Tightening Your Anal Sphincter

Learning to strengthen your pelvic floor muscles can help incontinence

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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. Not unlike your thighs or biceps, your anal sphincter is composed of thick bands of muscle. And not unlike these other muscles, the muscles that control your bowel can be strengthened through exercise. While the internal anal sphincter is not under conscious control, the pelvic floor muscles that form an external band of muscle around the anus are readily strengthened through relatively simple exercises.

Bowel control problems are surprisingly common, reportedly affecting 18 million people in the United States alone (and it's thought that the true incidence is even higher). Sadly, too few people realize that often times simple measures may improve not only their social life and sex life but the quality of life in general.

Anal Sphincter Anatomy

Knowing the muscles that control your anal sphincter and how they work makes understanding the exercises much more clear.

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, which is why most adults do not leak stool while they sleep. However, you can control your external sphincter muscles, which can help you maintain control of your bowels.

The Pelvic Floor Musculature

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. In conjunction with your anal sphincter, these muscles help you stop embarrassing gas and stool leaks. These are the muscles that you squeeze tightly when you feel a bout of diarrhea coming on and no restroom is in sight. Likewise, these muscles also help you control urine flow and flatulence (gas).

Causes of Inability to Control Bowel or Bladder

As we age, bladder and fecal incontinence can occur due to loss of muscle tone in the pelvic floor, but weakness may occur in younger people as well. It might begin as having less control than usual over passing gas or leaking a little urine or stool with sneezing or standing quickly. Yet over it can progress to the inability to control your bladder or bowels completely. Other 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)

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 evaluated, and this may include tests such as an EMG, ultrasound, and more when appropriate.

See Your Doctor Before Self-Treating with Exercises

There are many treatable diagnoses that can lead to fecal incontinence. In those instances, simply tightening the pelvic floor muscles with exercise would not only be ineffective but may inadvertently lead to a delay in starting necessary treatment.

How to Exercise Your Bowel Muscles

In the absence of any treatable disease or functional problems, you can work to tighten the sphincter and pelvic floor muscles in the privacy of your own home with just a few minutes of exercise daily. The Kegel exercise—consciously tightening your pelvic floor muscles—has been around for decades and is a very simple procedure.

If you've stopped your urine flow midstream or consciously held in gas then you have already done a Kegel. For women who may have had Kegel exercises recommended after childbirth, it's the same thing. 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. 

Practicing Kegel Exercises

Although you can practice your Kegels standing or lying down, if you're a beginner it may be helpful to try the exercise while seated in a firm chair. Make sure to relax your abdomen and buttocks, as you don't want to exercise those muscle groups.

With your legs spread slightly apart, consciously squeeze your anus and pelvic floor muscles—as if you were trying to stop urinating midstream—and hold for five to ten seconds. It might help to visualize that these muscles are an elevator and 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.

It's recommended that this exercise is repeated at least five times, which equates to one set of Kegels. Try to complete at least two to three sets a day routinely. No one has to know that you're exercising your pelvic floor—you can do Kegels sitting at your desk or sitting 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 ten seconds, but as your muscle tone improves it will become easier. If you stick with it and repeat the exercise a few times daily, you should have improvement in just a few months. 

Practicing patience is important, just as with trying to strengthen any muscles. 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.

A Word of Warning

Don't overdo it. In this case, more is not better and you can actually fatigue these muscles and cause a little bit of temporary incontinence.

When Strengthening Isn't Enough

When weakness of the pelvic floor muscles isn't due to an irreversible injury (such as complete spinal cord injuries), a significant number of people improve with the exercises, and for some, the problem goes away completely. If your symptoms persist, there are many options.

Physical Therapy May Help Some People

If you aren't noticing a change, it's important to make sure you are performing the exercises properly. Your doctor may refer you to a physical therapist to assist you, though it's important to find a therapist who has experience working with people with pelvic floor muscle dysfunction. A 2018 study found that people who underwent supervised pelvic floor muscle training (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.

Adding Biofeedback or Electrical Stimulation to Pelvic Floor Exercises

For those who don't achieve the result they wish, 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 resulted in further improvement.

If Symptoms Persist

Anal incontinence or even small leakages of stool (or gas) can seriously impact the quality of life. If you aren't getting relief with conservative measures there are still plenty of options that may be successful. 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.

A Word From Verywell

If you're experiencing leakage of stool or gas or coping with frank anal incontinence, you're not alone. The problem is actually very common, and in being so, a significant amount of research has been done on the different ways people can get relief. Therapies such as anal strengthening exercises can take time but are well worth it.

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