Navigating Incontinence Challenges in IBD: Can Pelvic Therapy Make a Difference?

A holistic approach to pelvic floor strength and function can reduce pain, help with bowel control, and minimize embarrassing accidents.

I’d never heard of pelvic floor therapy until after having babies. Stopping my bladder leaking when I coughed sounded good to me, so I did the squeezy exercises (more formally known as Kegels) for a few months, got my pelvic floor back in shape, and then forgot about it again.

But how does this apply to inflammatory bowel disease (IBD)?

I’ve had both Crohn’s and ulcerative colitis (UC), two forms of IBD, since my late teens. Since then, I’ve tapped into various therapies, medications, and dietary treatments to keep my body healthy. I never once thought about how pelvic floor therapy could help with my IBD. But can it? Let’s find out.

Join the free IBD community!

Connect with thousands of members and find support through daily live chats, curated resources, and one-to-one messaging.

Sign up

More than pelvic floor exercises

It turns out pelvic floor physical therapy (PFPT) is good for more than just preventing urine leakage after giving birth. According to a 2019 systemic review, it’s well established as a useful therapy for fecal incontinence and evacuation difficulties (such as straining, constipation, or feeling like you can’t clear your bowels properly) that occur in people without IBD.

“The pelvic floor muscles play a crucial role in supporting the organs within the pelvis, including the bladder, uterus, and rectum,” says Maritza Linzey, a New Zealand-based core and pelvic floor corrective exercise specialist.

“Pelvic floor physiotherapy involves a combination of techniques, exercises, and education to assess, diagnose, and treat various conditions related to the pelvic floor, such as pelvic pain, pain with sex, injuries to the pelvic floor during childbirth, urinary or fecal incontinence, and pelvic organ prolapse,” she says.

It also involves more than those little squeezy exercises I was doing after pregnancy.

Linzey says a good pelvic floor physiotherapist will use a range of treatments. These can include manual techniques to assess and release tension in the muscles and tissues, biofeedback therapy machines, therapeutic exercises, and lifestyle modifications to optimize the function and coordination of the pelvic floor muscles to improve symptoms and overall pelvic health.

“A fantastic pelvic floor physio will take this a step further and go beyond just looking at your pelvic floor for answers,” says Linzey. “They will take into account how your pelvic floor interacts with the muscles surrounding it and take a whole-body approach to strengthening and stabilizing your pelvic floor function.”

The benefits of pelvic therapy for people with IBD

Pelvic floor therapy may be an effective way to prevent and treat several of the symptoms that people with IBD experience.

For example, fecal incontinence is probably the most embarrassing problem with IBD. Yet it happens to 24–74% of us.

Improved pelvic floor awareness can help with bowel control, says Linzey. “PFPT teaches people about their pelvic floor muscles and how they function. Increased awareness of these muscles allows [people with] IBD to better understand and control their symptoms, such as managing urgency or improving the coordination of bowel movements.”

Constipation is another uncomfortable problem we often face, even during remission. As many as 26% of us with UC and 6% with Crohn’s disease have issues with constipation.

Sluggish bowel muscles make it hard to keep things moving regularly. And we all know what happens next! The three B’s: bloating, blockages, and sometimes even blood when you finally pass a stool. That’s no one’s idea of fun.

“By working on pelvic floor muscle coordination and function, PFPT can help regulate bowel movements. This can help with constipation or diarrhea,” says Linzey.

Pelvic floor dysfunction can also cause pain. You might feel it under your belly button, in your lower back, or as rectal, vaginal, or perineal pain. It’s normal to have pelvic pain due to menstruation or pregnancy, but if people with IBD are feeling pelvic pain at other times, therapy can help.

Linzey says pain is another main reason people may want to seek out PFPT. “Techniques like manual therapy, massage, and stretching, or relaxation exercises can help soothe bloating and discomfort help with pain management.”

How does it work?

First, we need to understand what causes our pelvic floor muscles to become dysfunctional in the first place. For people with IBD, it’s often our body’s response to pain. If going to the toilet is painful, you might clench and have trouble letting go, or the opposite. Both can cause issues.

We need our pelvic floor muscles to work in tandem with our anal sphincter muscles, contracting and relaxing. Years of bloating, distention, and pain can affect our core and pelvic floor muscle function.

Margie from our Bezzy community has UC and pelvic floor dysfunction. “When my pelvic floor was really bad, I was extremely bloated, constipated, had spasms in my pelvis and pain in my back,” says Margie. “My doctor thinks years of colitis could have created the issue with my pelvic floor.”

As Linzey explains, “When we lose muscle tone in our abdominal wall, the [peristaltic] ‘waves’ helping to mix food with enzymes in the small intestine and keep the stool moving along in the colon don’t work as well.

“It’s not just about digestion though — there’s another set of contractions called the motor migrating complex that helps clear out bacteria, food debris, and the cells that shed from our intestinal walls when we’re not eating,” she says. “But if our muscle tone is impaired, we can end up with an overgrowth of bacteria in both our colon and small intestine. So strengthening the core and pelvic floor pressure system improves the underlying muscle tone and helps to support proper gut function.”

Pain and bloating from IBD can also lead to postural problems, adding to our back and hip pain.

“IBD distention and bloating can make anterior pelvic tilt worse,” says Linzey. “This means your hip flexors get even tighter, and it puts more strain on your lower back muscles as they try to keep you upright since your abs aren’t properly engaged.”

“It’s a nasty little feedback loop that strengthening your deep core muscles and pelvic floor can break you free of,” she says. “PFPT can include down-training of hyperactive muscles or strengthening of weaker muscles to rebalance your core and pelvic floor pressure system.”

Who benefits most?

A small study in 2019 found pelvic floor therapy was most helpful for people like myself who are in remission or currently have inactive IBD. For this group, symptoms improved in 68% of people with evacuation difficulty and 80% of people with fecal incontinence.

For people with an ileoanal pouch (also known as a J-pouch), pelvic floor muscle training didn’t appear to reduce the risk or severity of fecal incontinence.

Importantly, you need to find an expert to get the benefits of pelvic floor therapy.

Linzey explains, “You can’t go to a regular sports physiotherapist, for example, and expect them to have the knowledge to be able to manually assess and treat your pelvic floor issues. You need to see a specialist pelvic floor physiotherapist.” In the United States, you can find a specialist at APTA Pelvic Health.

The takeaway

“The best PFPTs will not only help you with your pelvic floor,” says Linzey, “but they will also work on posture, getting you out of anterior pelvic tilt, help you strengthen your deep core muscles, and work on your internal core pressure system and breathing patterns to help support your gut function and nervous system.”

Linzey points out that not every PFPT will take a whole-body approach, so it’s worth asking them if they do at your first appointment.