Guide to Anal & Rectal Dilators

While certain types of anal dilators can be used for sex play, medically-designed anal and rectal dilators are used to relieve anal and pelvic pain for all genders. Pelvic floor disorders, anorectal surgeries, painful pelvic trigger points, and anal narrowing due to scar tissue or stenosis can all result in anorectal discomfort.

Depending on the cause, symptoms can range from mild to severe and often result in pain during or after sex, chronic constipation, or an ongoing feeling of pressure in the rectum. 

Thankfully, relief can be found in a gradual process that can be practiced at home known as anal & rectal dilator therapy. 

Read on, to learn all about anal and rectal dilators, how they help to relieve pain, which conditions they help treat, and how to use them.   

What Is an Anal Dilator?

Anal dilators, also known as rectal dilators, are medical tools that are used to slowly and gently restore elasticity to the anal canal and rectal muscles. Typically made from a smooth and body-safe, medical-grade material, anal dilators are designed in sets of gradually increasing sizes to allow for a progressive relaxation of anal and rectal tightness. 

Anal Dilator Uses

When recommended in a medical capacity, anal and rectal dilators are normally prescribed to treat a pelvic condition, injury, or trauma that has caused the anal canal to narrow or the rectal muscles to tighten. 

Conditions known to cause anal tightness and pain inlcude: 

• Chronic pelvic pain
• Crohn's Disease/ Irritable Bowel Syndrome
• Fecal incontinence 
• Functional constipation
• Levator ani syndrome
• Anal stenosis or painful scar tissue formation 
• Post-Radiation treatment for anal, colon, ovarian, cervical, or vulvar cancer
• Post-surgery for anorectal conditions
• Proctalgia fugax
• Tension myalgia
• Hemorrhoids or fissures

How Do Anal Dilators Help Relieve Pain & Tightness?

The most effective anal and rectal dilators are sold as a set where the smallest dilator is less than half an inch in width. Once gently inserted and held in place, each size dilator is designed to restore elasticity to the tissues of the anal canal and re-train the sphincter muscle without over-stretching it. 

When relief from tightness is evident from using the first dilator, patients move up to the next size, and so on, until pelvic pain is relieved, sex doesn’t hurt anymore, and bladder and bowel function has returned to normal.  

There is no rush with anal and rectal dilator therapy. It is a slow and gentle process that may cause some discomfort but should never increase your level of pain. In essence, the slower patients progress through a set of anal dilators, the better the results afterward.  

Do All Anal Dilator Sets Include the Same Sizes and Shapes? 

No, not all anal dilator sets include exactly the same sizes, nor are all anal dilators the same shape, or made from the same material. 

Some anal dilator sets include more sizes than others, which is beneficial for those with severe pelvic or anal pain because moving from one size to the next should be gradual as opposed to a big leap. 

VuVatech, for instance, sells a set of seven dilators ranging from 0.375 inches wide at the tip to 1.625 inches wide. Intimate Rose anal dilator sets include the smallest anal dilator available in today's market, with sizes ranging from 0.3 inches wide to 1.4 inches wide.   

When it comes to shape, most of the traditional anal dilator sets are tube-shaped, straight, and made from body-safe, medical-grade plastic, similar to those from VuVatech.

For patients who struggle with the inflexibility of plastic in such a delicate part of the body, Intimate Rose produces anal dilators made from medical-grade silicone, which is much softer than plastic but firm enough to be comfortably effective. Intimate Rose anal dilators are also hourglass-shaped, which helps to tenderly exercise the sphincter muscle thin the wall of the anal canal without overstretching it.  

Are Anal Dilators Safe?

Anal and rectal dilators are perfectly safe when used correctly. For best results, patients seeking relief from anal tightness or rectal pain should schedule a consultation with a pelvic physical therapist or OB/GYN. It’s wise to check that anal dilation is right for your condition rather than self-diagnose and it’s also vital to fully comprehend the exact instructions for use before beginning. 

It is also important to be patient with anal dilators. It takes time and plenty of lubrication to relax tight pelvic floor muscles, retrain sphincter muscles, or reduce scar tissue or stenosis. Take it slow, be patient and results will become apparent with time.  

What Does it Feel Like to Use an Anal Dilator?

For those experiencing pelvic pain linked to any of the conditions mentioned above, anal dilation can be a little uncomfortable with an odd feeling of pressure. Some describe the sensation of inserting an anal dilator as feeling like they are going to pass a stool, but this rarely happens. 

Although sometimes uncomfortable, anal dilator therapy should not be painful. As long as the correct size dilator is used with a generous amount of lubricant for insertion the muscles and tissues will gradually adapt and slowly stretch to their original pliability. 

How to Prepare for Anal Dilator Therapy

Preparing for anal dilation is an incredibly important part of the process. Essentially, the more time patients can spend on their prep, the more comfortable the experience will be. The anorectal region is an incredibly sensitive part of the body after all, and the more care it receives the better. 

The following tips should help you prepare before each dilation session. 

• Choose the right time. Anal dilation should never be rushed, so choose the right time of the day for you. Ideally, when you have time to fully relax without interruptions or pressing time limits. 
• Find a comfortable position in a quiet part of your house where you will not be disturbed. The position for insertion (and relaxing afterward with the dilator in place) can vary for each person. Physical therapists recommend lying on the back with the knees bent, lying on the side with knees bent, or sitting into a deep squat with something to hold onto for support. If a partner is willing to help with insertion, coming to all fours can also be comfortable.
• Relax. If the mind and body are not relaxed, then the anus and rectum will not be relaxed. Take some time to meditate, have a warm bath, or do some relaxing breathing exercises before you begin each anal dilation session.  
• Try to pass a stool before you begin. Anal dilation can increase the impulse to poop and allowing the bowels to move beforehand can considerably release the urge to go during dilation.  
• Always wash your hands and your dilator with warm water and fragrance-free soap before use. 
• Be generous with lubricant. Applying a generous amount of lube to anal dilators as well as the anal opening will help with gentle insertion and prevent micro-tears on sensitive anal skin. If you are using silicone dilators, be sure to use water-based lube to protect the outer coating of the dilator. Silicone lube can be used on plastic dilators without damaging the outer coating, but oil-based lubes should be avoided to prevent skin irritation. 

How to Insert an Anal Dilators Comfortably

Once patients have adequately relaxed and prepped for anal dilation, the following steps can be followed for comfortable insertion.  

1. Place the tip of the anal dilator at a 45–90-degree angle to the rectum. There will likely be some natural resistance from the anus so breathe deeply, with long slow inhales through the nose and exhales through the mouth to relax the anal muscles.  
2. Focusing on an inhale, use a slow and steady exhale to tenderly ease the tip of the dilator into the anus. 
3. Over the next 2-3 minutes, keep breathing consciously, easing the dilator a little deeper into the rectum with each exhale.    
4. If the dilator doesn’t insert easily, remove it slowly, relax for a few minutes, and try again with more lubrication. 
5. Anal dilators are fully inserted when the rim base of the dilator meets with the anus. Once this happens, continue to breathe gently, allowing the anal muscles, the mind, and the nervous system to accept the presence of the dilator in the body. 
6. Try to stay relaxed and still (no walking around) while the dilator remains in place for the amount of time agreed with your physical therapist or healthcare provider. 

How Long Should an Anal Dilator Stay In? 

The length of time that an anal dilator stays in will depend on the advice from your healthcare provider, as well as the condition you are treating.  Anal dilator sessions can start with just a few seconds and gradually increase to ten  minutes as the muscles and tissue begin to relax over time.  

Removing Anal Dilators Safely

Similar to how anal dilators are tenderly eased in with a focus on each inhale and exhale, they are just as gently removed. 

With each exhale, gently bear down as if passing gas and release the dilator from the anus slowly, one breath at a time. Once removed, wash the dilator, and your hands, with warm water and fragrance-free soap. Let it air dry or pat it dry with a clean towel and store it in a safe place. 

When to Move to The Next Size Anal Dilator?

When the first anal dilator in a set can be inserted pain-free and held comfortably within the rectum for the agreed amount of time, patients are usually ready to move up a size. That said, it’s always a good idea to check in with your pelvic health specialist to see if you are ready. 

Initially, the next size dilator can feel a little uncomfortable when inserted, but by ensuring the guidelines for insertion are followed, along with a generous amount of lube for each session, the discomfort will eventually diminish. Following this method, patients gradually move through the set of dilators to relieve anal tightness, muscle spasms, and pain.   

A little bleeding is normal when moving up to the next size anal dilator in a set, but excessive bleeding is not. Should you notice any significant bleeding during anal dilation, contact your healthcare provider for guidance. 

How to Ease Off Anal Dilation Therapy 

By committing to a regular anal dilation practice and following the guidelines from their healthcare provider or physical therapist, most patients find relief from chronic pain and can being to wean themselves off dilator therapy within a few months. Although patients can feel pain-free toward the end of anal dilation therapy, stopping suddenly could cause symptoms to return. 

To avoid recurring symptoms, the frequency of anal dilation is typically slowed instead of abruptly stopped. For instance, instead of dilating every second day, patients might be advised to dilate only twice per week for a few months, and then once a week for a few more weeks. 

If symptoms reoccur, it simply means that therapy may have ended too quickly and patients are advised to resume dilation for a few more months. 

Conclusion

Anal and rectal dilators are regularly used in conjunction with physiotherapy for rehabilitation after anorectal surgery, injury, radiation, or trauma. They are also used to relieve pelvic floor disorders and treat pain during sex, chronic constipation, as well as incontinence. Regular anal dilator therapy can also relax a tightened anal canal, reduce scar tissue and stenosis, and relieve anal muscle spasming. 

If you or someone you know are experiencing any of these symptoms, contact a pelvic physical therapist or healthcare provider in your area to see if anal and rectal dilators are right for you.  

References 

Science Direct - Anatomy of the rectum and anal canal- https://www.sciencedirect.com/science/article/pii/S0263931922002344

Cleveland Clinic – Anal Pain - https://my.clevelandclinic.org/health/symptoms/anal-pain

National Library of Medicine – Common Anorectal Disorders - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076876/

American Society of Colon and Rectal Surgeons - Pelvic Floor Dysfunction Expanded Version - https://fascrs.org/patients/diseases-and-conditions/a-z/pelvic-floor-dysfunction-expanded-version

National Library of Medicine - Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600265/