IBS and pelvic floor dysfunction: understanding the connection and how to treat it

Living with irritable bowel syndrome (IBS) can feel unpredictable. One day you’re dealing with constipation, the next it’s urgent trips to the bathroom, bloating, cramping, or pelvic pain. And for many people, those digestive symptoms don’t exist in isolation — they’re closely connected to the muscles and nerves of the pelvic floor.

In fact, research shows there’s significant overlap between IBS and pelvic floor dysfunction. “Your pelvic floor muscles and your digestive system work together very closely,” says Dulce Bhatt, PT, DPT, a pelvic floor physical therapist with Hinge Health. “When one system becomes irritated or dysregulated, the other often does too.”

Gentle movement, pelvic floor physical therapy, stress management, and bowel retraining strategies can all help improve symptoms and quality of life.

Here’s what to know about the connection between IBS and pelvic floor dysfunction, and how treatments like targeted exercises recommended by Hinge Health physical therapists may help.

The above exercises all help to strengthen and stretch pelvic floor muscles, so you can better manage both your pelvic floor dysfunction and your IBS. Diaphragmatic breathing allows you to coordinate your abdominal and pelvic floor muscles. Stretches like child’s pose and happy baby help release tension from tight pelvic floor muscles, while the glute stretch targets your hip muscles. Finally, deep squatting relaxes pelvic floor muscles, so you can have more coordinated bowel movements. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for IBS and pelvic floor dysfunction

Since IBS and pelvic floor dysfunction go hand in hand, treatment approaches should address both issues. “When you treat pelvic floor dysfunction with pelvic floor therapy, you see an improvement in both IBS and pelvic pain,” explains Dr. Bhatt. These simple strategies include:

• Try pelvic floor physical therapy and targeted exercises. Targeted exercises, such as the ones above, help relax tense pelvic floor muscles and improve coordination so you can have more comfortable bowel movements. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. Walking, yoga, stretching, and mobility exercises can all help improve circulation, digestion, and muscle relaxation. “The more active we are, the more it stimulates blood flow to both your GI tract and your pelvic region,” explains Dr. Bhatt. 

• Practice stress management. Mindfulness techniques, such as breathing exercises, meditation, and talking to a therapist, can help calm the gut-brain connection and reduce symptom flare-ups.

• Make dietary changes. You may find that certain foods, including dairy, beans, or cruciferous vegetables like broccoli or cabbage, tend to worsen your IBS symptoms. Your health care provider may recommend that you try a low-FODMAP diet temporarily, which eliminates foods with specific carbohydrates that can trigger flares.

• Try over-the-counter (OTC) options. If you have IBS-C, your health care provider may suggest you take a fiber supplement or an OTC laxative like polyethylene glycol (Miralax). 

• Try a belly massage. Another option you can do yourself is a belly massage. “Right before you go to the bathroom to have a bowel movement, gently massage your stomach,” says Dr. Bhatt. “Begin at your right hip, move up across your rib cage, and then back down in a circular pattern.” 

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for IBS and pelvic floor pain relief, such as massage, acupuncture, or chiropractic care. 

Tips to manage IBS and pelvic floor dysfunction 

Small, consistent habits — from how you breathe to how you sit on the toilet — can reduce strain on your pelvic floor and support better bowel function with IBS. Consider these tips:

• Don’t strain or push. Bearing down hard during bowel movements increases pelvic floor tension. “When you strain or push, your anal sphincter closes up, which makes it even harder to have a BM,” explains Dr. Bhatt. 

• Use a footstool. A slight squat position on the toilet (like a Squatty Potty) can make it easier to have a BM. “It relaxes your pelvic floor and helps to straighten out your rectum,” says Dr. Bhatt. 

• Don’t rush or linger. Sitting on the toilet for extended periods increases pelvic floor strain. Go when you have a clear urge, then leave.

• Move your body daily. Regular walking and gentle movement have been shown to improve both IBS and pelvic floor symptoms. 

• Mind the stress connection. Stress can worsen both IBS and pelvic pain. “It activates the gut-brain axis, which can either speed up or slow down your gut, and tighten pelvic muscles,” says Dr. Bhatt. Brief breathwork or relaxation practices can help interrupt this cycle. 

When to see a doctor

IBS-related pelvic symptoms often improve with pelvic floor physical therapy and lifestyle changes. But if your symptoms are severe, worsening, or significantly affecting daily life, see a healthcare provider. It’s also a good idea to get care if you have unanswered questions or concerning symptoms like:

• Persistent constipation or diarrhea

• Blood in stool

• Unexplained weight loss

• Severe abdominal or pelvic pain

• Pain with bowel movements

• Symptoms that interfere with daily life

• Difficulty controlling bowel movements

• Ongoing pelvic pressure or urinary symptoms

Can pelvic floor dysfunction be misdiagnosed as IBS? 

Absolutely. “Many people are told their symptoms are just part of IBS, when in reality it’s both IBS and pelvic floor dysfunction,” says Dr. Bhatt. But if you’ve tried treatments to manage your IBS, like diet, medications, and cognitive behavior therapy, and they don’t address your symptoms, she suggests you make an appointment with a pelvic floor physical therapist. Pelvic floor dysfunction often can’t be cured entirely, but for many people, symptoms significantly improve with consistent pelvic floor therapy. 

PT tip: Manage your stress

Stress doesn’t cause IBS or pelvic floor dysfunction, but it can absolutely worsen symptoms. “People sometimes feel frustrated when they hear stress plays a role, because they think it means the symptoms are ‘all in their head,’” says Dr. Bhatt. “But stress creates very real physical changes in the nervous system, muscles, and digestion.” Prioritizing stress management, sleep, gentle movement, and recovery can help calm both the gut and pelvic floor over time.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.