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How Pelvic Physical Therapy Can Help With Digestive Issues

acidreflux biofeedback bowel breathingtechniques constipation digestion gerd nervoussystem pelvicphysicaltherapy sibo Aug 04, 2022

When you think of physical therapy, you may think of rehabbing your knee or elbow after an injury in a large gym setting. Did you know that there are pelvic physical therapists that can help with digestive dysfunction?

Many of my clients are surprised to hear that digestive issues like IBSSIBO, and GERD may have multiple causes or complications that may contribute to symptoms. While changing your diet can help, we need to address physical dysfunction for maximum relief and lasting results.

How Can Pelvic Physical Therapy Help with GERD?

Acid reflux or GERD may be caused by a hiatal hernia which is diagnosed by a gastroenterologist. 

  • A hiatal hernia occurs when the stomach protrudes through an opening in the diaphragm, pushing it into the chest cavity.
  • This can move the esophagus higher into the chest, so it may not close properly.
  • When this happens, stomach acid and/or acidic contents from the stomach can move into the esophagus, where it does not belong.
  • Symptoms include acid reflux, chest pain, bloating, feeling that food is not digesting, and more.

A pelvic physical therapist can do gentle visceral mobilization techniques and work on the spine to help the stomach and organs move and thereby function better.

How Can Pelvic Physical Therapy Help with SIBO?

If you've had abdominal surgery, you may have scar tissue in or pressing up against the small or large intestine. These are called adhesions and can cause 'kinks in the hose,' which can impede the forward motion of digesting food or stool. 

Adhesions are a common root cause of SIBO. The adhesions can be loosened and smoothed out by a pelvic physical therapist with visceral mobilization training to encourage proper digestive function.

Another potential root cause of SIBO is a malfunctioning ileocecal valve. This is the valve located between the small and large intestines. Its job is to prevent the retrograde movement of stool (and bacteria) into the small intestine. If it's not working correctly, it may need a "tune-up" via visceral mobilization and gentle spine muscle myofascial release by a pelvic physical therapist.

How Can Pelvic Physical Therapy help with constipation?

Have you been diagnosed with chronic constipation, IBS-C, or SIBO-C? As noted above, constipation can be caused by the adhesions created by abdominal surgery. Constipation can also be caused by "pelvic floor dyssynergia." This happens when the anal muscles constrict instead of relaxing during a bowel movement. Evelyn Hecht PT is a physical therapist specializing in pelvic floor and GI issues at EMH Physical Therapy in Sag Harbor. She describes a variety of techniques that can be used to help improve constipation, including:

  • Gentle manual therapies and release techniques to restricted muscles and fascia of the pelvic floor.
  • Visceral mobilization techniques help the abdominal organs move better and function optimally.
  • Biofeedback to retrain the pelvic floor muscles, so they relax and open fully during a bowel movement and not stay contracted.
  • Teach breathing techniques and other stretching exercises that stimulate the parasympathetic nervous system (this is the part of the nervous system responsible for the rest and digestion functions of the body).

She also shared a great massage technique you can perform at home to reduce bloat and stimulate bowel movements.

How to Do the "I Love You" (ILU) Massage: 

Apply very light cream to your abdomen region first. With your fingertips, lightly stroke clockwise, starting from the lower right pelvis upwards to just below the rib cage, then across to just below the left rib cage, then down to the lower left pelvis. You can add small circular motions. Repeat for 1-3 minutes or until you hear a 'gurgling' of your stomach. You can find a video about this and other self-care techniques at

How Can Pelvic Physical Therapy Help with Abdominal Distension?

You know those pictures people post on social media where they look five months pregnant after eating or towards the end of the day? While we may call it bloating - medically, it's referred to as abdominal distension.

Doctors refer to bloating as a sensation that you may register as fullness, heaviness, or general discomfort in the lower abdomen. It may be caused by overeating, eating foods you don't tolerate, dysbiosis, or being constipated.

Distension, on the other hand, refers to the physical expansion of the abdomen. While abdominal distension may occur with IBS or SIBO, it may be caused by a condition called 'abdomino-phrenic dyssynergia.'

In this situation, the bloating sensation sends the wrong signal to the brain. The diaphragm presses down against the stomach when eating instead of moving up, allowing the stomach to expand when eating.

A pelvic physical therapist teaches breathing techniques, gentle stretches, and/or biofeedback to alleviate this condition.

How do You Find a Qualified Pelvic Physical Therapist?

I highly recommend Evelyn Hecht, PT, if you live in the Hamptons.

Outside the Hamptons, search for a pelvic physical therapist specializing in your digestive condition or symptom.

Evelyn created PelvicSense, an online pelvic healing home program so anyone struggling with these issues can learn how to heal. The educational program and guided mind/body exercises help you significantly heal in 3 months. One of her members writes: "it's a gold mine for pelvic healing." 

As a nutritionist using the functional medicine approach, my job doesn't just stop with recommending a diet and supplements. I help my clients understand WHY they are struggling with digestive issues. And in some cases of GERD, constipation, or abdominal bloating and distension, the root causes may be a hypersensitive nervous system and underlying chronic pelvic floor muscle tension. You can benefit from seeing a pelvic physical therapist and practicing Evelyn's affordable home program.

Author: Sara Kahn, MS, CNS, CDN is a Certified Dietitian Nutritionist

Belly Bliss Nutrition