking.
| Characteristics | Values |
|---|---|
| Anal sphincter muscles | Made up of thick bands of muscle that surround the entrance of the anus |
| Control | Involuntary internal muscle and voluntary external muscle |
| Kegel exercises | Consciously squeeze the anus and pelvic floor muscles, hold for three seconds, release and repeat |
| Physiotherapy | Strengthening exercises and biofeedback techniques |
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What You'll Learn
Kegel exercises
These exercises can be done in any position—sitting, standing, or lying down—and at any time of day. They are discreet and can be practiced while working, driving, or even waiting at a traffic light. No one needs to know you're exercising your pelvic floor! It may be challenging to contract these muscles initially, but with consistent practice, you will notice an improvement in muscle tone and bowel control within a few months.
To ensure you are performing the Kegel exercises correctly, it is crucial to identify the correct group of muscles. One method is to sit on a toilet and insert a well-lubricated finger into the rectum. Then, tighten the sphincter muscles and feel them contracting around your finger. Additionally, you should feel the pelvic floor muscles lifting if you are doing the exercise correctly.
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Physiotherapy
The anus has two rings of muscles—the internal anal sphincter and the external anal sphincter. The external sphincter is a voluntary muscle that can be exercised and strengthened to help control bowel movements.
To locate your sphincter muscles, pretend that you are trying to hold in a bowel movement or prevent yourself from passing wind. You should now feel the muscles around your anus start to tighten. Consciously squeeze these muscles and hold for up to 10 seconds, then relax. Repeat this up to 10 times. Next, squeeze the muscles as hard as you can and then relax. Repeat this up to 10 times. Try to do each of these sets of exercises 3 times a day.
In addition to physiotherapy, other treatments for anal incontinence include diet changes, medication, and surgery.
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Biofeedback techniques
Biofeedback therapy is an instrument-based learning process centred on operant conditioning. It uses computer graphs, audible tones, and visual or verbal feedback to help you understand and control your body functions. The goal of biofeedback therapy for defecatory disorders is to strengthen the pelvic floor muscles, retrain rectal sensation, and coordinate pelvic floor muscles during evacuation.
During anorectal biofeedback training, a well-trained gastroenterologist inserts a small anal probe through the rectum. The images obtained from this probe indicate the pressure patterns of the rectal sphincter muscles, which are then analysed and displayed on a screen. This helps patients learn and memorise proper techniques to achieve appropriate bowel movements.
Biofeedback therapy can be used to treat constipation, chronic constipation, and fecal incontinence. It can also be used to help women learn to control and strengthen the pelvic floor muscles, which can improve bladder control. The average number of sessions is four, but more or fewer may be needed, and visits are typically scheduled every two to three weeks. It's important to practice pelvic floor exercises at home as well, as biofeedback is a learning tool.
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Electrical stimulation
Anorectal electro-stimulation (ARES) is a form of electrical stimulation that has been shown to positively affect the functionality of treated patients. However, the specific effects of ARES on the structural tissues of the anorectal segment are still unknown.
A 2015 study found that a combination of pelvic floor physical therapy and biofeedback improved results for patients with bowel incontinence. Adding electrical stimulation (sacral nerve stimulation) to these two therapies further improved results.
In a study on rats, it was found that ARES increased the widths of the mucosal, submucosal, and muscle layers of the rectum. It also caused hyperplasia of the smooth muscle of the internal anal sphincter and hypertrophy of the external anal sphincter muscle.
The procedure for electrical stimulation involves placing the patient in the supine position and inserting an electro-stimulator probe into the anus. The probe is pre-lubricated with conductive gel. The patient is then subjected to multiple sessions of electro-stimulation, with a short rest in between.
Sacral nerve stimulation, a type of electrical stimulation, involves implanting a small device (a neurotransmitter) under the skin in the upper buttock area. The device then sends mild electrical impulses through a lead positioned close to a nerve in the lower back (the sacral nerve), positively influencing the rectal sphincters and pelvic floor muscles.
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Voluntary vs involuntary muscles
The human body is composed of various muscles, including voluntary and involuntary muscles, which work together to facilitate movement and essential bodily functions. Voluntary muscles, such as the biceps, triceps, and quadriceps, are responsible for the movement of body parts and locomotion. These muscles exhibit rapid contraction and relaxation but require regular rest as they fatigue quickly. They are controlled by the somatic nervous system and are attached to bones and skin.
In contrast, involuntary muscles, like the cardiac and smooth muscles, are found in the internal organs, including the heart, intestines, stomach, and blood vessels. These muscles are responsible for vital functions like pumping blood throughout the body, aiding digestion by pushing food molecules through the alimentary canal, and maintaining proper blood circulation. Involuntary muscles contract and relax slowly and at regular intervals, allowing them to work continuously without tiring easily.
The primary distinction between these muscle types lies in their control and function. Voluntary muscles are under conscious control, allowing deliberate movement of the body. On the other hand, involuntary muscles, as the name suggests, are not under conscious control and often work automatically to maintain essential bodily functions. Their actions are governed by the autonomic nervous system.
While voluntary muscles are composed of long, multinucleated cells with sarcomeres arranged in bundles, involuntary muscles, such as cardiac muscles, are striated and branched. Cardiac muscles, composed of cardiomyocytes, have a unique structure and function, generating their nerve stimulus internally. This results in the electrical stimulation that causes the release of calcium ions, leading to muscle contraction.
Understanding the differences between voluntary and involuntary muscles provides insight into the body's complex muscular system, which is responsible for various functions, from movement and posture to the circulation of blood. The interplay between these muscle types ensures the body's overall functionality and adaptability to different physical demands and physiological needs.
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Frequently asked questions
The anal sphincter is a band of muscles that surrounds the entrance of the anus. It has two rings of muscles—the internal anal sphincter and the external anal sphincter.
The anal sphincter is in charge of holding the stool inside the body until one is ready to have a bowel movement.
Bowel incontinence, or faecal incontinence, is a common problem that occurs when you leak stool or gas. This can happen during exercise or when coughing or sneezing.
You can perform Kegel exercises, which involve squeezing your anus and pelvic floor muscles as if you were trying to stop urinating midstream. Hold for three seconds, release gently, and repeat up to 10-15 times.
Yes, physiotherapy treatments can help improve symptoms through strengthening exercises and biofeedback techniques to make the external sphincter thicker and stronger. Electrical stimulation is another therapy used to treat faecal incontinence.
