Irritable Bowel Syndrome

Patients who participate in pelvic floor physical therapy can present with bowel dysfunction which encompasses a myriad of conditions from constipation to the other end of the spectrum being fecal incontinence (FI).  As a fairly new pelvic floor physical therapist having worked at Sullivan PT for 1 year and 3 months, I admit that I struggle with resolving bowel issues.  I have learned that there is a fine balance that needs to be figured out with regards to gastrointestinal (GI) function, primarily gut health, as well as the musculoskeletal component including addressing any muscle tension and connective tissue restrictions within the pelvic girdle or addressing pelvic floor muscle weakness.  I find that one of the main difficulties I have is setting the right expectations in terms of “healing time” as like with any other systems, each person’s body responds differently to physical therapy.  For FI, more often than not, the time frame for symptom improvements tends to be a higher duration due to the time it can take for a muscle to get stronger, physiologically speaking.

Since I have struggled with this condition, I took an opportunity to do some research and found a couple of articles which delved into Irritable Bowel Syndrome (IBS) as well as FI.  In the article I found regarding IBS, patients tend to have tense pelvic floor muscles.  An effective PT treatment involves providing education and prescribing exercises to address behavioral aspects that contribute to symptoms such as incorrect toilet posture, prolonged time spent in the toilet, and use of inappropriate cues to trigger need to defecate.  This information was provided in the article which was called “Treatment of irritable bowel syndrome” written by Chamara Basnayake, MD.  On the other hand, the article regarding FI mentioned that sacroiliac joint (SIJ) pain and pelvic ligaments can contribute to fecal leakage due to the effect on the nerve which innervates GI organs.  This information was provided in the article which was called “Faecal urgency and pelvic pain: a case study implicating pudendal nerve entrapment” written by Peter Dornan, PT.

Fit Splint

“I had a c-section, so my pelvic floor is totally fine.” Probably not.

Patients who have undergone vaginal delivery and are working with me to eliminate postpartum symptoms such as urinary leakage, pain with intercourse at the site of tearing, or prolapse will sometimes say “I wish I would have just had a c-section, then I wouldn’t have all of these problems.”  Well…yes and no. They may not have presented in exactly the same way, but I think, when it comes to coping with symptoms postpartum, the grass is always assumed greener on the other-method-of-delivery side.

For individuals who have undergone a c-section, sometimes I feel that postpartum recovery education is even less available (if that could be possible).   There are many symptoms that we see in these moms that are very treatable, even years down the road but everyone seems to think that because they had a surgical procedure, they just have to deal with the aftermath. False.

Symptoms commonly reported:

  • Problem: The scar itself may be painful and restricted or is unsightly

Fix:  we can perform scar massage to decrease restrictions and alleviate pain, while desensitizing the skin, sometimes even (as a bonus) getting clothing to fit better and get rid of that shelf-like appearance over the scar.

  • Problem: The individual feels like they have no abdominal strength, or they have back pain


Insight/Fix: Again, we’ll work through scar tissue while teaching the patient to properly activate abdominal musculature in the proper manner . Once abdominals can work as they were prior to surgery, those muscles can support the spine, thereby resulting in decreased back pain with activities and safe return to exercise.


  • Problem: Bladder frequency and urgency, leakage

Insight/Fix: This one is actually often overlooked as having anything to do with caesarean  history.  Very frequently, we find significant scar tissue deep to the visible scar.  What you can see is really just the tip of the iceberg. Those deep aspects can become wrapped around the area of the bladder, limiting the bladder’s ability to fill well and causing bladder spasms.  This can make it feel like you have to pee all the time or actually contribute to bladder leakage when it feels like you have to pee.  Manual work to the scar and bladder can often make a huge impact in these symptoms.


  • Problem: Painful intercourse

Insight/Fix: if  the uterus or deep aspect of vaginal canal are also restricted or have scar tissue wrapped around them, the scar can actually be a large contributing factor to painful intercourse.

A mix of internal and external manual therapy can alleviate this pain.


Take home points: A caesarean  is not a routine procedure. It involves lots of disruption of the musculature and tissue throughout the area and forms significant scarring that can cause numerous abdominal and pelvic symptoms.  See a pelvic floor physical therapist to assess your scar and find out what can be done to help you heal fully.




There can be many factors as to why someone might experience pelvic pain. Injury, scar tissue, past surgeries, or even overly contracted pelvic floor musculature may be the culprit. Endometriosis is also a diagnosis that can sometimes be overlooked as a factor in pelvic pain and pelvic floor dysfunction. Endometriosis is a condition where the inside lining of the uterus, the endometrium, be found on other areas of the abdominal cavity outside of the uterus. Endometrial tissue has been found in some women to be on the ovaries, fallopian tubes, peritoneum, bladder, bowels, rectum, and in some studies even in the eye! Now, how did it get there, you ask? Researchers and still investigating how this might be the case, but a working theory is that this tissue gets displaced during fetal development, or the activation of certain genes, a science called epigenetics, later on in child or adulthood.

Endometrial tissue is unique in that it is receptive to normal cyclical hormonal changes of the menstrual cycle and bleeds and sheds every month. This process works just as designed when this tissue is inside of the uterus and has a way to exit our body through the vagina. When endometrial tissue is found in areas outside the uterus, however, it cannot be eliminated which can create irritation and inflammation to the surrounding tissues or organs. Over time, this can create scar tissue or adhesions throughout the abdominal cavity, causing pain and inflammation.

Common symptoms of endometriosis include painful, debilitating periods. Not just gentle cramping that makes you reach for a heating pad or your nearest ibuprofen, but unable to get out of bed, go to work, or engage with family or friends type of pain. Heavy bleeding or clotting, fatigue, excessive abdominal bloating, painful bowel movements, constipation, painful sex or bladder urgency and frequency or infertility are also potential symptoms for endometriosis.

Women who have endometriosis may wait anywhere on average from 6-11 years from first symptoms to final diagnosis. Diagnosis can be challenging as surgery is currently considered the gold standard, meaning physicians must look at the tissue via small cameras inserted through the abdomen in order to be diagnosed. Current treatments to assist in reducing symptoms for endometriosis include hormonal birth control and surgery via excision or ablation. Other treatment modalities such as acupuncture, modifications to diet and exercise, yoga, meditation and mindfulness practice, self care routines, and pelvic floor PT may be helpful in management of pelvic pain from endometriosis. Communicating with your doctor and other providers of your health care team allow for the best plan to be created based on what your specific needs are.




Optimizing the Digestive System

A proper functioning digestive system acts as a good barrier to undigested food particles, bacteria, mold, and yeast. Additionally, it allows for optimal nutrient absorption. If our digestive system is not functioning properly, one could experience digestive complaints such as heartburn, difficulty swallowing, bloating, abdominal pain, gas, and diarrhea and/or constipation. Additionally, one may experience symptoms of food sensitivities including eczema, headaches, sinus infection, difficulty with weight loss or weight gain, allergies, and asthma.


There are a variety of reasons our digestive system may not be functioning at an optimal level. The good news is there are certain lifestyle modifications one can begin to make in order to improve the function. Below are 3 suggestions you can begin to incorporate into your life to optimize digestion.


  1. Our brain and gut work together, therefore, the sight of food alone can trigger thoughts in the brain that trigger a stress response. When eating under a stressful environment, our body does not produce the digestive juices, saliva, and digestive enzymes necessary to help digest and absorb food. On the other hand, when we eat in a relaxed environment and feel pleasure with eating, these responses do occur. Due to this, it is important to eat in an environment that is calm and relaxing and to prepare our foods in a way that appeal to us – this includes the look, smell, and taste of our foods.
  2. Adequate chewing is necessary to ensure our food is broken down into small enough pieces for our body to absorb. Smaller particles are absorbed into our system at a faster rate than larger particles. Additionally, larger particles may get eliminated before they are absorbed. This means one could be eating nutrient rich foods, but not receive the benefits of those nutrients if they are eliminated prior to absorption. Research shows chewing each bite of food 40 times is optimal, especially for harder foods like nuts.
  3. General stress management is important for many aspects of our lives. As far as digestion goes, general stress can interfere with our ability to produce enough stomach acid, which helps us to properly absorb and digest various nutrients, vitamins, and minerals. Therefore, stress management is key for proper digestive functioning. Incorporating simple stress management strategies, such as meditation and deep breathing, can be very helpful to ensure optimal digestion.



Going on a walk can be a great activity for self care and has multiple benefits for our health. It is great for our heart and lungs, helps build bone density and safe for our joints, gets us outdoors in the fresh air, reduces time spent in front of a screen, helps us relax, clears our mind, and just plain and simply gets us moving. Researchers recommend getting 30 minutes of brisk walking in most days of the week, meaning you can still talk to a friend while you are walking, but maybe not sing and dance. If walking 30 minutes is too difficult to do at once, break it up by starting at 8-10 minutes and slowly increase your time.

How you walk can be just as important as the walking itself. Is your posture rounded through your shoulders with your head down, or are you upright, head and shoulders back, with a smile? Studies have shown your posture can effect the things you remember, and potentially your mood. Mindful walking, taking in the scenery, feeling your body move, and focusing on your breath can decrease mental stress and improve quality of life.

Having trouble finding time to incorporate walking into your daily routine? Try scheduling it at the same time each day. If this is challenging to do, here are some other useful tips to get those steps in.

-Take the stairs instead of the elevator whenever you have the opportunity

-Park at the back of the parking lot when you go to the store

-walk your dog

-get off public transport one stop earlier

-have your ride share driver drop you off at the end of your block.

You might find asking a friend or neighbor to walk with makes it more enjoyable and helps to keep you accountable. Writing a log or keeping track of your activity can also help with making self care happen and meeting your self care goals.