Fiona McMahon PT, DPT Bloating is the worst. It hurts. It makes us feel uncomfortable in our clothes and can be super unpredictable. There is so much that can cause bloating and many times bloating can be caused by more than one thing: diet, gut flora balance (the ratio of good gut bacteria to bad), hormones, and your menstrual cycle/history, for those of us who menstruate. All these things can all play a part in bloating. Did you know the pelvic floor can contribute too? The truth is there are a lot of things that can contribute to bloating. In this blog we will give you a quick overview of where to start as well as explain how a tight pelvic floor can contribute to bloating. Nothing fits and my belly really hurts! Help! I’m so sorry! The first thing I would suggest at this point is get yourself an appointment with a trusted general practitioner. There really is a lot that can go into a rip roarin’ case of abdominal bloating, and having a good clinician to look through possible causes is worth their weight in gold. They are the first line to start sorting this stuff out. Go in prepared, if you notice any dietary contributors try and remember to tell your doc. Do you bloat at a specific time of day or after a specific activity? Does your bloating change based on your menstrual cycle, if you have one? Is there anything else amiss in your health, like fatigue, hair loss, overheating or feeling really cold? All of these details can be so helpful in the hands of the right clinician. My Doctor did a bunch of tests, now what? If your doctor found something on testing, hooray! You are closer than you were before, even if you have yet to see results. Samesies if your doctor didn’t find anything, because now you know the bloating isn’t caused by whatever they tested for. If you haven’t seen results OR didn’t receive a diagnosis at all, it’s time to look a bit deeper into your potential cause of bloating, the pelvic floor. First of all, “The pelvic what?” and second of all, how can I tell if this is an avenue I want to go down? Ah, the pelvic floor. If you are new to this blog, understand you are not alone if you have never heard of it. No one really talks about it, but it’s super important. The pelvic floor lives between the pubic bone in front and tail bone in back. No matter what anatomy you were born with, we all have one. The pelvic floor is a group of muscles that stabilizes the pelvis, regulates urination and defecation, and provides sexual function. When people have pelvic floor dysfunction, many times the muscles are very tight and cannot move well to let stool out or keep urine in amongst other symptoms. A tight pelvic floor can affect your belly bloating by not moving down well to accommodate digestive gas. When we digest our food, the naturally occurring bacteria in our guts put off gas. In a healthy person, the pelvic floor will have some give to accommodate the bloat and allow you to expand like a balloon, up, down, side-to-side, and front to back. If you have a tight pelvic floor, much of the pressure is pushed out through your belly and you get that familiar and rather uncomfortable belly bulge. This is worsened if you have a weak transverse abdominis, which is the lovely little muscle that wraps around your belly and lies underneath to your six pack muscles. You may also find that you get heartburn along with the bloat which can be related to the pressure from the gas pushing up on your upper GI tract. Signs the Pelvic Floor Could be Your Bloating Puzzle Missing Piece Because the pelvic floor does so so so much for the body, we often see pelvic floor issues manifesting in many different aspects of our lives. Here are some symptoms that are caused by pelvic floor dysfunction. If you have these symptoms as well as bloating, pelvic floor physical therapy is very likely to be the right place to go.

• Painful penetration
• Painful orgasm/ejaculation
• Painful sexual arousal
• Urinary pain/burning
• Urinary frequency (going to the bathroom more than once every 2 hours)
• Urinary hesitancy
• Urinary leakage
• Urinary urgency
• Bowel frequency (going more 3+ times a day)
• Bowel urgency
• Constipation
• Bowel incontinence
• Pelvic pain
• Low back pain

How will Pelvic PT Help Me? Pelvic floor physical therapy can help teach tight muscles contributing to bloating how to relax, normalize bowel movements, and strengthen the transversus abdominis, amongst many, many, other things. Learn more about how it can help, here. There is so much that can be done to keep you from warring with your waistband and it may just start with pelvic floor PT. Abraham S, Luscombe G, Kellow J. Pelvic floor dysfunction predicts abdominal bloating and distention in eating disorder patients. Scandinavian Journal of Gastroenterology. 2012. 12(6)