Overview of the Anal Sphincter

This complicated structure is actually two muscles

Anal Canal illustration

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An anal sphincter is a group of muscles at the end of the rectum that surrounds the anus and controls the release of stool, thereby maintaining continence. There are two sphincter muscles: one is internal and one is external.

The external muscle helps maintain continence and keep stool in the rectum. If there is a loss of muscle control in the sphincter, incontinence may occur. The inner muscle is not under voluntary control but rather is controlled by the autonomic nervous system.

The external sphincter can be voluntarily controlled, meaning it can be clenched and unclenched. The internal and the external muscles work together to eliminate stool from the body via a bowel movement.

Diseases and Conditions

There are several diseases and conditions that can affect the anal sphincter.

Anal stenosis: Anal stenosis is not a common condition, but it can be related to inflammatory bowel disease (IBD), and in Crohn's disease more so than in ulcerative colitis. In anal stenosis, the anal sphincter becomes narrowed, to the point where it is difficult to have a bowel movement. Other symptoms include pain and bleeding. 

Anal stenosis can occur after surgery—especially hemorrhoid removal—or be associated with laxative overuse or infections.

Anal Crohn's disease: Because Crohn's disease can affect any part of the digestive tract from the mouth to the anus, it can also affect the anal sphincter. It's estimated that as many as one third of patients with Crohn's disease will have complications in the perianal area (the part of the body around the anus).

People with Crohn's disease may develop disease in the anal sphincter, including:

  • Abscesses: An abscess is an area of pus that collects after an infection. 
  • Fissures: A fissure is a tear in the anal canal that can be very painful.
  • Fistulae: A fistula is an abnormal channel between two parts of the body, such as the anus and the skin.
  • Swelling in the anal sphincter
  • Ulcers: An ulcer is a hole or sore in the lining of a structure, such as the anal muscles.

Hemorrhoids (piles): A hemorrhoid is a vein around the anus that becomes swollen. Almost anyone can develop a hemorrhoid, and they are a special problem for pregnant women, people with IBD, anyone who experiences chronic constipation or diarrhea, and people over the age of 50. 

Incontinence: Some people with IBD experience incontinence, or the involuntary release of stool from the rectum. This could happen because of a flare-up of the disease ​or could be a result of damage to the muscles of the anal sphincter.

Fecal incontinence can be very distressing for patients, and getting the inflammation from IBD under control is important to prevent it.

A Word From Verywell

Complications involving the anal sphincter are more common in people with IBD than they are in people who do not have Crohn's disease or ulcerative colitis. However, in many cases, there are treatments available that can help.

Patients may be uncomfortable discussing incontinence with physicians, but it is an important sign of disease and it can often be managed with treatment. If incontinence is never discussed, of course it won't ever get treated.

Perianal Crohn's disease can be challenging to treat, and seeing a physician (or at least getting a consult with a physician) that specializes in IBD can be helpful in managing it.

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Article Sources

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  2. Kelley KA, Kaur T, Tsikitis VL. Perianal Crohn's disease: challenges and solutions. Clin Exp Gastroenterol. 2017;10:39-46. doi:10.2147/CEG.S108513

  3. Barros LL, Farias AQ, Rezaie A. Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment. World J Gastroenterol. 2019;25(31):4414-4426. doi:10.3748/wjg.v25.i31.4414

  4. Nanaeva B, Shapina M, Khalif I. P559 Tacrolimus as a topical therapy for perianal Crohn’s diseaseJournal of Crohn's and Colitis. 2018;12(supplement_1):S388-S389. doi:10.1093/ecco-jcc/jjx180.686

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