Pelvic Floor Therapy for Constipation & IBS

Is Your Pelvic Floor Impacting Your Digestion? Learn how pelvic floor therapy for constipation and IBS from a physical therapist can help you manage your digestive symptoms.

Regarding digestion and gut health, what you eat matters a lot. But what is happening on the other end of the digestive tract?

Enter your pelvic floor which is responsible for more digestive symptoms than most people realize. And it may be the missing piece of the IBS puzzle you’ve been looking for!

Thank you so much to Erin Rahter, PT, DPT, WCS, for writing this post on pelvic floor physical therapy for constipation and other IBS symptoms. You can learn more about Erin and her services at the end of this post. If you live in California and need a physical therapist specializing in pelvic floor therapy for IBS, I highly recommend Erin!

What is the pelvic floor?

The pelvic floor is a group of muscles and supportive structures that sit like a bowl at the bottom of your pelvis. These muscles help to control your bowel, bladder, and sexual function. They also support your inner organs from below as you stand and move upright. 

Like other muscles in the body, the pelvic floor muscles can contract and relax to help you accomplish tasks. For the pelvic floor, these tasks include holding in stool and urine when you’re going about your day. They also relax when you’re in the restroom so you can empty your bowel and bladder.

When you do activities that place extra stress on the pelvic floor like jumping, laughing, or sneezing, these muscles are programmed to contract and close off the urethra and anus so that you do not experience unwanted leakage. With sexual activity, the muscles assist in erection as well as orgasm.

While women usually have heard about their pelvic floor or been told to do Kegels, men have very similar muscle anatomy and rely on their pelvic floor for bladder, bowel, and sexual function.

What is pelvic floor dysfunction?

Like other muscles in the body, the pelvic floor muscles don’t always function optimally. This dysfunction can be caused by muscle trauma like childbirth or a fall on the tailbone. Pelvic and abdominal surgeries can also contribute to dysfunction due to scar tissue formation or modification to the anatomy like removal of the uterus or prostate. And sometimes dysfunction can begin from an early age or without obvious cause. 

Women are more at risk of developing pelvic floor dysfunction due to the nature of pregnancy/childbirth and hormonal changes with menopause. But it is important to remember that men can also develop pelvic floor dysfunction.

Whatever the initial cause, you may experience digestive and other symptoms when the pelvic floor isn’t functioning properly. If the muscles are too tense or restricted, you can see problems like constipation, hemorrhoids, urinary urgency, or pelvic pain. 

On the other hand, if the muscles are weak or not coordinating well, you may experience things like urinary or fecal leakage or pelvic organ prolapse. 

These issues are more common than most people realize. A 2008 study of almost 2,000 US women found that 23% had at least one symptom of pelvic floor dysfunction. This number typically increases following childbirth and as women age. 

While pelvic floor dysfunction is less common in men, research shows that symptoms like urinary incontinence can affect 11-34% of men and typically increase with age or following prostate surgeries. Constipation affects anywhere from 12-17% of the population, and pelvic floor dysfunction is often a contributing factor.

Many people are embarrassed by these symptoms or assume that they are a normal part of childbirth or aging. This causes many people to suffer in silence without seeking help. Whether you’ve recently started experiencing symptoms or have been dealing with it for years, you do not need to suffer or accept it as the norm!

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a subspecialty of physical therapy that focuses on pelvic floor dysfunction. In addition to the doctorate-level education that physical therapists receive, pelvic floor therapists get additional training that enables them to treat pelvic floor conditions. 

Like other fields of physical therapy, pelvic floor therapists assess muscle strength, flexibility, and coordination of your pelvic floor muscles. Assessing the pelvic floor can be a bit more intimidating for patients than other body regions, but it should not hold you back from seeking help! 

Pelvic floor therapists are trained on how to assess the pelvic floor muscles internally (vaginally or rectally). Still, we also have ways to assess without an internal exam if you are uncomfortable with this. You and your therapist can discuss this during your first visit and devise a plan that works for you. 

In addition to a pelvic floor assessment, we also look at things like posture and the surrounding body regions like the abdominals, low back, and hips to get a full picture of your musculoskeletal system.

This is done along with a thorough history of your symptoms, diagnostic testing you’ve undergone, and a discussion of past medical history and medications. We may also ask you questions about your diet and lifestyle to see if you may benefit from behavioral modifications.

Following the evaluation, your physical therapist will discuss their findings with you and let you know if they think physical therapy is a good option. Treatment plans can vary significantly based on your symptoms, the length of time you’ve been experiencing them, and other factors. You and your therapist will make a plan in terms of frequency and duration of care based on your individual needs.

Pelvic floor therapy for constipation and other IBS Symptoms

In addition to managing diet (like a low FODMAP diet) and stress, pelvic floor physical therapy can be a missing piece of the puzzle for some people struggling to manage constipation and other IBS (irritable bowel syndrome) symptoms.

IBS is subdivided into constipation, diarrhea, or mixed. Physical therapy treatment may vary depending on the type you have and the specific symptoms that you are experiencing.

For those with constipation-type IBS, assessing if the pelvic floor muscles contribute to constipation is important. To pass stool successfully, the pelvic floor muscles must relax and lengthen to allow easy passage.

If your muscles are not relaxing well or they cannot properly coordinate this task, it is much more difficult to empty the bowels (especially when stool is hard). This often leads to straining which increases your risk of hemorrhoids and fissures.

It also makes it much more difficult to have regular and complete bowel movements, thus contributing further to the irritable bowel. 

Assessing the pelvic floor muscles to rule out dysfunction is still beneficial for diarrhea patients. In some cases, diarrhea may be masking underlying constipation. If you cannot empty the formed stool, it will start to get backed up and block the passageway.

If this happens, all that can pass through is very loose stool appearing as diarrhea. Addressing underlying constipation can help you to empty more completely and improve bowel regularity. 

In other cases, the pelvic floor muscles and surrounding nervous system may be overactive, leading to increased bowel urgency and frequent bowel movements. Addressing the overactive musculature and nervous system in physical therapy can calm down this urgency and reduce bowel movement frequency.

In addition to addressing pelvic floor dysfunction, your therapist may discuss additional management strategies with you to help manage your IBS such as:

• Abdominal bowel massage to encourage the movement of gas and stool through your colon.
• Toilet seated position and pushing techniques to empty your bowels fully.
• Timed toilet training to get your digestive system on a regular schedule.
• Reviewing dietary and fluid intake recommendations.
• Strategies to decrease stress and promote optimal nervous system activity. 

If your physician suspects pelvic floor dysfunction contributes to your IBS, they may order diagnostic tests like anorectal manometry or defecography. While these tests can be useful to help your physician rule in or out pelvic floor dysfunction, they are not required before seeing a pelvic floor physical therapist. 

Dr. Erin Rahter is a physical therapist and board-certified Women’s Health Clinical Specialist (WCS). She resides in San Diego, California, and owns and founded Remedy Pelvic Health Physical Therapy. Erin works to transform health care for women by providing education, care, and support as they transition through each stage of life.

Erin offers in-home services to the San Diego community and virtual services throughout California. You can learn more about Erin and schedule a free 15-minute phone consultation to determine if Remedy Pelvic Health is right for you at Remedy Pelvic Health.

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