The Connection Between the Pelvic Floor and IBS

Featuring an interview by pelvic floor specialist, and Nashville-based physical therapist, Jen Le Coguic, PT, DPT, OCS.

Jen Le Coguic, PT, DPT, OCS is a pelvic floor physical therapist practicing at Susan Underwood Physical Therapy in Nashville, TN. She completed her Doctorate of Physical Therapy at Belmont University in 2011 and received her Board Certification as an Orthopedic Specialist in 2013. She completed her training as a pelvic floor specialist through the Herman and Wallace Institute.


I find it absolutely beautiful how our bodies are created to work together. As someone who lives with and works with IBS, I get to discover connections like this all the time. While every connection can add another layer to an already complicated IBS puzzle, they present opportunities for us all to grow and understand our bodies a little better.

One connection I have been diving into for the last few months is the pelvic floor. It’s not surprising that the pelvic floor is connected to our digestive process, but understanding how is fascinating.

What is the pelvic floor?

The pelvic floor refers to the layer of muscles that stretch along the bottom of the pelvis, extending from the tailbone to the pubic bone (front to back). These muscles work like a hammock to support the pelvic organs, including the bladder, bowels, and uterus (for women).

The pelvic floor has openings for the urethra, anus, and vagina (for women), and the pelvic floor muscles work with the anal and urethral sphincters to keep these passages shut. This allows us to have control over the bladder and bowels to determine when we release urine, feces, and faltus (wind). The pelvic floor also plays a major role in sexual function for both men and women, and they work with the abdominals and back muscles to support and protect the spine.

That’s a lot of important stuff, right? So why don’t we hear more about the pelvic floor? 

Generally, the pelvic floor muscles do what they need to do. But, when they become weak or damaged, which can happen from a variety of causes including childbirth, this can lead to urinary incontinence, fecal incontinence, and/or pelvic organ prolapse (where the pelvic organs “drop” through the vaginal canal).

When the pelvic floor muscles are too tight (a healthy muscle is able to both contract AND relax), this can cause constipation, straining during bowel movements, and incomplete defecation/emptying.

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Many people with both IBS-D and IBS-C could be experiencing an issue with their pelvic floor that may not get recognized due to the symptoms being a “result of their IBS.” While pelvic floor dysfunction may not be the sole cause of your digestive issues, it could play a major role. And if you’ve been living with IBS for a long time, you may have more damage to your pelvic floor as a result of your symptoms.

If you’re dealing with a weak pelvic floor and incontinence, you can try strengthening your muscles through exercises like pilates. My favorite workout for this is Barre3, because these moves are woven into every class! If you’re dealing with tight pelvic floor muscles and constipation, you can try relaxing your muscles with deep breathing practices, warm baths, and yoga.

If you’re concerned about the health of your pelvic floor, it’s best to work with a physical therapist who specializes in this area. I used to believe simply strengthening my pelvic floor was the answer to all pelvic floor issues, but I’ve recently learned that a personalized plan based on your symptoms is key. They can use biofeedback to help you gain control over your pelvic floor.

For your diet, if you’re dealing with a lot of constipation and straining during bowel movements, look at your fiber intake and hydration. Increasing fiber and water may be able to relieve constipation to prevent damage to the pelvic floor muscles. You may find that using a stool, like a Squatty Potty, helps improve bowel movements and completely emptying the colon. There are also medications, like diazepam, that can help relax the pelvic floor muscles that you can talk to your doctor about.

To learn more about the pelvic floor, I had the honor of interviewing a local physical therapist, Jen Le Coguic, that specializes in this area.


Erin: In the most simple way, can you explain what pelvic floor physical therapy is?


Jen:
Pelvic floor physical therapy is a specialized form of physical therapy with emphasis on the muscles, nerves, and connective tissues within the pelvis. These muscles encircle the openings and form a muscular support layer that runs from your pubic bone, out towards your sits bones, and back to your tailbone.

These muscles help control your bladder, bowel, and sexual function, and they are an integral part of the body’s core stability system by supporting the spine, pelvis, and hips. Dysfunction can arise if these muscles are too weak or too tight.

For example, if the muscles are too weak, a woman may leak urine with coughing or sneezing. On the other hand, if the muscles are too tight or uncoordinated, a woman may have problems with constipation, urinary frequency and urgency, pelvic pain, and/or pain with intercourse.

Erin: What is the function of the pelvic floor?

Jen: The pelvic floor has a wide range of functions but can be summarized by the 5 “S”’s:

  1. Sphincters: Keep things in/ let things pass!

  2. Stability: Stabilize the spine, hips, and pelvis.

  3. Support: Support the pelvic organs in their proper position within the pelvis.

  4. Sexual: Aid in sexual appreciation and orgasm.

  5. Sump pump: Help clear fluid out of the pelvis.

Erin: How would pelvic floor be beneficial for those with IBS?

Jen: In addition to IBS, there are many musculoskeletal conditions that could cause abdominal pain, such as nerve irritation coming from the back or spasms in the muscles of the abdomen. The pelvic floor muscles can even refer up into the lower abdominal region!

It can be helpful to have these areas assessed to see if they contribute to your IBS symptoms. Some physical therapists also have training in visceral mobilization which can be helpful for IBS. “Viscera” refers to the internal organs of the body, such as the stomach and intestines. Visceral mobilization is a gentle manual therapy technique that aids your body’s ability to release restrictions or compensations that can cause pain and dysfunction.

One final component that can be helpful in treating IBS symptoms is learning ways to calm the nervous system. Breathing techniques, such as diaphragmatic breathing, as well as learning how to avoid muscular gripping patterns, can help calm the nervous system and promote healthier bowel function.

Erin: What can we do today to start supporting the health of our pelvic floor?

Jen: Educating ourselves and other women to recognize symptoms of pelvic floor dysfunction and getting evaluated by a pelvic floor therapist if needed are important steps. Many women are not even aware that pelvic floor PT’s (or even their pelvic floor!) exist unless their doctors tell them.

If you have symptoms of incontinence, urinary frequency/urgency, constipation, pain in or around the pelvis (including abdomen and low back), and/or pain with intercourse, you may benefit from an evaluation with a pelvic floor therapist.

It’s also important to realize that pelvic floor treatment is not all about Kegel’s. Many women actually have pelvic floor musculature that is overactive, and they need to work on relaxing and coordinating the musculature.

Pelvic floor PT’s can be an excellent resource for helping you navigate this complicated terrain, and often address many symptoms that women don’t even realize are related.


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