Pelvic floor muscle training, often called Kegel exercises, is the primary way to strengthen the muscles that control your rectum and anus. These exercises target the external anal sphincter and the surrounding pelvic floor muscles, and research consistently shows they can improve both muscle squeeze strength and bowel control. Success rates for pelvic floor rehabilitation in treating fecal incontinence land between roughly 50 and 80 percent across most published studies, making it the recommended first step before considering more invasive options.1PubMed Central. Pelvic floor rehabilitation in the treatment of fecal incontinence The catch is that the exercises need to be done correctly and consistently, and some people benefit from professional guidance to get there.
Which Muscles You Are Actually Training
When people say “rectal muscles,” they usually mean the group of muscles that keeps the anal canal closed and helps you hold stool until you reach a bathroom. Three structures do most of the work. The internal anal sphincter is a smooth muscle ring that stays contracted on its own, without any conscious effort from you. It handles the baseline tone that keeps the canal sealed at rest. The external anal sphincter is a voluntary muscle that you can consciously squeeze, and it provides the extra grip you need when you feel urgency. Above both of those sits the puborectalis muscle, which wraps around the junction where your rectum meets the anal canal like a sling, pulling it forward to create an angle that acts as a natural barrier against leakage.2PubMed Central. Puborectalis muscle and External Anal Sphincter: a functional unit?
Pelvic floor exercises primarily target the external anal sphincter and the puborectalis, since these are under your voluntary control. The internal sphincter operates automatically, so you cannot train it directly. When researchers measure the results of pelvic floor training, they track squeeze pressure, which is the force generated when you voluntarily tighten, and sustained squeeze endurance, which is how long you can hold that contraction. Both of these reflect the condition of the voluntary muscles.
How to Do the Exercises
The basic technique is straightforward: you contract the muscles you would use to stop the flow of urine or hold back gas, hold the contraction for several seconds, then relax. The challenge is that many people either squeeze the wrong muscles (bearing down with their abdomen instead, or clenching their buttocks) or cannot isolate the pelvic floor at all. This is why clinical protocols typically include an initial assessment to confirm you are engaging the right muscles before prescribing a home routine.
In clinical trials, a common structure involves an initial in-person assessment session lasting around 45 minutes, followed by periodic supervised sessions where technique is checked and progressed. Between visits, patients are typically asked to perform sphincter exercises at home twice per day.3PubMed. Randomized, controlled trial of biofeedback with anal manometry, transanal ultrasound, or pelvic floor retraining with digital guidance alone in the treatment of mild to moderate fecal incontinence A reasonable at-home routine involves both quick squeezes (contract and release rapidly for a set of repetitions) and sustained holds (contract and hold for five to ten seconds, then rest for an equal period). Doing these in sets of ten or more, a couple of times a day, is a standard starting point. The key is consistency over weeks and months rather than intensity in a single session.
Standardized protocols used in pelvic floor rehabilitation clinics often break training into stages: first learning to isolate the correct muscles, then building strength through progressive resistance, and finally training endurance so the muscles can sustain contractions longer.4PubMed Central. Pelvic muscle rehabilitation: a standardized protocol for pelvic floor dysfunction If you have been squeezing and relaxing at home for weeks without noticing improvement, it is worth seeing a pelvic floor physical therapist who can verify you are doing it right.
What the Evidence Says About Effectiveness
A randomized controlled trial comparing supervised pelvic floor muscle training with an attention-control group found that people who received proper training were more than five times as likely to report improvement in their incontinence symptoms, with no adverse events reported.5PubMed. Efficacy of Supervised Pelvic Floor Muscle Training and Biofeedback vs Attention-Control Treatment in Adults With Fecal Incontinence That is a substantial advantage from a non-invasive treatment. In a large cohort study of 281 patients who received electrical stimulation alongside pelvic floor training with biofeedback, researchers saw a meaningful increase in squeeze pressure along with improvement in how much rectal volume patients could tolerate comfortably.6PubMed. Electrical stimulation and pelvic floor muscle training with biofeedback in patients with fecal incontinence: a cohort study of 281 patients
That said, the research base has limitations. A Cochrane review of the field found only a handful of eligible trials, all small, and noted that the methodological quality was generally poor or uncertain. The review found some suggestions that specific techniques like rectal volume discrimination training help more than sham training, but concluded that broad conclusions were not warranted from the data available at the time.7Cochrane Database of Systematic Reviews. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults The practical takeaway is that pelvic floor training clearly helps many people, but the field still lacks the kind of large, high-quality trials that would let researchers pin down exactly which techniques work best for which patients.
Biofeedback and Electrical Stimulation
If Kegel exercises alone are the foundation, biofeedback and electrical stimulation are the tools that can amplify their effect. Biofeedback uses sensors placed in or near the anal canal to give you a visual or auditory readout of your muscle contractions in real time. You can see when you are squeezing the right muscles and how strongly, which helps you learn faster and push harder. In one randomized trial, combining Kegel exercises with biofeedback significantly boosted both squeeze pressure and squeeze endurance compared to exercises alone.8Journal of Neurogastroenterology and Motility. Kegel Exercises, Biofeedback, Electrostimulation, and Peripheral Neuromodulation Improve Clinical Symptoms of Fecal Incontinence and Affect Specific Physiological Targets: An Randomized Controlled Trial That same trial found that electrical stimulation combined with Kegels also improved squeeze pressure and endurance, and additionally shortened the nerve signaling time to the anal region.
Electrical stimulation works by delivering small pulses through a probe to trigger involuntary muscle contractions. This can be especially useful if your muscles are too weak for you to generate a meaningful voluntary contraction on your own. Think of it as training wheels: the electrical pulses contract the muscle for you at first, and as the muscle strengthens, you gradually take over more of the work yourself. Biofeedback is also effective in cases of dyssynergic defecation, a coordination problem where the pelvic floor muscles tighten instead of relaxing during a bowel movement. Several randomized trials have confirmed biofeedback’s value in retraining this dysfunctional pattern.9PubMed Central. Treating pelvic floor disorders of defecation: management or cure?
Training at Home Versus in a Clinic
Not everyone can get to a specialized clinic for ongoing sessions, so researchers have tested whether home-based biofeedback can match office-based care. For fecal incontinence, a randomized trial found that home biofeedback produced significant reductions in weekly incontinence episodes and was statistically non-inferior to office-based therapy. Both groups saw meaningful improvements in resting and maximum squeeze sphincter pressures.10PubMed. Randomized controlled trial of home biofeedback therapy versus office biofeedback therapy for fecal incontinence A similar trial looking at constipation with pelvic floor dysfunction found the same pattern: roughly 68 percent of home-based patients improved, compared to 70 percent in the office group, with no meaningful difference between the two.11The Lancet Gastroenterology & Hepatology. Home-based versus office-based biofeedback therapy for constipation and dyssynergic defecation: a randomised controlled trial
This is genuinely good news. Home biofeedback devices have become more accessible, and if you have received initial professional instruction on technique, continuing your training at home appears to work just as well as making repeated clinic trips. The initial professional assessment still matters, though. Walking in off the street and using a home device with no guidance is not the same as what these trials tested. Participants in the home groups received proper instruction first and then transitioned to self-directed practice.
Why These Muscles Weaken in the First Place
Aging is one of the major drivers. As you get older, the external anal sphincter loses muscle mass and gains connective tissue. Animal research has found that the muscle content in the aging external sphincter drops substantially, from around 70 percent in young subjects to about 52 percent in older ones, with the lost muscle replaced by collagen and fibrous tissue.12PubMed. Age-related external anal sphincter muscle dysfunction and fibrosis: possible role of Wnt/β-catenin signaling pathways In humans, thinning of the external sphincter corresponds to lower squeeze pressures and is associated with incontinence, while the internal sphincter actually tends to thicken with age.13ScienceDirect. Anal sphincter structure and function relationships in aging and fecal incontinence
Childbirth is another common cause. Vaginal delivery can stretch or tear the anal sphincter muscles, and even when the tear is repaired surgically, some women experience ongoing weakness. The recovery experience varies enormously. Some women recover quickly with minimal rehabilitation, while others face a long, difficult process requiring intensive physical therapy.14PubMed Central. Women’s experiences of obstetric anal sphincter injury and physical therapy interventions – A qualitative study Chronic straining from constipation, obesity, and conditions that increase abdominal pressure can also gradually weaken the pelvic floor over time.
The Role of Nerve Health
Your muscles are only as strong as the nerves that control them. The pudendal nerve is the main nerve supplying the external anal sphincter, and damage to it, whether from chronic straining, childbirth, or other causes, can undermine your ability to generate a strong voluntary squeeze. Research has shown that pudendal neuropathy, even when it affects only one side, is associated with reduced anal resting tone and lower squeeze pressures.15PubMed. Unilateral pudendal neuropathy is common in patients with fecal incontinence Interestingly, pudendal nerve damage tends to impair conscious contraction, the deliberate squeeze, while leaving the unconscious baseline contraction relatively intact.16PubMed. Pudendal Neuropathy Alone Results in Urge Incontinence Rather Than in Complete Fecal Incontinence
This distinction matters because it affects what kind of symptoms you experience and how well exercises alone can help. If your issue is primarily nerve-related, you can still benefit from pelvic floor training, but the gains may be more modest, and additional treatments like neuromodulation or electrical stimulation may be needed to see meaningful progress. A pelvic floor physical therapist or gastroenterologist can help sort out whether weakness, nerve damage, or some combination of both is driving your symptoms.
Rebuilding After Rectal Surgery
People who have undergone low anterior resection for rectal cancer often experience a cluster of bowel problems afterward, sometimes called low anterior resection syndrome: frequent bowel movements, urgency, clustering of trips to the bathroom, and leakage. Pelvic floor muscle training has shown clear benefits in this population. A multicenter randomized trial found that patients who received pelvic floor training had significantly fewer bowel movements per day, less solid stool leakage during both day and night, and fewer clustering episodes compared to the control group at four months.17PubMed Central. The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial
A systematic review of available studies on pelvic floor rehabilitation after low anterior resection came to the same overall conclusion: the training is useful for improving functional outcomes, even though the individual studies were of limited quality.18PubMed Central. Pelvic floor rehabilitation to improve functional outcome after a low anterior resection: a systematic review If you have had rectal surgery and are dealing with bowel control issues, pelvic floor rehabilitation is worth pursuing. It is not a cure-all, and some degree of altered function may be permanent, but training can reduce the severity and frequency of the most disruptive symptoms.
An integrative approach has also shown promise beyond standard cancer surgery recovery. A case report of an older adult with rectal prolapse documented a 90 percent reduction in prolapse severity over just seven visits of physical therapy that included pelvic floor training alongside complementary techniques, along with elimination of rectal pain that had been rated five out of ten at baseline.19Journal of Women’s & Pelvic Health Physical Therapy. Conservative Management of Rectal Prolapse in an Older Adult Using Acupressure and Integrative Physical Therapy: A Case Report While a single case report is not strong evidence, it illustrates that pelvic floor training can play a role even in structural problems where surgery is typically the default recommendation.
Lifestyle Factors That Support Your Training
Exercises are the most direct way to strengthen these muscles, but what you eat and how you use the bathroom also matter. Hard, dry stool forces you to strain, and chronic straining over time can stretch and weaken both the muscles and the nerves that supply them. Soluble fiber supplements like psyllium have been shown to improve stool consistency and reduce pain during bowel movements, making defecation easier and reducing the mechanical load on your pelvic floor.20PubMed. Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation Adequate water intake works alongside fiber to keep stool soft.
Toileting posture is another variable. Squatting naturally relaxes the puborectalis muscle more fully than sitting upright, widening the anorectal angle and allowing stool to pass with less effort.21PubMed Central. Sit or Squat? Toilet Type Is a Determinant of Diverticulosis Development If you use a standard Western toilet, placing a small stool under your feet to elevate your knees above your hips can approximate a squatting position and reduce the need to push forcefully. This is not a replacement for pelvic floor exercises, but it removes one of the daily stressors that can work against your training.
How Progress Gets Measured
If you are working with a clinician, progress is typically tracked through anorectal manometry, a test that measures the actual pressures your sphincter muscles generate at rest and during a squeeze. Research after pelvic floor training programs consistently shows increases in squeeze pressure, confirming that the muscles are genuinely getting stronger rather than patients merely adapting to their symptoms.22Female Pelvic Medicine & Reconstructive Surgery. Impact of Pelvic Floor Physical Therapy on Quality of Life and Function After Obstetric Anal Sphincter Injury: A Randomized Controlled Trial
For a rough gauge at home, some clinicians use digital rectal examination as a simple assessment tool. Studies show a good correlation between a clinician’s digital assessment of sphincter tone and formal manometric pressure readings.23PubMed. Comparison of digital and manometric assessment of anal sphincter function What this means practically is that a pelvic floor therapist can evaluate your progress with a physical exam even without expensive equipment. One interesting finding from imaging studies is that the thickness of the external sphincter muscle does not correlate reliably with the squeeze pressure it generates, so a muscle does not have to visibly bulk up to be functionally stronger.24PubMed. Sonographic, manometric, and myographic evaluation of the anal sphincters morphology and function If you are doing the exercises and your symptoms are improving, the training is working even if nothing looks different on a scan.
When Exercises Are Not Enough
Pelvic floor training is a first-line treatment, but it is not always sufficient. If you have a significant structural injury, such as a complete tear through the sphincter, or if nerve damage is severe, exercises alone may not restore adequate function. In those cases, options include sacral nerve stimulation, injectable bulking agents that add volume to the anal canal lining, or surgical sphincter repair. Even with these interventions, pelvic floor training is typically recommended as part of the overall rehabilitation plan, not abandoned in favor of the procedure.
It is also worth noting that exercises can be counterproductive if your problem is actually pelvic floor over-tightness rather than weakness. Some people have a hypertonic pelvic floor where the muscles are chronically clenched, causing pain, constipation, and difficulty evacuating. For them, the treatment is down-training, which involves learning to relax the muscles rather than tighten them further.4PubMed Central. Pelvic muscle rehabilitation: a standardized protocol for pelvic floor dysfunction This is one of the reasons a professional assessment before starting a program is valuable. Without it, you might spend months doing exercises that make your actual problem worse.