Pelvic floor exercises, often called Kegels, are the fastest and most accessible way to strengthen the muscles around the anus and improve bowel control. Most people can begin them today with no equipment, and measurable gains in squeeze pressure show up within weeks of consistent training. But “fast” is relative: rebuilding muscle function that affects continence is a process of weeks to months, not hours or days. The encouraging part is that the same exercises used for urinary control also strengthen the anal sphincter complex, and several additional strategies can be layered on top to accelerate results.
The Two Muscles That Keep You Continent
Your anal canal is controlled by two distinct rings of muscle that work as a team. The internal anal sphincter is a smooth muscle that stays contracted automatically, without you thinking about it. It generates more than 70 percent of the resting pressure that keeps the canal closed between bowel movements.1PubMed Central. Control of Motility in the Internal Anal Sphincter You cannot voluntarily squeeze this muscle any harder than it already squeezes itself. The external anal sphincter, by contrast, is skeletal muscle under your conscious control. When you clench to hold in gas or stool, the external sphincter is doing that work. It is also the muscle you can train.
This distinction matters because some bowel control problems stem from weak voluntary squeeze (the external sphincter), while others stem from low resting tone (the internal sphincter). Exercises target the external sphincter directly and may improve coordination of the whole system, but if the internal sphincter has been damaged by surgery or injury, exercise alone has limits. Higher resting anal pressures before surgery, for example, are associated with better continence outcomes afterward, underscoring how much baseline internal sphincter tone matters.2PubMed Central. The Clinical Utility of Anorectal Manometry: A Review of Current Practices
How to Do Pelvic Floor Exercises for Bowel Control
The basic technique is simple but easy to get wrong. You want to contract the ring of muscle around your anus as if you are trying to stop yourself from passing gas. The squeeze should feel like a lift and tighten inward, not a bearing-down push. A common mistake is to hold your breath, clench your buttocks, or push your abdomen outward. All three of those recruit the wrong muscles and can actually work against you.
A practical starting routine looks like this:
- Quick flicks: Squeeze and release the anal sphincter quickly, five to ten times in a row. These train the fast-twitch fibers that snap the sphincter shut when you cough, sneeze, or feel sudden urgency.
- Sustained holds: Squeeze and hold for five to ten seconds, then relax for the same duration. Repeat eight to twelve times. These build endurance in the muscle, which is what keeps the canal sealed during daily activities.
- Frequency: Aim for three sets of each type, spread across the day. Sitting, standing, and lying down are all fine positions.
The sustained holds are where most of the strengthening happens. If you can only hold for three seconds at first, start there and add a second per week. The goal is gradual overload, not straining.
Why Breathing Technique Matters More Than You Think
Your pelvic floor muscles do not work in isolation. They contract in coordination with the diaphragm and the deep abdominal muscles, responding to changes in pressure inside your abdomen. Research has shown that contracting the pelvic floor activates the deep abdominal wall and raises intra-abdominal pressure, and conversely, the pelvic floor engages automatically during breathing, coughing, and even talking to manage that pressure.3PubMed Central. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing This means that holding your breath while doing pelvic floor exercises disrupts the natural coordination pattern you are trying to improve.
The practical fix is to breathe normally, or even exhale gently, during the squeeze phase of each repetition. Some physiotherapists teach a “blow as you go” cue: exhale slowly while contracting the pelvic floor upward. This trains the muscles to work the way they need to work in real life, when you are walking, bending, or lifting something heavy.
Adding Resistance to Anal Sphincter Training
Just as lifting weights strengthens a bicep faster than flexing against air, contracting the anal sphincter against some form of resistance may produce greater gains than simple squeeze-and-release exercises. A study using a novel resistance device found that repetitive contractions against a compressible load induced muscle fatigue in the external anal sphincter, which is the physiological trigger that stimulates strengthening. Contractions without a load did not produce the same fatigue response.4PubMed Central. Fatigability of the external anal sphincter muscles using a novel strength training resistance exercise device
Specialized devices for anal resistance training are not widely available outside clinical research settings, but the principle is worth knowing. Some pelvic floor physiotherapists use weighted vaginal or anal probes that provide the sphincter something to grip against. If you are working with a professional, ask whether resistance-based training is an option for your situation.
Biofeedback-Guided Training
Biofeedback uses a small sensor placed in the anal canal that displays your muscle contractions on a screen in real time. The idea is straightforward: when you can see whether you are squeezing the right muscles and how strong the contraction is, you learn faster. This is especially useful for people who are not sure they are performing pelvic floor exercises correctly, which is more common than you might expect. Surveys consistently find that a large proportion of people initially do Kegels incorrectly, sometimes pushing down instead of lifting up.
The literature on biofeedback for fecal incontinence reports success rates above 70 percent in the short term, though controlled trials comparing biofeedback to standard supervised pelvic floor training have been less enthusiastic about the added benefit of the technology itself.5PubMed Central. Bio-feedback treatment of fecal incontinence: where are we, and where are we going? What this probably means is that the structured training program, guided by a therapist, matters more than the screen. If you can access biofeedback, it is a useful learning tool, particularly in the early weeks. But doing pelvic floor exercises consistently at home with correct technique delivers most of the benefit.
Electrical Stimulation
Electrical stimulation sends small pulses to the nerves or muscles of the anal sphincter to trigger contractions you do not have to initiate yourself. This can be delivered through a probe in the anal canal or, in more advanced cases, through electrodes placed near the sacral spinal nerves. Early work on sacral nerve stimulation showed promising results: in a small series, two out of three patients with severe incontinence regained full continence after six months, and anal closure pressure increased in all of them.6PubMed. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence
However, when researchers tested simpler anal electrical stimulation in a controlled trial, the results were more modest. Patients reported some improvement in bowel control, but there was no significant difference between high-frequency and low-frequency stimulation settings. The researchers noted that the benefit might not come from strengthening the sphincter at all, but rather from sensitizing the patient to the anal area, essentially improving awareness of when the sphincter needs to engage.7PubMed. Randomized, controlled trial of anal electrical stimulation for fecal incontinence This is a useful insight: sometimes the problem is not raw muscle weakness but a disconnect between sensation and response. Electrical stimulation, like biofeedback, may help retrain that connection even if it is not building bulk in the muscle itself.
Topical Medications That Boost Resting Tone
Because the internal anal sphincter operates on autopilot, you cannot strengthen it through exercise the way you can the external sphincter. But there are pharmacological options that temporarily increase its resting pressure. Topical phenylephrine, applied as a gel to the anal canal, has been studied for this purpose. In healthy volunteers, a 10 percent concentration raised resting anal pressure by about a third compared to baseline.8PubMed. Topical phenylephrine increases anal sphincter resting pressure
The effect has also been tested in patients with fecal incontinence. A dose-response study found that higher concentrations of phenylephrine gel raised resting pressure into the normal range, with the effect sustained for at least two hours.9PubMed Central. Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence A separate controlled trial in patients who had undergone pouch surgery confirmed a significant rise in resting anal pressure compared to placebo.10PubMed. Randomized, controlled trial of topical phenylephrine for fecal incontinence in patients after ileoanal pouch construction These are not products you pick up at a pharmacy; topical phenylephrine for anal use is typically compounded by a pharmacist and prescribed by a specialist. But for someone whose continence problem comes mainly from low resting tone in the internal sphincter, especially after surgery, it represents a potential tool that exercises alone cannot replicate.
Stool Consistency and the Role of Diet
Even well-functioning sphincter muscles struggle to contain liquid stool. One of the most practical things you can do alongside exercise is make sure your stools are well-formed. Loose, watery bowel movements are much harder to hold back than firm, solid ones, regardless of how strong your muscles are. This is why clinicians often address stool consistency first when treating fecal incontinence.
Dietary fiber is the most common recommendation for firming stool, and it makes sense in principle: soluble fiber absorbs water and adds bulk, turning loose stool into a cohesive mass. However, a randomized clinical trial testing fiber supplementation specifically for fecal incontinence found that stool characteristics like consistency and amount did not differ significantly among the fiber and placebo groups during the study period.11PubMed Central. Dietary Fiber Supplementation for Fecal Incontinence: A Randomized Clinical Trial That does not mean fiber is useless. It means the evidence for fiber specifically reducing incontinence episodes is weaker than most people assume. Still, maintaining a diet that produces predictable, manageable stools reduces the demands on your sphincter muscles day to day. Staying hydrated, avoiding foods that trigger loose stools for you personally, and eating regular meals all contribute to this baseline.
How Toilet Posture Affects the Pelvic Floor
Your position on the toilet changes the angle of the anorectal junction, which affects how easily stool passes. A scoping review of sitting versus squatting postures found that squatting may reduce digestive strain and improve bowel evacuation, potentially benefiting people with constipation.12PubMed Central. Sitting vs. squatting: a scoping review of toilet postures and associated health outcomes If you strain less during bowel movements, you put less downward pressure on the pelvic floor muscles you are trying to strengthen. Chronic straining can stretch and weaken the very muscles you are training, working against your exercise program.
You do not need to install a squat toilet. A small footstool placed in front of a standard toilet raises your knees above your hips and mimics enough of the squat angle to make a difference for most people. Leaning forward slightly with your elbows on your knees adds to the effect. The goal is to let stool pass with minimal pushing, which protects pelvic floor integrity over time.
When Tightening Becomes the Problem
There is such a thing as a pelvic floor that is too tight. If the muscles around the anus do not relax properly during a bowel movement, stool gets trapped even though there is nothing blocking the way. This pattern, known as dyssynergic defecation, is a common contributor to chronic constipation in both children and adults.13PubMed. Benefit of Pelvic Floor Physical Therapy in Pediatric Patients with Dyssynergic Defecation Constipation The muscles contract when they should relax, essentially fighting the body’s attempt to evacuate.
If you are dealing with both incontinence and constipation, or if pelvic floor exercises seem to make your constipation worse, this is worth investigating. The solution is not more squeezing but rather retraining coordination, learning to contract and relax on cue. Pelvic floor physiotherapy is particularly effective for dyssynergic patterns because it teaches the relaxation phase just as carefully as the contraction phase. Strengthening without proper relaxation training can make things worse, so if you have any doubt about whether your symptoms fit a tightening pattern, get assessed before ramping up an aggressive exercise program.
Keeping Your Gains Over the Long Term
Like any muscle, the external anal sphincter loses strength if you stop training it. A follow-up study of women who had completed a structured pelvic floor exercise program found that five years after organized training ended, about 70 percent were still exercising at least once a week on their own. Their muscle strength had declined slightly over those five years, but the drop was not statistically significant, meaning the gains held reasonably well for those who kept up some level of practice.14PubMed. Long-term effect of pelvic floor muscle exercise 5 years after cessation of organized training
The takeaway is practical. You do not need to maintain the same intensive schedule forever. Once you have built strength over the initial training period (usually eight to twelve weeks of daily work), scaling back to a few sessions per week appears to preserve most of the benefit. The key is not stopping entirely. Treating pelvic floor exercises like brushing your teeth, a brief daily or near-daily habit that is just part of your routine, is the most reliable way to maintain bowel control improvements for years rather than months.
When to See a Specialist
Most mild bowel control issues respond well to the strategies above, particularly consistent pelvic floor exercises combined with dietary attention. But some situations call for professional assessment. If you have had anal surgery, an obstetric injury, a neurological condition affecting the pelvis, or if your symptoms are worsening despite several weeks of dedicated exercise, a specialist can run tests that measure exactly what is going on. Anorectal manometry, for instance, measures both resting and squeeze pressures in the anal canal and can distinguish between internal sphincter weakness, external sphincter weakness, and coordination problems.2PubMed Central. The Clinical Utility of Anorectal Manometry: A Review of Current Practices That information changes which treatments will actually help, rather than guessing.
A pelvic floor physiotherapist is often the most useful first referral. They can confirm you are exercising correctly, identify whether you have a tightening problem rather than a weakness problem, and design a program tailored to your specific pattern. Gastroenterologists and colorectal surgeons become relevant when conservative measures have been tried and the problem persists, or when structural damage needs to be evaluated. The earlier you seek guidance, the more options remain on the table.