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Leaflet: Sphincter Exercises

Sphincter exercises can help you to improve your bowel control. When done correctly, these exercises can build up and strengthen the
muscles to help you to hold both gas and stool in the back passage.

Where are these muscles?

The back passage, or anus, has two rings of muscle around it (see diagram).

Image of rectum and sphincter

The inner ring is the internal sphincter, an involuntary muscle, which should be closed at all times, except when you are actually trying to open your bowels.

This is normally automatic; you don’t have to think about doing it. The outer ring of muscle is the external sphincter, which is a voluntary
muscle that you can tighten up to close it more firmly if you have urgency or diarrhoea. It is part of the pelvic floor muscles. Both muscles wrap right around the anus.

When a stool comes into the rectum the internal sphincter relaxes and allows the stool to enter the top part of the anus. Very sensitive nerves in the anal canal can tell you if it is gas or stool waiting to come out. If it is stool, you squeeze your external sphincter to stop it from coming straight out.

Image showing muscles involved in moving poo down towards the sphincter
Image showing muscles involving in returning poo to the rectum

This squeezing moves the stool back into the rectum, where it waits until you get to the toilet.

Either or both of these sphincter muscles can become weak. This may be because of childbirth, constipation and straining or general wear and tear. Sometimes there is no obvious reason why.

If you have weak muscles and cannot squeeze enough to hang on, you will feel urgency and may leak gas, liquid or even solid stool.

How can exercises help?

Exercises can strengthen these muscles so that they once again give support. This will improve your bowel control and improve or
stop leakage of gas or stool. Like any other muscles in the body, the more you use and exercise them, the stronger the sphincter
muscles will be.

Learning to do the exercises

It is important to learn to do the exercises in the right way, and to check from time to time that you are still doing them correctly. Sit comfortably with your knees slightly apart. Now imagine that you are trying to stop yourself passing wind from the bowel. To do this you must squeeze the muscle around the back passage. Try squeezing and lifting that muscle as tightly as you can, as if you are really worried that you are about to leak.

You should be able to feel the muscle move. Your buttocks, tummy and legs should not move at all. You should be aware of the skin around the back passage tightening and being pulled up and away from your chair.

Really try to feel this. You are now exercising your anal sphincter. You should not need to hold your breath when you tighten the muscles!

Practising your exercises

  1. Sit with your knees slightly apart. Slowly tighten and pull up the sphincter muscles as tightly as you can. Hold tightened for at least five seconds, then relax for at least 5 seconds. Repeat at least five times. This will work on the strength of your muscles.
  2. Next, pull the muscles up to about half of their maximum squeeze. See how long you can hold this for. Then relax for at least 5 seconds. Repeat at least five times. This will work on the endurance or staying power of your muscles.
  3. Pull up the muscles as quickly and tightly as you can and then relax and then pull up again, and see how many times you can do this before you get tired. Try for at least five quick pull-ups.
  4. Do these exercises – five as hard as you can, five as long as you can and as many quick pull-ups as you can – at least 3 times every day. Progress to doing in the standing position
  5. As the muscles get stronger, you will find that you can hold for longer. than five seconds (aim for 10 seconds), and that you can do more pull-ups each time without the muscle getting tired (aim for 10 reps).
  6. It takes time for exercise to make muscle stronger. You may need to exercise regularly for several months before the muscles gain
    their full strength.

Tips to help you

At first it is probably a good idea to set aside some time for these exercises and really concentrate on getting them right. But quite
soon they should become easy to do wherever you are. Nobody need know what you are doing!

  • Get into the habit of doing your exercises with things you do regularly
  • If you are unsure that you are exercising the right muscle, put a finger on the anus as you squeeze to check. You should feel a gentle
    lift and squeeze if you are exercising the right muscle. Or look at the area in a mirror – you should see the anus pucker up as you
    squeeze it.
  • Use your muscles when you need them – pull up the muscles if you feel urgency and that you are about to leak. But remember that
    you cannot hold your tightest squeeze for very long, so you are better to use a gentler squeeze that you can hold for longer. Your control will gradually improve.
  • Watch your weight – extra weight puts extra strain on your muscles.
  • Once you have regained control of your bowel, don’t forget your exercises. Continue to do them a few times each day to ensure that the problem does not come back.

We wish to acknowledge that some information in this leaflet is replicated from St Marks Hospital, The Burdette Institute for Gastrointestinal Nursing.