Pelvic Floor Physical Therapy for Bowel Dysfunction in San Francisco, CA

Your pelvic floor muscles voluntarily and involuntarily support your rectum and are directly involved in typical bowel function. When they are functioning correctly, pelvic floor muscles prevent gas and stool leakage, relaxing to evacuate when necessary. The sphincter uses complex neuromuscular signals to detect air, liquid, and solid waste. These signals trigger the pelvic floor muscles to respond involuntarily. Unfortunately, a large group of people in the United States suffer from gastrointestinal distress. When gastrointestinal pain is persistent, pelvic floor dysfunction will follow, consequentially worsening the bowel dysfunction. This creates a painful cycle of Gastrointestinal stress and pelvic pain, but there is a solution. Pelvic floor physical therapy can help break the cycle of discomfort and dysfunction.

The Facts

  • Constipation affects up to 28% of the population
  • Over 25% of all Americans suffer from gastrointestinal distress
  • Anal incontinence and fecal urgency is reported by up to 40% of postpartum women
  • Constipation is three times more common in women than in men and increases over the age of 65
  • Irritable Bowel Syndrome affects up to 30% of U.S citizens
  • Small Intestinal Bacterial Overgrowth (SIBO) affects 38% of the American population
  • Chronic constipation is a leading cause of pelvic pain and pudendal neuralgia
  • Constipation exacerbates bladder and pelvic pain symptoms
  • 3 bowel movements per day to 3 bowel movements per week is considered normal, but less than three bowel movements per week is an abnormal amount


  • Straining to evacuate stool
  • Constipation
  • Need for excessive toilet paper
  • Fecal or gas leakage and incontinence
  • Hemorrhoids and fissures
  • Pain before, during or after bowel movements
  • Anal/rectal pain, burning or itching

Associated Diagnoses

Irritable Bowel Syndrome, Proctalgia Fugax, Small Intestinal Bacterial Overgrowth (SIBO), H. Pylori, Celiac Disease, Endometriosis, Crohn’s disease, Ulcerative Colitis, transit and motility disorders, anal fissures, and hemorrhoids are associated with pelvic floor dysfunction.

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Causes of Bowel Dysfunction

  • Medication-induced constipation (opiates, mood stabilizers, oral contraceptives, etc)
  • Pelvic floor muscle dyssynergia, tightness, and/or weakness
  • Peripheral nerve injuries from childbirth, chronic straining, or surgical trauma
  • Visceral-somatic consequences from gastrointestinal distress (IBS, SIBO, Crohn’s disease, ulcerative colitis, etc)

Diagnostic Challenges

Millions of Americans are plagued by gastrointestinal symptoms and bowel disorders yet many are not referred to pelvic floor physical therapy; therefore, they continue to suffer. Our diets, various medications, environmental factors, and our gastrointestinal and musculoskeletal systems all play a role in keeping our bowels functioning properly. When things go awry many people are offered bits and pieces of appropriate therapies but rarely in a coordinated effort. As pelvic floor physical therapists, we are well-positioned to work with doctors and integrative health providers to make sure all aspects of our patient’s health are being considered and appropriately treated.

How We Can Help You

The pelvic floor muscles are intimately tied to our gastrointestinal system and bowel health. In the presence of gastrointestinal symptoms or difficulty around bowel movements a pelvic floor physical therapy evaluation is warranted. Bowel dysfunction can be associated with pelvic floor muscles that are too tight, and/or too weak, or they can be uncoordinated and do not function properly. It is important to understand that historically people were told to ‘do your kegels’ for bowel health. If your pelvic floor muscles are too tight, kegel exercises may make your symptoms worse, which is why we advise working with a pelvic floor physical therapist to ensure proper rehabilitation. The pelvic floor muscles may need to be lengthened before they are strengthened. During the evaluation, the physical therapist reviews your history and symptoms with you, what you have been diagnosed with in the past, the treatments you have undergone, and how effective or not effective these treatments have been. Importantly, we understand what you have been going through and that most people are frustrated by the time they get to see us.

During the physical examination, the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once the examination is complete your therapist reviews your findings with you. The physical therapist creates an assessment that explains how you developed your symptoms and creates short and long-term goals for your treatment plan.

Most physical therapy treatment programs last around twelve weeks, with sessions 1-2 times per week. You will have an at-home exercise regimen to support the in-person appointments and our physical therapists will assist with your treatment coordination for a smooth, successful recovery.

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Pelvic Health and Rehab Center