Logan Steele
The anal sphincter is made up of two rings of muscles: the internal and external sphincter. The internal sphincter is involuntary and stays shut at all times until you need to empty your bowels, while the external sphincter is a voluntary muscle that you can control and squeeze more tightly when you need to. Anal sphincter exercises can help treat bowel incontinence and reduce the chance of leaking stool or gas. These exercises aim to strengthen the external sphincter muscle to make it thicker and stronger, providing more support and potentially compressing the internal muscles to prevent leakage.
How to Train Anus Muscles
| Characteristics | Values |
|---|---|
| Reason | To treat or prevent incontinence, bowel leakage, or wind |
| Muscle location | Two rings of muscles around the anus: internal and external sphincter muscles |
| Internal sphincter | An involuntary muscle that stays shut at all times until needing to empty the bowel; cannot be strengthened by exercise |
| External sphincter | A voluntary muscle that can be exercised and strengthened to control bowel movements |
| Exercise technique | Pretend to hold in a bowel movement or prevent passing wind; squeeze muscles for as long as possible, up to 10 seconds; relax in between each squeeze; repeat up to 10 times |
| Exercise frequency | Recommended 24 exercises a day; 8 holds, 3 times a day with 5-second rests in between |
| Exercise position | Sit, stand, or lie down with legs slightly apart; abdomen and buttocks relaxed |
| Additional tips | Only the fingertips should feel a squeeze, not the buttock muscles; maintain correct weight to avoid extra strain on the muscles |
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What You'll Learn
Kegel exercises
The anus has two rings of muscles: the internal anal sphincter and the external anal sphincter. The internal sphincter is an involuntary muscle, meaning it does its job of keeping the anus shut without conscious control. The external sphincter, on the other hand, is a voluntary muscle that can be consciously controlled and exercised to improve bowel control.
To perform Kegel exercises, one must first relax the abdomen and buttocks, as the focus should be on exercising the pelvic floor muscles. The exercise can be done standing, sitting, or lying down. One should then consciously squeeze the anus and pelvic floor muscles as if trying to stop urinating midstream or stopping a bowel movement. It is important to isolate the correct group of muscles and not engage the abdominal, thigh, or buttocks muscles.
For beginners, it may be helpful to try this exercise while seated in a firm chair with the legs slightly apart. One can also sit on a toilet and insert a well-lubricated finger into the rectum to identify the correct muscles. Hold the squeeze for three seconds, then gently release. Repeat this up to 10-15 times, working towards doing these exercises three times per day.
It may be challenging to contract these muscles initially, but with consistent practice, muscle tone will improve, and it will become easier. Regular and correct performance of Kegel exercises can lead to stronger pelvic floor muscles and improved bowel control.
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Locating the anal sphincter muscles
The anal sphincter muscles, also known as the sphincter ani muscles, are the muscles that surround the anal canal and regulate defecation. They include two sets of muscles: the internal anal sphincter and the external anal sphincter.
The internal anal sphincter is located inside the rectum and is an involuntary muscle, meaning you cannot consciously control it. It stays shut to prevent stool leakage, even when you sleep. The external anal sphincter, on the other hand, is a voluntary muscle that you can control and close more firmly. It surrounds the outside end of the anal canal and is composed of three parts: the upper or deep part, the middle or superficial part, and the lower or subcutaneous part.
To locate these muscles, you can perform a digital rectal examination. This involves gently massaging and relaxing the anal sphincter muscles with a lubricated index finger. Start by placing your index finger on the outer surface of the anus. Slowly and gently insert your finger into the anus to perform a full-circle examination of the rectum and anus, checking for tension, bleeding, or tenderness. This examination is an important diagnostic method for anal, rectal, and pelvic diseases.
Additionally, you can locate and exercise the external anal sphincter through Kegel exercises. To do this, relax your abdomen and buttocks, as you want to isolate the anal sphincter and pelvic floor muscles. Spread your legs slightly apart and consciously squeeze these muscles as if you were trying to stop urinating midstream. Hold the squeeze for three seconds, release gently, and repeat up to 10-15 times. You can practice Kegels standing, lying down, or seated in a firm chair.
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Squeezing and relaxing
The act of squeezing and relaxing the anal muscles is a great way to train them. The anus has two rings of muscles, the internal and external anal sphincters. The external sphincter is a voluntary muscle that you can control and close firmly. This muscle can be exercised and strengthened to help control bowel movements.
To train the external anal sphincter, you can perform exercises such as Kegels. To do this, relax your abdomen and buttocks, as you don't want to engage those muscle groups. Spread your legs slightly apart, and then consciously squeeze your anus and pelvic floor muscles, as if you were trying to stop urinating midstream. Hold the squeeze for three seconds, then gently release. Repeat this process as many times as you can, up to 10-15 times. It may help to visualise an elevator: as you contract the muscles, imagine the elevator slowly rising to the top, and as you release, picture it returning to the ground floor. Aim to work up to performing these exercises three times per day.
It's important to note that the internal anal sphincter is an involuntary muscle, meaning you cannot consciously control it. It works to keep stool inside your body and only opens when you are ready to have a bowel movement.
In addition to strengthening the external sphincter, it is also beneficial to learn how to relax these muscles. Anal penetration is easier when you have better control, and relaxation is a key part of this. Foreplay can help relax the sphincter, and light touch or feathering around the anus can aid in this process. Using different types of touch and pressure can help you explore what feels good. For those who are overly sensitive in this area, desensitisation exercises can be beneficial. Applying deep, broad pressure (such as with a flat hand) around the anus can help calm the nerve endings.
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Holding for longer
The anal sphincter is a band of muscles that surrounds the entrance of your anus. It is in charge of holding the stool inside your body until you are ready to have a bowel movement. These muscles can be strengthened through exercise.
Exercises to strengthen and tighten your anal sphincter may help treat bowel incontinence (fecal incontinence) or reduce your chance of leaking stool or gas in the future. These exercises are also beneficial for patients who are due to have a colostomy or ileostomy (stoma) reversal operation. When done correctly, these exercises can build up and strengthen the muscles to help you hold both wind and stool in the back passage.
To perform these exercises, sit comfortably with your knees apart. Imagine you are trying to stop passing wind and, at the same time, try to stop the flow of urine midstream. You should feel a sensation of 'squeeze and lift' as you close and draw up the back and front passages. Hold this for as many seconds as you can (up to a maximum of 10 seconds). At the end of the hold, there should be a definite feeling of 'letting go'. It is easy to use the wrong muscles, so try not to pull in your tummy, squeeze your legs together, clench your buttocks, or hold your breath. You can check that you are doing the exercises properly by gently resting a couple of fingertips on the outside of the back passage.
You can also try a more gentle contraction that you can hold for longer until the urge passes. It might help to think of these muscles as an elevator. As you contract (squeeze) them, the elevator slowly rises to the top. As you gently release the tension on your muscles, imagine the elevator returning to ground level. Gradually work up to doing these exercises three times per day.
A 2018 study found that people who received supervised pelvic floor muscle training (i.e., they worked with a physical therapist) were five times more likely to report improvements in fecal incontinence than those who did the exercises on their own. Biofeedback is a technique that can help you learn to control body functions. During this treatment, you are connected to electrical sensors that give the healthcare provider information about your body so they can coach you during the exercises. A 2015 study found that using a combination of pelvic floor physical therapy and biofeedback worked better than pelvic floor muscle exercises alone. In addition, adding electrical stimulation (sacral nerve stimulation) to these two therapies improved results even more.
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Building repetitions
To build repetitions, it is recommended to perform 24 exercises a day, with 8 holds, 3 times a day. Each hold should be performed with at least 5 seconds of rest in between. You can gradually work up to this level by starting with fewer repetitions and increasing the number as you get more comfortable with the exercises.
When performing the exercises, it is important to sit, stand, or lie down in a comfortable position with your legs slightly apart. Relax your abdomen and buttocks, as you don't want to engage those muscle groups. Imagine that you are trying to stop passing wind and, at the same time, trying to stop the flow of urine midstream. You should feel a "squeeze and lift" sensation as you close and draw up the back and front passages.
Hold this position for as long as you can, up to a maximum of 10 seconds. You should feel a definite "letting go" sensation at the end of the hold. It is important to note that you should only feel the squeeze in your fingertips, not in your buttock muscles.
As you build repetitions, you can also try to increase the duration of each hold, aiming for 10 seconds per hold. Additionally, you can incorporate gentle contractions that you can hold for longer if you feel the urge to leak, which can be more effective in preventing leakage.
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Frequently asked questions
Anal sphincter exercises are a set of exercises that can help strengthen the muscles around the anus, which in turn can help treat or prevent incontinence and reduce the chance of leaking stool or gas.
Sit, stand, or lie in a comfortable position with your legs slightly apart. Now, try to hold in a bowel movement or prevent yourself from passing wind. You should feel the muscles around your anus tighten.
Consciously squeeze the muscles around your anus and pelvic floor muscles for as long as you can (up to 10 seconds). Relax in between each squeeze. Try to do this 10 times, 3 times a day.
