Tightening Your Anal Sphincter

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. Your anal sphincter is made up of thick bands of muscle. They surround the entrance of your anus and can open and close.

The anal sphincter keeps stool inside your body until you are ready to have a bowel movement. These muscles can be strengthened through exercise.

Bowel control problems are surprisingly common. They affect 36% of primary care patients in the United States (and it's thought that this number may be even higher). Sadly, most people don't realize that simple exercises may improve not only their social and sex life but the quality of life in general.

This article discusses the anal sphincter, how fecal incontinence affects it, and what you can do to strengthen this part of your body. It will also talk about what a doctor can do to help you.

Anal Sphincter Anatomy

Knowing the muscles that control your anal sphincter and how they work makes it easier to understand the strengthening exercises you can use to improve them.

The Internal Anal Sphincter

The internal anal sphincter is an involuntary muscle, which means you cannot consciously control it. Similar to your beating heart and your diaphragm, this muscle does its job every second of the day without you having to think about its function.

The internal sphincter is programmed to stay shut. This is why most adults do not leak stool while they sleep. However, you can control your external sphincter muscles, which can help you keep control of your bowels.

The Pelvic Floor Muscles

The organs in your lower pelvis, such as your bladder and colon, are supported by a large group of muscles called the pelvic floor muscles. Working with your anal sphincter, the pelvic floor muscles help you stop embarrassing gas and stool leaks.

These are the muscles that you squeeze tightly when you feel diarrhea coming on and there's no nearby restroom. Likewise, these muscles also help you control urine flow and flatulence (gas).

Causes of Incontinence

As we age, bladder incontinence and fecal incontinence can occur due to loss of muscle tone in the pelvic floor. Weakness may occur in younger people as well.

It might begin as having less control than usual over passing gas. Or maybe you leak a little urine or stool when you sneeze or quickly stand up. But it can progress to the inability to control your bladder or bowels completely.

Factors leading to fecal incontinence include:

• Vaginal childbirth
• Chronic constipation and straining to have bowel movements
• Chronic urinary tract infections
• Inflammatory bowel diseases such as Crohn's disease or ulcerative colitis
• Neurological issues (such as a spinal cord injury)
• Nerve damage
• Rectocele (a weakening of the wall between the vagina and rectum)
• Physical inactivity

Before Doing Anal Sphincter Exercises

If you are struggling with leakage of gas or stool, it's important to first talk to your doctor. New cases should always be carefully studied. And this may include tests such as an electromyography (EMG) or an ultrasound.

How to Exercise Your Bowel Muscles

If you do not have a disease or functional problem that is causing your fecal incontinence, you can work to tighten the sphincter and pelvic floor muscles in the privacy of your own home. It will take just a few minutes of exercise each day. The Kegel exercise—consciously tightening your pelvic floor muscles—has been around for decades. And it is very simple to do.

The key to Kegel exercises is knowing which muscles to contract—it's the same muscle group you use to stop your urine flow. You may wish to urinate and start and stop your stream to make sure you know the muscles involved.

Men might feel the muscles differently than women—most men report feeling tightness around the anus whereas many women feel the pull closer to the vagina. 

How to Do Kegel Exercises

You can practice your Kegels standing or lying down. But if you're a beginner, it may be helpful to try the exercise while seated in a firm chair:

1. Relax your abdomen and buttocks since you don't want to exercise those muscle groups.
2. Spread your legs slightly apart.
3. Consciously squeeze your anus and pelvic floor muscles—as if you were trying to stop urinating midstream.
4. Hold for five to 10 seconds.
5. Release gently.
6. Repeat five times.

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.

Do two sets of this exercise per day, or 10 repetitions. No one has to know that you're exercising your pelvic floor. You can do Kegels sitting at your desk or waiting in your car at a stoplight.

Muscle Strengthening Takes Time

If you're doing the exercise correctly, you should actually feel the pelvic floor muscles lifting. It may be difficult to contract these muscles for a full 10 seconds. But as your muscle tone improves, it will become easier. If you repeat the exercise a few times daily, you should see an improvement in just a few months. 

When you're trying to strengthen any muscles, it's important to be patient. If you've ever tried to get in shape more quickly by lifting too much weight or running too many miles, you know that trying to hurry the process along can backfire.

When Strengthening Isn't Enough

When the weakness of the pelvic floor muscles isn't due to an irreversible injury (such as complete spinal cord injuries), many people improve with these exercises. For some, the problem goes away completely. Other people may find that their symptoms don't go away. But there are many options to treat your fecal incontinence.

Physical Therapy

If you aren't noticing a change, it's important to make sure you are doing the exercises correctly. Your doctor may refer you to a physical therapist to assist you. It's important to find a therapist who has experience working with people who live with pelvic floor muscle dysfunction.

A 2018 study found that people who received supervised pelvic floor muscle training (that is, 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 or Electrical Stimulation

Biofeedback is a technique that is used to help you learn to control body functions. During this treatment, you are connected to electrical sensors. The sensors 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.

Summary

Bowel incontinence, also known as fecal incontinence, is a common problem. It occurs when you leak stool or gas. Your doctor can help pinpoint any problems you may be having that cause the incontinence.

Your doctor may suggest you try strengthening your anal sphincter. The anal sphincter is a band of muscles that surrounds the entrance of your anus. It's in charge of holding the stool inside your body until you are ready to have a bowel movement. Strengthening the anal sphincter by performing Kegel exercises can help treat fecal incontinence.

A Word From Verywell

If you're experiencing leakage of stool, leakage of gas, or severe anal incontinence, you're not alone. The problem is actually very common. Since many people struggle with this issue, experts have conducted a great deal of research on the different ways people can get relief.

Anal incontinence or even small leakages of stool (or gas) can seriously affect your quality of life. If you aren't getting relief from basic treatments and strengthening exercises, there are still plenty of options that may help you. While it's embarrassing at times, speaking to your doctor and exploring the available options can get you closer to living your best life today.