Athena Vale
The anal sphincter is a group of muscles at the end of the rectum that controls the release of stool. There are two rings of muscles that form the anal sphincters: the internal anal sphincter and the external anal sphincter. The internal sphincter is not under voluntary control, whereas the external sphincter can be controlled voluntarily. The strength of the muscles around the anal sphincter is one of the factors that can be altered to improve bowel control.
| Characteristics | Values |
|---|---|
| Muscle name | Anal sphincter |
| Muscle type | A group of two rings of muscles: internal anal sphincter and external anal sphincter |
| Muscle location | End of the rectum, surrounding the anus |
| Muscle function | Controls the release of stool, maintains continence, and prevents stool and urine from leaking out |
| Muscle control | The internal sphincter is involuntary, while the external sphincter can be controlled voluntarily |
| Muscle strength | Can be improved by practising squeezing exercises |
| Muscle damage | May occur due to various conditions, resulting in fecal incontinence |
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What You'll Learn
The internal and external anal sphincters
The anal sphincter is a group of muscles at the end of the rectum, surrounding the anus and controlling the release of stool. There are two muscles: the internal anal sphincter and the external anal sphincter.
The internal anal sphincter is located inside the rectum and is ring-shaped. It is made up of smooth muscle and is responsible for keeping the rectum closed when you're sleeping, for example. This muscle cannot be controlled voluntarily. When the rectum fills up, stretch receptors in the wall of the anus send signals to the brain, which then sends signals back to the lining of the anus, causing the internal sphincter to open and creating the urge to empty your bowels.
The external anal sphincter, on the other hand, is under voluntary control. This means you can consciously relax it to empty your bowels or tighten it to hold back your stool. However, it can also act involuntarily, either supporting the internal sphincter or helping pass stool. Together, these two muscles work to produce a bowel movement.
The anal sphincters are crucial for bowel control. If the muscles become weak or damaged, they may not close completely or immediately after a bowel movement, leading to leakage. To improve bowel control and prevent leakage, it is essential to strengthen these muscles through specific exercises. By sitting comfortably and squeezing the muscles around the back passage as if trying to prevent passing wind, you can effectively exercise the anal sphincters.
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Pelvic floor muscles
The pelvic floor muscles play a crucial role in controlling bowel movements, working in conjunction with the anal sphincters and hemorrhoids. These muscles are embedded in the pelvic floor and work together to regulate the release of stool, maintaining continence.
The pelvic floor muscles support the anal sphincters, which consist of two sets of muscles: the internal anal sphincter and the external anal sphincter. The internal sphincter is ring-shaped and composed of smooth muscle. It remains closed, preventing the accidental release of stool, except when you voluntarily choose to open your bowels. The external sphincter supports and assists the internal sphincter in its function. While it can contract involuntarily, you can also control it voluntarily to empty your bowels or hold back stool.
When the rectum fills up, stretch receptors in the wall of the anus send signals to the brain, prompting the inner sphincter to open and creating the urge to empty your bowels. The pelvic floor muscles relax and descend slightly, allowing the muscles in the rectum to push out the stool. If you choose to follow through with a bowel movement, you voluntarily relax your outer sphincter muscle as well. However, you can also delay defecation by tensing the muscles in your pelvic floor, abdomen, and outer anal sphincter.
To improve bowel control, it is essential to strengthen the pelvic floor muscles and the anal sphincters. This can be achieved through specific exercises, such as practising squeezing and lifting the muscles surrounding the back passage multiple times a day. By consistently exercising these muscles, you can enhance their strength and improve your ability to control bowel movements.
Weak or damaged pelvic floor muscles and anal sphincters can lead to difficulties in controlling bowel movements and may result in leakage. Conditions such as anal fissures, Crohn's disease, hemorrhoids, and fecal incontinence can affect the proper functioning of these muscles. In some cases, surgery may be required to repair or tighten the sphincter muscles and restore bowel control.
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Hemorrhoids
Passing stool involves several parts of the end of the digestive tract, including the rectum and anal canal, the sphincters (circular muscles), and hemorrhoids. Hemorrhoids are “cushions” of blood vessels and supporting tissue, found at the end of the rectum, just before the anus. They work with the anal sphincters to close off the bowel, preventing stool from leaving the body.
There are two types of hemorrhoids: internal hemorrhoids, which occur in the lower rectum, and external hemorrhoids, which develop under the skin around the anus. External hemorrhoids are the most uncomfortable because the overlying skin becomes irritated and erodes. If a blood clot forms inside an external hemorrhoid, the pain can be sudden and severe. Internal hemorrhoids are typically painless, even when they produce bleeding. For example, you might see bright red blood on the toilet paper or dripping into the toilet bowl. Internal hemorrhoids may also prolapse, or extend beyond the anus, causing several potential problems. When a hemorrhoid protrudes, it can collect small amounts of mucus and tiny stool particles that may cause an irritation called pruritus ani.
To treat hemorrhoids, it is recommended to eat high-fibre foods, take a stool softener or a fibre supplement, drink enough fluids, avoid straining during bowel movements, and not sit on the toilet for long periods. Over-the-counter pain relievers and warm baths can help relieve pain. For external hemorrhoids, over-the-counter creams, ointments, or suppositories can be used to relieve mild pain, swelling, and itching.
If at-home treatments for hemorrhoids are ineffective, medical procedures may be required. These procedures cause scar tissue to form in the hemorrhoids, cutting off the blood supply and shrinking them. In severe cases, surgery may be necessary.
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Pudendal nerve
The act of defecation involves several parts of the end of the digestive tract, including the rectum and anal canal, the sphincters (circular muscles), and hemorrhoids. These parts are embedded in the pelvic floor muscles. The pudendal nerve is a major nerve in the pelvic region that plays a crucial role in controlling the muscles involved in defecation.
The pudendal nerve carries motor and sensory axons from the ventral rami of the sacral spinal nerves S2-S4. There is one pudendal nerve on each side of the body, and they innervate regions of the rectal canal, anus, perineum, and external genitalia. The nerve provides sensory information about touch, pleasure, pain, and temperature to the penis or vagina, perineum, anal canal, and anus. It also controls the external anal sphincter muscles, which help in holding in or releasing feces.
The pudendal nerve is closely associated with the internal pudendal artery and vein branches throughout most of its path. After exiting the pelvis, the nerve enters the perineum and passes through a connective tissue sheath on the medial wall of the obturator internus muscle, known as the pudendal (Alcock's) canal. Within this canal, the nerve gives off its first branch, the inferior rectal nerve, which carries somatic motor fibers to the external anal sphincter and sends sensory information back from the anal canal.
Damage to the pudendal nerve can result in fecal incontinence and loss of sensation in the nerve's distribution area. Pudendal nerve injuries can occur during childbirth or due to complications from pelvic surgeries, diabetes, difficult labor, prolonged pressure from activities like cycling, radiation therapy, or tumors and cysts. Pudendal nerve entrapment syndrome is a rare condition caused by pressure on the nerve, leading to chronic stabbing pain.
To improve bowel control, individuals can perform exercises to strengthen the muscles around the back passage, such as the anal sphincter. These exercises involve squeezing and lifting the muscle as tightly as possible, multiple times a day. By improving the strength of these muscles, individuals may enhance their bowel control and prevent leakage.
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Fecal incontinence
The condition can be caused by various factors, including chronic illnesses, injuries, surgeries, and muscle or nerve damage in the rectal and anal regions. Diarrhoea, for instance, can make it challenging for the muscles to retain loose, watery stools, leading to potential muscle weakness over time. Similarly, constipation can also weaken the muscles in these areas due to frequent straining. Muscle damage during childbirth or surgeries, such as haemorrhoid removal or treating an abscess, can contribute to fecal incontinence.
To diagnose fecal incontinence, a healthcare provider will take a detailed health history, conduct a physical examination, and assess the patient's emotional well-being and quality of life. They may also recommend specific tests, such as anal manometry, MRI imaging, or anorectal ultrasound, to identify any structural or functional abnormalities in the anal and rectal regions.
Treatment options for fecal incontinence include dietary changes, exercises, medications, and surgery. Dietary modifications, such as reducing high-fibre foods or incorporating a high-fibre diet with adequate fluids, can help improve stool consistency and make it easier to control bowel movements. Muscle-strengthening exercises, such as pelvic floor exercises, can enhance bowel control and prevent leakage. Biofeedback therapy can also help individuals learn to control the muscles involved in bowel movements. In more severe cases, medications, nerve stimulation, anal plugs, or surgery may be recommended.
It is important to remember that fecal incontinence is a common condition that many people experience but may not openly discuss. Seeking professional help and following the recommended treatment plans can effectively manage the condition and improve one's quality of life.
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Frequently asked questions
The anal sphincter is a group of muscles at the end of the rectum that controls the release of stool. There are two muscles: the internal anal sphincter and the external anal sphincter.
The internal anal sphincter is located inside the rectum and it should be closed at all times, except when you are trying to open your bowels. You cannot control this muscle. When stool comes into the rectum, the internal sphincter relaxes and allows the stool to enter the top part of the anus.
The external anal sphincter goes around the outside of the end of the anal canal. You control this muscle and can tighten it to close it more firmly if you need to. The external sphincter supports the internal sphincter, helping it to perform its function.
To improve bowel control, you can try to alter three factors: the strength of the muscles around your back passage (the anal sphincter), the consistency of your bowel contents (stool), and your weight. You can practice squeezing the area many times each day to exercise the muscles and improve their strength.
