If you have irritable bowel syndrome (IBS), you know what we mean when we talk about a “sensitive stomach.” You may feel like your bowels control your life. You don’t want to go to social events because you are worried about pain, gas, and leaking, or you may be worried about intimacy with your partner for the same reasons. Don’t feel hopeless! The prognosis is good for controlling symptoms of IBS through lifestyle changes (Goodman, 2009). This week we are going to dive into what irritable bowel syndrome is, how it affects the pelvic floor, and what treatment options you have.
IBS is one of the most common gastrointestinal disorders in the United States affecting 10-15% of individuals, and it is the most common reason for a referral to a gastroenterologist (Goodman, 2009; Irion 2010). IBS is more prevalent in women than men (Goodman, 2009). It is important to note that IBS does not cause changes in bowel tissue, does not have an inflammatory component, and it does not increase the risk of colorectal cancer like inflammatory bowel disease (IBD). Since IBS and IBD have similar symptoms (and similar names), it is important to see a healthcare provider to determine which you have. A healthcare provider can also help to rule out other conditions with similar symptoms like parasites or cancer.
What are the Symptoms of IBS? (Mayo Clinic, 2020)
Cramping
Abdominal pain
Bloating
Gas
Diarrhea, constipation, or both
IBS is often classified as one of three subtypes: diarrhea predominant, constipation predominant, or mixed with both diarrhea and constipation (Mayo Clinic, 2017).
What Causes IBS?
While the exact cause of IBS is still not known, researchers think it involves both the motor and sensory systems of the gastrointestinal tract and the central nervous system (your brain and spinal cord) (Irion, 2010). IBS is thought to be caused by abnormal contractions of the smooth muscles in the intestinal tract in response to certain triggers like emotions, stress, or certain chemicals in foods (like caffeine or lactose) (Goodman, 2009). It may also be cause by an imbalance of the “good bacteria” in the gut or an imbalance of the neurotransmitter serotonin (Goodman, 2009).
How does IBS affect the pelvic floor? (Irion, 2010)
The symptoms of IBS can cause a cascade of events that lead to pelvic floor dysfunction. Constipation and diarrhea can lead to anal incontinence (unable to hold in gas, poop, or both). IBS is also associated with chronic pelvic pain. Chronic pelvic pain can lead to incoordination and weakness of the pelvic floor muscles causing a variety of symptoms like:
Urinary frequency and urgency
Dyspareunia (pain with sex)
Low back pain
IBS is also associated with sleep difficulties, fibromyalgia, chronic fatigue syndrome, and temporomandibular joint (TMJ) dysfunction which can indirectly impact pelvic floor health (Goodman, 2009)
What Are My Treatment Options for IBS?
Keep in mind that this is not medical advice. This information is for educational purposes and can be used to guide conversations with your individual providers.
Regular exercise can help improve bowel motility and reduce overall stress (Irion, 2010; Goodman 2009)
Getting enough fiber in your diet, either through whole foods or supplements like psyllium husks or flaxseed (normal adults should aim for 25-38 grams per day)
Taking pre- and pro-biotics, but research is limited on how helpful this is (Ford, 2018)
Soft tissue work to address adhesions and tight muscles of the hips, pelvis, chest, abdomen, and back
Diaphragmatic breathing and relaxation techniques to calm the central nervous system
Stress management and psychotherapy for dealing with dramatic lifestyle changes, problems in relationships and work
Working with a dietitian to determine what foods may trigger your symptoms
Low FODMAP Diet (Mayo Clinic, 2017)
Medications depending on type of IBS (Irion)—your provider can prescribe medications to slow transit time if you are experiencing diarrhea symptoms or to speed up transit time if you are experiencing constipation
Abdominal Bowel Massage to help manage constipation, learn more here
Good toileting habits—a Squatty Potty is your friend!
Managing IBS successfully can take the teamwork of several providers including primary care providers, gastroenterologists, registered dietitians, psychologists, and of course, pelvic floor physical therapists.
A pelvic floor physical therapist can be a great resource for managing chronic pelvic pain, constipation, and anal incontinence. They are highly trained in soft tissue work, breathing techniques, and central nervous system down training to help alleviate the stress response. The YouTube video below by Jeanice is a great place to start when learning about pooping well.
Here are some great resources to learn more about your pelvic floor good pooping habits:
Ask your healthcare provider for a referral to a pelvic therapist.
Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.
Watch our YouTube video Irritable Bowel Syndrome with Dr. Kumkum Patel, MD, MPH
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics
Sign up for our email newsletter!
For providers, check our online courses to help your clients experiencing bowel dysfunction. Consider joining our Ambassador Program and most of our courses are included with your membership!
Pelvic Floor Rehabilitation for Inflammatory Bowel Disease with Amanda Olson, PT, DPT, PRPC
Prep H: Hemorrhoids in Pregnancy and the Postpartum Period with Lacy Forsyth BA (Hons); MA; MPT
What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.
Written by Emily Reul, PT, DPT
References
1. Irion JM, Irion GL. Women’s Health in Physical Therapy. Lippincott Williams and Wilkins; 2010.
2. Irritable bowel syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016. Published October 15, 2020. Accessed May 18, 2021.
3. Goodman CC, Fuller KS. Pathology: implications for the physical therapist. 3rdedition.2009. Saunders Elsevier St. Louis, MO. P 850-861
4. The role of lifestyle-related treatments for IBS. Mayo Clinic. https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/the-role-of-lifestyle-related-treatments-for-ibs/mac-20431272 . Published March 28, 2017. Accessed May 18, 2021.
5. Ford AC, et al. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Phamacol Ther. 2018;48(10):1044-1060.