Expert Q&A: All About Anal Kegels

Ok, you’ve heard of kegels, but have you heard of anal kegels? The term has been popping up in recent headlines and causing a bit of confusion. How, exactly, do you perform a back door kegel and why would you want to? We’re here with expert insights from Origin Advisor Uchenna "U.C." Ossai, DPT, PT, CSC, a sex-positive pelvic floor physical therapist and passionate educator, and Origin pelvic floor physical therapist Ashley Rawlins, DPT, PT.

Before we jump into the Q&A, we'll give you the bottom line: Focusing on the muscles around the anus while kegeling can improve your kegel technique, reduce symptoms like fecal incontinence or lack of sensitivity, AND increase pleasure if you’re into anal play. After reading what these pelvic floor gurus have to say, you'll know much more about your pelvic floor and will definitely have something fascinating to talk about on your next night out.

Curious about anal sex and want to learn more? Check out Beducated's info-packed guide to anal play.

First of all, is an anal kegel really a thing?

Dr. Rawlins: Yes and no. A kegel is an exercise that’s well known for strengthening the muscles around the vagina and urethra to improve sexual function, reduce bladder leaks, prepare your pelvic floor for childbirth and repair it postpartum. But it’s not common knowledge that this same strengthening exercise can condition the muscles around the anus, namely the puborectalis muscle. So while most pelvic floor physical therapists don’t use the term “anal kegel,” it really can help to focus on the puborectalis muscle if it isn’t functioning properly, or is weaker than other areas of the pelvic floor.

The puborectalis what?

Dr. Rawlins: The puborectalis muscle runs from the pubic bone, wraps around the rectum, and then heads back up to the pubic bone on the other side. It effectively forms a lasso of muscle around the rectum to help define and maintain what is called the anorectal angle, one of the main mechanisms that helps prevent poop from slipping out when you want it to stay in. So if you’re doing kegels with a focus on the puborectalis muscle, for example, because you’re working on improving fecal incontinence, you’re essentially doing an “anal kegel.”

So anal kegels can help with incontinence — what about anal play? Do They boost pleasure back there?

Dr. U.C.: I’m so glad you asked because we don’t talk enough about anal play or anal incontinence, for that matter. When it comes to anal play, some patients will tell me that they don’t have much sensation around the anus. They may have sustained an injury during childbirth — an episiotomy or vaginal tearing — that has impacted their ability to enjoy anal play. They say it just doesn’t feel the same as it used to. Kegeling with more of a focus on the anus can help them reconnect with this area of their body.

How do anal kegels increase sensitivity in that area?

Dr. U.C.: It’s about proprioception, aka the level to which you are aware of the position and movement of your body. It’s fairly common to lose some proprioception in the pelvic area, including around the anus, after childbirth. But you can use biofeedback to become more aware of the muscles controlling your anal sphincter and become more perceptive to what you’re feeling there.

You can use a clean finger or an anal toy like a butt plug. Just like you can pulse your vagina during vaginal penetration to increase pleasure, you can try pulsing your anus around your finger or a toy. You can also alternate pulsing your vagina and anus. You can do vagina, vagina, anus, anus. In both cases, you’re contracting your pelvic floor muscles, but it feels very different. You’re moving your body with intention and focusing your awareness. You may not feel a lot at first, but that awareness will grow over time.

Dr. Rawlins: Where you focus your attention while performing a kegel may not seem like a big deal, but it truly is. Well recognized as effective in sports training, mental imagery can help you control muscle function, and your pelvic floor is no exception. Injury to muscles in and around the anus can leave them less willing to activate, so you have to consciously get them back to work. Picturing your anus contracting or your tailbone tucking may really help to recruit the right muscle fibers, improving their rehab potential.

How exactly do you focus on the puborectalis muscle when doing anal kegels?

Dr. Rawlins: As a reminder, a kegel consists of a squeeze and release of your pelvic floor muscles. This is basically resistance training for your pelvic floor muscles, including those around your anus. To focus more on those muscles, try squeezing them as if you are stuck in an elevator with your boss and are trying not to pass gas. Some other cues that often help people understand the proper pelvic floor muscle motion:

• Use your muscles to “tuck” your tailbone, like an anxious dog.
• Imagine using your muscles to pick a blueberry up with your vagina or anus.
• Imagine using your pelvic floor muscles to drink a smoothie through a straw.

Dr. U.C.: Here’s another trick to try: Sit upright in a chair and squeeze and lift your pelvic floor like you’re pulling a turtle’s head back into its shell. Now try hinging forward at the hips and pull that turtle’s head back into its shell. Next, lean back in your chair and pull the turtle’s head in again. When you’re upright, you’ll probably feel the kegel in the vagina area. When you lean forward, you’re likely to feel it more around the vulva and clitoris. When you lean back, you’ll feel it more in the anus.

Who could benefit from doing anal kegels?

Dr. Rawlins: Individuals with anal leakage — defined as inability to prevent leakage of gas or stool (liquid or solid) — or prolapse of the anus or rectum with weak and underactive pelvic floor muscles may benefit from anally-focused kegels. That said, anyone with symptoms of pelvic floor muscle dysfunction, whether that's pain with intercourse, bladder and bowel leaks, pelvic heaviness, or the feeling that something may be falling out, should be seen by a properly trained pelvic physical therapist to determine if kegels or other pelvic floor strengthening exercises are appropriate for them.

And just like when doing regular kegels, it’s important to ensure good technique when focusing on your anal area. A pelvic floor physical therapist can teach you how to perform a proper inward contraction of your pelvic floor muscles, and how to fully relax your muscles in between kegels.

Since we're talking all things anal, what are some things to keep in mind when buying an anal toy?

Dr. U.C.: Be sure to buy toys that are designed specifically for the butt. A good anal toy should have curvature and stoppage - a cone shape to make sure it doesn’t go in too far. b-Vibe is my go-to place for butt toys. I recommend checking out their Anal Academy which is a fantastic source of information; they take you through everything you need to know.

An important precaution: If you think you might have any kind of nerve damage around the anus, you should not use an anal toy. Connect with a colorectal specialist to be evaluated and get the right treatment.

What advice would you give to people who are curious about anal play but too timid to try it?

Dr. U.C.: We’re not taught about anal sex in a sex-positive way. If we were, we would have a very different mindset around it and it wouldn’t seem so scary. Anal play is fabulous if you’re comfortable exploring it. And if you’re not comfortable exploring it, that’s ok, too. People often think they’re a prude if they don’t want to try anal play or a freak if they do. It doesn’t have to be so binary. It’s an orifice that has a ton of nerves that can be explored safely and carefully. That means not starting with a penis or toy that’s too big, which can lead to injuring yourself.

Start with your pinky finger, then index finger, then level up to a small butt plug. Use tons and tons of lube and practice engaging and relaxing your muscles around your finger or toy.

Could anal sex or other types of anal play harm my pelvic floor muscles?

Dr. Rawlins: Yes, while it is possible to explore anal play safely, there's certainly a risk. Anal and rectal tissues are more fragile than vaginal tissue. When you consider the fact that your butt doesn’t make its own lubrication like the vagina does, it's easy to see why penetration and friction during anal sex might lead to tearing. Tearing can then lead to pain and tension in your pelvic floor — and that tension can create more pelvic floor dysfunction.

Other factors such as pre-existing fissures (baby tears in the tissue of your anus), hemorrhoids (swollen veins in your anus because of excessive pressure down there), or even dry tissues due to breastfeeding (your vagina isn’t the only tissue affected by low estrogen) may also contribute to pain and injury down there.

Lastly, there is always a chance that the toy or penis you are using for pleasure is too big, which means your muscles aren't able to relax and lengthen enough to accommodate it. Everyone’s anatomy is different and trying to go too big too soon can potentially increase your risk of straining these muscles. Like Dr. U.C. says, start small and use lots and lots of lube!

Does having a healthy pelvic floor impact anal play in a good way?

Dr. Rawlins: Yes. A healthy pelvic floor has many benefits during anal fun. If this is an erogenous area for you, healthy pelvic floor muscles will encourage increased blood flow during arousal, which increases sensitivity. Once aroused, a healthy pelvic floor muscle may be able to help intensify an orgasm. And last but not least, a healthy pelvic floor is both strong AND flexible, meaning it has a full, pain-free range of motion and is able to stretch and open during sex as desired, without pain and tension. If you have any questions about the condition of your pelvic floor, reach out to an Origin pelvic floor physical therapist. We're here for you and there's no such thing as TMI!