The ability to control bowel movements relies on the coordinated strength of the rectal muscles. Maintaining this muscular network is important for continence and overall digestive health. Weakness in this area is common and can lead to accidental leakage of gas or stool. However, specific exercises and lifestyle adjustments can often restore muscle tone and improve control.
Understanding the Muscles Involved
The primary structures responsible for supporting the rectum and controlling continence are the pelvic floor muscles, particularly the levator ani, and the anal sphincters. The levator ani group forms a sling-like structure across the floor of the pelvis, providing direct support to the organs, including the rectum. These muscles help keep the anorectal angle bent, a natural mechanism that maintains continence.
The anal sphincters consist of two rings of muscle surrounding the anal canal. The internal anal sphincter is an involuntary muscle that stays closed most of the time to prevent leakage of gas or liquid. The external anal sphincter is a voluntary muscle that you consciously contract to hold back stool or gas. Weakness in these muscles often arises from factors like aging, the physical trauma of childbirth, or chronic straining caused by constipation.
Step-by-Step Strengthening Exercises
Targeted exercises, commonly known as Kegels, focus on strengthening the external anal sphincter and the posterior section of the pelvic floor. To begin, correctly identify the muscles by imagining you are trying to stop yourself from passing gas. The sensation should be a lifting and squeezing around the anal area, without contracting your buttocks, abdomen, or thighs.
Once the muscles are identified, practice two main types of contractions for comprehensive strengthening. Slow-twitch contractions involve squeezing and holding the muscle for three to five seconds, then fully relaxing for an equal amount of time. Work toward holding the contraction for up to ten seconds as strength improves.
Fast-twitch contractions involve quickly tightening and immediately releasing the muscles to improve reaction time and speed of closure. For both types, aim to complete a set of ten repetitions, performing at least three sets daily while standing, sitting, or lying down.
The isolated Kegel exercise remains the most direct way to strengthen the muscles controlling the rectum. Remember that the goal is to feel the muscles lift upward, not just squeeze, and to maintain normal breathing throughout the exercise.
Supportive Lifestyle and Habit Changes
Strengthening exercises are most effective when supported by habits that reduce strain on the rectal muscles. A high-fiber diet is essential because fiber adds bulk and absorbs water, making stool softer and easier to pass. Adults should aim for 20 to 35 grams of dietary fiber daily from sources like whole grains, fruits, vegetables, and legumes.
Proper hydration is equally important, as water works with fiber to prevent stools from becoming hard and difficult to pass. Aiming for eight to ten cups of water daily helps ensure the fiber moves smoothly through the digestive tract. Adopting a better posture when sitting on the toilet can significantly reduce the need to strain.
Elevating your knees so they are slightly higher than your hips, often achieved with a small footstool, helps straighten the anorectal angle. This position mimics a natural squat and allows for a more complete and effortless bowel movement. Avoid prolonged sitting on the toilet and respond promptly to the urge to go, as delaying a bowel movement can cause the stool to dry out.
When to Consult a Specialist
While self-directed exercises and lifestyle changes can often improve muscle tone, persistent or severe symptoms require professional evaluation. Consult a healthcare provider if you experience chronic pain, noticeable bleeding, or severe, unmanageable incontinence of gas or stool, as these symptoms may indicate a more complex issue.
A Pelvic Floor Physical Therapist (PT) is a specialist who can provide a precise assessment of your muscle function. They use internal examination to confirm correct muscle contraction and can tailor an exercise program to your specific needs.
For individuals who struggle to isolate or strengthen the muscles, a PT may recommend more advanced treatments. Biofeedback uses a sensor placed in the rectum to display muscle contractions on a monitor, helping you coordinate and strengthen the muscles more effectively. In some cases, electrical stimulation may be used, where a low-level electrical current passively contracts the muscles to improve strength and awareness.