Anal Sphincter Exercises for People with Accidental Bowel Leakage

The back passage (anus) has two rings of muscle around it, a bit like a donut! The inner ring is the internal anal sphincter and is an involuntary muscle over which we have no conscious control. This should be closed at all times except when we are trying to open our bowels (have a poo) and is automatic so that we don’t need to think about it. The outer ring of muscle is the external anal sphincter and is a voluntary muscle which we can tighten, especially if we have urgency or diarrhoea. Either of these muscles can become weak.

The sphincter muscles can become weakened or damaged due to childbirth, constipation and straining, general wear and tear, heavy lifting and surgery, but there may be no obvious cause. If you have weak sphincter muscles you may leak wind, loose or solid stools. Some people find it tricky to wipe clean after a poo, or find that they have poo stains on their underwear.

External anal sphincter exercises can help to reduce or stop this leakage from the bowel. By exercising, the muscle should become thicker and stronger and give more support to the internal sphincter thus helping to prevent leakage. Like any other muscle in the body, the more you exercise and use it, the stronger and more effective it will become!

How to exercise your external anal sphincter muscle: Step one – identifying

• Sit comfortably with your knees slightly apart.
• Now try to squeeze the muscle as if you are trying to stop yourself passing wind. You should feel your muscles around your anus start to tighten and move away from the chair.
• Your buttocks, tummy and legs should not move
• Make sure you are not holding your breath
• You are now exercising your sphincter muscle!

How to exercise your external anal sphincter muscle: Step two – the ‘lift technique’

• Imagine your sphincter muscle is a lift.
• If you squeeze it as tightly as you can, the lift goes up to the top floor.
• You probably won’t be able to hold it there for long and it probably won’t get you to the toilet in time.
• However, now try tightening more gently and only take the lift up to the 2nd floor. You should be able to hold this contraction for much longer.

How to exercise your external anal sphincter muscle: Step three – practising the exercises, strengthening

• Sit, stand or lie with your knees slightly apart. Many people find it easier to start doing the exercises sitting or lying down and moving up to standing once they feel more confident and their muscle is stronger.
• Tighten and pull up the sphincter muscle as hard as you can. Hold for a slow count of 5 -10 seconds and then relax.
• It is important to allow the muscle to relax between contractions, so if you can hold for 5, relax for 5 to allow the muscle to rest before the next contraction – this works the muscle best!
• You are aiming to hold for at least a slow count of 5.
• Repeat 5 times. This will help strengthen your muscles.

How to exercise your external anal sphincter muscle: Step four – practising the exercises, improving endurance

• Next pull up your muscles to about half of their maximum (as if going up to the 2nd floor).
• See how long you can hold this for.
• Relax for at least 10 secs.
• Repeat this twice.
• This will improve the endurance of the muscles.

How to exercise your external anal sphincter muscle: Step five – practising the exercises, preventing leakage

• Finally, pull up the muscles as fast and tightly as you can.
• Relax and then pull up again.
• See how many times you can achieve this before you get tired.
• You are aiming to do 10 eventually.
• This will improve the ability of the muscle to hold closed when the rectum fills with stool (poo)

Try and do these exercises 4 times a day. You may find it helpful to have a ‘cue’ to remind you to do the exercises, such as when you wake up or go to bed, when your favourite TV programme comes on or when you are waiting for the children to come out of school! If you are doing the exercises well, nobody will know what you are doing so once you are confident doing them you can do them anywhere.

As the muscles get stronger you will be able to hold for longer and to do more repetitions without the muscle getting tired. It can take a few months before you notice much change so don’t get despondent and try and stick with it, it WILL be improving!

If you are not sure you are doing the exercises properly, put a finger on the anus as you squeeze. You should feel a gentle lift and squeeze. Or look at the area in a mirror and you should see the anus pucker as you squeeze.

If you are struggling with your exercises, ask your GP to refer you to your local pelvic health physiotherapist. These are healthcare professionals who specialise in helping people with bladder and bowel problems and have a wealth of knowledge and experience in this area.

Don’t forget: The better you empty your bowels the less there will be to leak. Take your time when opening your bowels and don’t rush. When you think you have finished do some exercises before you wipe. See our blog on managing constipation for tips on correct positioning when opening your bowels!