Kegel Exercises and Anal Sphincter Strengthening for Anal Sex
Kegel exercises do strengthen the anal sphincters through targeted pelvic floor muscle training, and when performed correctly with proper technique instruction, they can improve sphincter control and function—however, the evidence specifically addressing their role in preparing for or improving tolerance of anal sex is absent from medical literature.
Evidence for Anal Sphincter Strengthening
Direct Evidence of Sphincter Function Improvement
The strongest evidence comes from post-surgical fistulotomy patients, where Kegel exercises demonstrated measurable recovery of anal sphincter function. After fistulotomy procedures that caused gas and urge incontinence in 20% of patients, regular Kegel exercises (50 repetitions daily for one year) resulted in complete recovery in 50% and partial improvement in another 50% of affected patients, with incontinence scores returning to near-preoperative levels 1.
Mechanism of Strengthening
Research demonstrates that pelvic floor exercises induce muscle fatigue—a prerequisite for successful strength training. Repetitive contractions against resistance show significantly greater fatigability of the external anal sphincter compared to exercises without resistance, indicating more effective muscle strengthening 2. This suggests that properly performed Kegel exercises can physiologically strengthen anal sphincter musculature.
Proper Technique for Optimal Results
Essential Exercise Protocol
You must receive instruction from trained healthcare personnel to ensure correct technique—studies show that 25% of individuals who receive only brief verbal instruction actually perform a technique that could potentially worsen sphincter function rather than strengthen it 3. The optimal protocol includes 4:
- Contraction duration: 6-8 seconds per squeeze
- Rest period: 6 seconds between contractions
- Repetitions: 15 contractions per session
- Frequency: Two daily sessions (15 minutes each)
- Minimum duration: 3 months for optimal benefits
Critical Technical Points
- Isolate only the pelvic floor muscles without contracting abdomen, glutes, or thighs 5
- Maintain normal breathing throughout—never hold your breath or strain to avoid Valsalva maneuver 4, 5
- Consider biofeedback therapy using surface EMG electrodes to ensure proper muscle isolation 4, 5
Clinical Applications Beyond Incontinence
Established Uses
Kegel exercises are recommended by multiple guideline organizations for:
- Post-prostatectomy incontinence in men 6, 5
- Stress urinary incontinence in women (achieving up to 70% symptom improvement) 6, 4
- Fecal incontinence when conservative measures fail 4
- Pelvic floor dysfunction with persistent pain or leakage 6, 4
Pelvic Floor Physiotherapy as First-Line Treatment
The American Society of Clinical Oncology recommends pelvic floor physiotherapy as first-line treatment for patients with pelvic floor dysfunction symptoms 6, 4. This includes manual therapy techniques that resolve muscular trigger points, lengthen contractures, and release painful scars 7.
Important Caveats
Lack of Specific Evidence for Sexual Activity
While Kegel exercises demonstrably strengthen anal sphincter muscles and improve sphincter control in clinical contexts (incontinence, post-surgical recovery), no published medical studies specifically evaluate their effectiveness in preparing for or improving tolerance of anal sex. The extrapolation that stronger, more controlled sphincters would theoretically improve anal sex tolerance is logical but unproven.
Risk of Incorrect Technique
Without proper instruction, 25% of individuals perform Kegel exercises incorrectly in ways that could worsen sphincter function 3. Professional instruction is not optional—it is essential for safety and effectiveness 4, 3.
Long-Term Adherence Required
Benefits require sustained practice over months, not weeks 4. The post-fistulotomy study showing sphincter recovery used a one-year protocol with 50 daily repetitions 1.
Practical Recommendation
If your goal is to strengthen anal sphincters for any purpose including sexual activity, perform Kegel exercises using the evidence-based protocol (6-8 second contractions, 6 second rest, 15 repetitions twice daily for at least 3 months), but seek instruction from a pelvic floor physical therapist to ensure correct technique and avoid counterproductive muscle activation patterns 4, 3. Consider biofeedback-assisted training for optimal muscle isolation 4, 5.