How to relax sphincter muscles for constipation (Dr. Farahat).
Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.
Today, I will share the step-by-step guide to relaxing your sphincter muscles when constipated.
This actionable guide results from the perfect combination of my professional knowledge and experience with constipation.
I hope it will help you master the bowel training for constipation.
Table of Contents
Before you start:
- Passing a hard poop can be a painful experience if you fail to relax your sphincter muscles.
- This guide is super detailed and in-depth. When you implement it, you can defecate smoothly without pain.
- Focusing on relaxation instead of straining is the key idea of this guide.
- The best time to start this relaxation practice is when you feel the urge to poop.
- Some people with chronic constipation may not have the urge. If so, you must choose a scheduled time every day (ideally 20 to 30 minutes after your main meal) to retrain your bowel.
- You may fail in the initial trial to relax your sphincter. However, don’t give up; try again and again until you optimize the process. It is a learning curve; you need more time to master the relaxation of your anaI sphincters and pelvic floor muscles.
How to do Bowel retraining with conscious relaxation.
1- Take the squatting position.
We (humans) are designed to poop in a squatting position. This is because squatting will relax your pelvic floor muscles and sphincters (shown in the video below).
How squatting can greatly relax your sphincter muscles (ref):
- First, it relaxes the puborectalis muscle, which allows the straightening of the angle between the rectal and anaI canal.
- Helps to generate more abdominal pressure to push the poop out.
- Also, it lifts the kink in the sigmoid colon (straightens the angle between the rectum and the sigmoid colon).
You can take a squatting position by:
- Sitting “on” your toilet (be careful if you are overweight or your toilet is unable to carry you).
- Using a conventional footstool: if you have any food stool, you can elevate your legs to simulate a squatting position. But it has to be at least 7 to 9 inches in height.
- A permanent solution (squatty potty): purchase a tool that can fit your toilet set curvature and help you sit in the perfect squatting position (has optimal height).
This video explains the effect of squatting using a squatty potty:
2- Get over the pain mindset.
The greatest part of the defecation process is not under your conscious control. In particular, the internal anaI sphincter relaxation (ref).
Relaxation of your internal sphincter is under the control of what is called “the autonomic nervous system (parasympathetic and sympathetic).
Unlike your somatic nerves, your autonomic nerves are greatly affected and controlled by emotions such as fear and pain.
Fear and pain from the passage of the hard stool and constipation may cause spasms or failure to relax your sphincters.
So it would be best to overcome the fear of pain and self-awareness of your thoughts and expectation.
Believe that the moment you stop the fear, your sphincter will relax, and the pain will go away.
3- Don’t overstrain.
As we explained before, any wrong move resulting in painful poop can result in more spasms in your sphincters.
The most common wrong move is rapid, forceful straining. Overstraining can result in severe pain, leading to the failure to relax your sphincters.
Not only this, but overstraining with hard poop may also lead to (ref):
- AnaI fissures: a small tear in the lining of the anaI canal, which is very painful. It may bleed and cause bright red blood on the outside of the stool.
- Hemorrhoids: continuous overstraining over time may lead to congestion and dilation of veins inside your anaI canal and rectum, leading to hemorrhoids.
- Deep anaI tears can happen, especially if you strain while you have a large hard mass of poop inside your rectum (fecal impaction).
- RectaI Prolapse: overstraining may cause a small part of your rectum to stretch and protrude into the anaI canal or even to the outside.
So, The first step to relaxing your anaI sphincters and pelvic floor muscles is to stop the conventional forceful straining.
4- Close your eyes.
After you sit in a squatting position (preferably using a footstool or a squatty potty), close your eyes instead of straining.
Closing your eyes helps you eliminate distractions and start focusing on relaxing your sphincter to help constipation.
While closing your eyes, start a slow, deep breathing exercise; this is because:
- Practicing conscious breathing exercise puts your body in a relaxing mode (as meditation or yoga).
- Helps you to start gaining control over your fear of pain.
- Shifts your focus toward your sphincters and makes you aware of how relaxed they are.
- Keeping slow, conscious breathing through defecation will give you full control over your sphincters.
And here is how you can practice conscious breathing exercises:
- With your eyes closed, bring awareness to your breaths without changing your breathing.
- Start with slow inspiration for about 4 seconds (or four counts in your head).
- Then a small pause (for one count).
- Then a slow expiration for four counts.
- Repeat the cycles of conscious, slow breaths until you get used to it (4 to 5 cycles).
- Continue with the same conscious respiration through the whole steps below.
6- Bring your full attention to the pelvic floor muscles and sphincters.
- After getting used to slow, conscious breathing, focus on your sphincters and pelvic floor muscles.
- Focusing means you have to know where they’re exactly.
- By focusing on your sphincters and pelvic muscles, you will feel the degree of their tension.
- Bringing your conscious mind to feel and connect to your sphincters is your first step to gaining control over them.
7- Start imagining.
After making your brain aware of your sphincter tension and feeling, it’s time to control it.
- Closing your eyes, continue the slow deep breathing.
- Now try to make an order to your sphincter to relax.
- And start telling your brain that “relaxation” is your power to get over pain and spasms.
- You can use this affirmation to help you imagine “relaxation”:
Now, I am feeling my sphincters, and taking control over them. My brain can totally control and relax my sphincters progressively. Any pain will go away every time I relax no matter how great it is.
- For example, imagine that your sphincter is relaxed, and passing hard poop without pain will help you relax more.
8- Attach your sphincters to your breaths (Gentle straining with expiration).
A very effective tactic is attaching your sphincter muscles to your breaths.
- During inspiration, focus on the maximum relaxation of your sphincter muscles.
- During expiration, slowly and gently push your poop down.
- At the end of expiration, stop pushing (straining) and hold the position even if you start to feel some pain.
- At the next cycle of inspiration, start to relax your sphincter muscles more and more again (without pushing down).
- And then, gently push down again with expiration (use your abdominal muscle to help to push)
- REMEMBER, Be very gentle & very slow (Relax with inspiration, Gentle pushing with expiration, eyes closed).
9- Take a pause (Never let your sphincter contract again).
After continuing progressive sphincter relaxation and gentle pushing, the poop starts passing through your sphincter.
At this time, the pain sensation may increase. And pain is the biggest enemy against sphincter relaxation. This is especially evident if the poop is too hard and too dry.
So, DON’T EVER LET YOUR SHINCTERS SPASM AGAIN. THIS WILL PUSH THE POOP BACK INTO THE iRECTUM AGAIN.
Instead, Focus on relaxation while the poop is inside your rectum and take a pause.
This pause while the poop is still in the middle of its way out has many advantages:
- It will give you more time to relax and take control of your conscious breathing and conscious relaxation of your sphincters.
- It is more in line with your anal sphincter physiology, as its relaxation is gradual.
- It gives time to your anorectal canal to accommodate the large-sized poop of constipation.
- Also, it greatly decreases the painful sensation and allows your brain to develop the power of pain tolerance.
- REMEMBER, DON’T EVER LET YOUR SPHINCTER SPASM EVEN IF YOU FEEL PAIN. JUST PAUSE THE STRAINING.
10- When comfortable, try to push again.
After some while (usually a few seconds), your sphincter muscle will relax more to accommodate the poop hold inside the anorectal canal.
After getting used to the new position of poop, start the cycle of inspiration-relaxation and expiration-gentle pushing again.
11- Repeat, optimize, and never give up.
When you feel pain again, hold it, breathe, relax, and tolerate the pain, and when you get used to it, start the gentle pushing with expiration again.
It is a game of mind control over pain. But, as with any game, it has a learning curve.
Don’t get frustrated if you fail to relax or your sphincter spasm in the middle of relaxation.
Get over it, and be aware that it is completely normal to fail with this relaxation exercise.
When you start over again and repeat, you will learn to take control of your mind and sphincter muscles.
Relaxation is your key to a smoother poop process.
Bonus tips to help sphincters relax:
1- High fiber diet.
Eliminating hard stools is the best way to prevent sphincter muscle spasms, and the best way to make your poop softer is for fibers.
It is recommended to take 20 to 25 grams of fiber daily, especially soluble fibers (ref).
Fibers (particularly the soluble type) help to hold more water and form a build that stimulates more bowel movements.
You can obtain it by eating high-fiber foods or obtaining a soluble fiber supplement; the best is psyllium (Metamucil).
RECOMMENDED PRODUCT, #AD:
Metamucil (psyllium) is the best soluble fiber for chronic constipation, as it adds bulk to stool and keeps water inside your colon.
2- Be hydrated.
Fibers need water to work; if you are not drinking enough water, your colon will absorb more water for the poop inside.
This will make your poop more dry and hard to pass. soluble fiber holds water and forms a gel-like substance that softens your stool.
3- Be physically active.
Taking a 30-minute daily walk or light exercise at home helps to stimulate colon motility.
A sedentary lifestyle is one of the biggest risk factors for constipation.
4- laxatives and stool softeners
A laxative, stool softer, or enema helps relax sphincters by making the poop easier to pass.
When the poop is too hard and dry, it becomes more difficult to pass through the anorectal canal.
Lubricating its way using a warm water enema or inserting a lubricant (such as KY gel) will help more relaxation and easier passage of poop.
You can insert the lubricant gel inside the anorectal canal with your gloved little or index finger.
6- Finger relaxation
Another bonus technique you can use with the above method is to use your finger for relaxation.
This method helps people with medical conditions such as spinal cord injuries or dyssynergic defecation.
- Use a latex glove and some lubricant on your index finger.
- While squatting and relaxing your sphincter, insert your gloved finger into your anorectal canal.
- At least the half-length of your finger should be inside your anorectal canal to reach the internal anal sphincter.
- Start circular motions with your finger to relax the muscle.
- Then apply the same relaxation technique (mentioned above) after removing your finger.
This initial step has two advantages, it provides initial relaxation to your sphincter and lubricates your anal canal.
7- Pro-tip, the water cannon method:
Using a water spray accessory installed into your toilet can be very effective; it works like magic with me. Also, many of my patients use it.
No one talks about it because toilet water bidets are not common in the USA.
We will release a complete guide on using the water canon method soon. Stay tuned.
Check the cause of your constipation and eliminate it.
It is important to check the cause of your constipation. Not all constipation is primary or idiopathic. Some medical conditions, medications, and hormonal imbalances can lead to constipation.
Check your doctor for overlooked causes of constipation and eliminate them if present, such as:
- Medications: many antibiotics, IBS medications (antispasmodics), blood pressure, anti-anxiety, and anti-depression medications can lead to constipation.
Review the list of medications with your healthcare provider to determine what is best for you.
- Endocrinal disease: hypothyroidism, hypokalemia, panhypopituitarism.
- Neurological diseases: diabetic neuropathy, autonomic neuropathy, intestinal pseudo-obstruction, Multiple sclerosis, Parkinson’s disease.
Identifying and treating any causes of secondary constipation will help the relaxation of sphincter muscles in the long term.
When to get help? And what is biofeedback?
Sometimes, you will fail no matter how hard you try to relax your sphincter.
Some people may have other issues, such as age or fecal impaction.
So, if you fail again and again, it is time to visit your doctor. Your doctor may offer another method to relax your sphincter is “biofeedback.
Biofeedback is an emerging and promising technique to treat constipation. Biofeedback connects you to your pelvic floor muscles, teaches you to control them, and relaxes your sphincter. (ref)
Biofeedback’s basic idea is conscious relaxation, as the technique, I mentioned above. But it takes it to another level by connecting your mind to your muscles with real electrodes or tools inserted into the anus. This allows more conscious and more powerful control over your sphincters.
The video below explains Biofeedback: