What training exercises or devices help relax anal muscles safely?
Executive summary
A combination of behavioral training, physiotherapy techniques, simple home practices and a handful of devices can safely reduce external anal sphincter tension and teach voluntary relaxation, but choice depends on cause (constipation, proctalgia fugax, sexual comfort, hemorrhoids) and clinical supervision is often recommended [1] [2] [3]. Evidence supports pelvic floor retraining and biofeedback as effective clinical approaches, while warm baths, diaphragmatic breathing and graded dilators are widely used adjuncts; novel resistance devices exist but are aimed at strengthening rather than relaxation and require specialist oversight [4] [1] [2] [5] [6].
1. Clinical biofeedback and guided pelvic-floor retraining: the therapeutic backbone
For patients who cannot relax the voluntary external sphincter—classically described in anismus or obstructive defecation—biofeedback using manometric anal probes or surface sensors teaches down-regulation of the striated sphincter through real‑time visual or auditory feedback and general relaxation techniques, an approach tested in outpatient clinical series and presented as dual therapy in the literature [1] [4]. Pelvic-floor muscle training programs delivered by therapists are the standard for identifying the right muscles and practicing coordinated contraction and relaxation patterns (for example, contract for up to 10 seconds then fully relax), and specialists can use sensors to verify that relaxation, not accessory muscle compensation, is occurring [4].
2. Behavioral and breathing methods to reduce sphincter tone at home
Non‑device approaches used widely include diaphragmatic (deep) breathing to coax pelvic floor relaxation and warm water soaks; research and physiotherapy guidance cite that warm baths at about 40°C can lower anal canal pressure and relieve spasm such as proctalgia fugax, while breathing techniques reduce sympathetic tone that contributes to muscle tightness [2]. Patient-facing guidance from bladder and bowel charities and NHS leaflets likewise recommend learning the muscle (try to “hold in a bowel motion” to locate it), then practicing controlled squeezes followed by deliberate relaxation—important because correct isolation avoids recruiting buttock or abdominal muscles that undermine relaxation training [7] [8] [9].
3. Graded dilators and rectal dilatation: controlled stretching under guidance
Rectal or anal dilators are used in pelvic physiotherapy to gradually stretch tight sphincter and pelvic floor muscles and are reported as effective for chronic pelvic pain, levator ani syndrome, post‑injury stiffness and anal stenosis prevention after surgery; protocols emphasize gradual progression, clinical oversight and combining dilator use with physiotherapist‑led exercises to retrain relaxation reflexes [5]. The evidence in practice-based sources portrays dilators as a practical adjunct, not a standalone cure, and they are most appropriate when tightness is structural or longstanding [5].
4. Medications and topical relaxants: short‑term symptomatic relief
Topical sphincter relaxants and certain medications are described in hemorrhoid management literature as options to reduce sphincter spasm and pain—agents such as trimebutine have been used to lower sphincter tone and relieve symptoms rapidly—yet these are symptomatic tools rather than definitive retraining and should be used within a treatment plan discussed with a clinician [3]. Reporting on these treatments frames them as adjunctive measures alongside fiber, stool habit changes and physical therapies [3].
5. Devices and resistance training: strengthening versus relaxing—and the research gap
A novel compressible intra‑anal device (the continence muscles Resistance Exerciser Device, cRED) was developed to overload sphincter muscles during voluntary contraction and study fatigability; its design provides resistive, isotonic load and visual external feedback to measure contraction but the published work and device focus on strengthening and fatigue, not relaxation training per se, highlighting that some intra‑anal devices are intended for rehabilitation of weakness rather than easing spasm [6]. Overall, the reporting shows a split: several safe, evidence‑based paths exist to teach relaxation (biofeedback, physiotherapy, dilators, heat and breathing) while other tools and medications are either adjunctive or aimed at strengthening; careful triage by a clinician or pelvic physiotherapist is necessary because causes differ [1] [5] [2] [3].
Limitations of the available reporting include relatively small or specialized clinical series for biofeedback and device studies and practice-based guidance rather than randomized trials for some interventions; where randomized evidence is absent in the sources provided, certainty about comparative effectiveness cannot be stated [1] [6] [5].