The Gut-Brain-Pelvic Floor Connection: How Your Belly and Brain Impact Pelvic Health
Your gut does a lot more than digest food. It produces serotonin, houses most of your immune system, and communicates directly with the brain—and even with your pelvic floor.
Thanks to the gut-brain axis, we now understand that gut health can impact a wide range of conditions, including mental health, pelvic pain, constipation, and organ prolapse. And it works both ways: your stress levels and emotional health can also impact your digestion.
In this post, we’ll explore how the gut and brain talk to each other—and how this powerful system influences your pelvic floor.
Understanding the Gut-Brain Axis
The gut-brain axis is the communication superhighway between your digestive system and nervous system. This two-way connection is powered by the enteric nervous system, which contains over 500 million nerve cells that constantly send messages back and forth.
This axis helps regulate:
Nutrient absorption
Inflammation and immune response
Hormone production (like serotonin and estrogen)
Pain perception
Stress responses
You’ve probably felt this connection in action. Ever had butterflies before a big event or felt nauseous during a stressful moment? That’s your gut-brain axis at work.
How Stress Affects Digestion
When we’re stressed, the sympathetic nervous system kicks in—commonly known as “fight or flight.” It helps us escape danger but also puts digestion on pause.
Your body can’t tell the difference between real danger and everyday stressors, such as work overload, conflict with a loved one, or financial worries. If your body stays in stress mode for too long, digestion slows down, nutrient absorption suffers, and gut inflammation increases.
On the flip side, the parasympathetic nervous system (the “rest and digest” mode) helps calm the body and support digestive and hormonal balance. Activating this system through stress-reduction techniques is one of the best things you can do for your gut and overall health.
Gut Disorders and the Pelvic Floor
Because the gut and pelvic floor share space and nerve pathways, digestive issues can have a major impact below the belt. Let’s look at a few examples:
1. Constipation
Constipation is one of the most common gut issues that affects pelvic floor function, and your stool can tell you a lot about what’s going on. When constipated, the stool is hard and dry, which puts strain on the muscles of the pelvic floor, especially during bowel movements. This can lead to:
Hemorrhoids
Anal fissures
Painful bowel movements
Avoidance of going, which worsens the cycle
Chronic straining is also a major risk factor for pelvic organ prolapse (POP). POP occurs when the pelvic organs, such as the bladder, uterus, or rectum, shift out of position and press downward, against the vaginal canal. A 2025 cross-cultural study linked chronic constipation and straining to increased rates of cystoceles (bladder prolapse) and enteroceles (small intestine prolapse). For more information about the different types of prolapse, check out our blog, A Deeper Look Into POP.
Pelvic floor therapy can help retrain these muscles, relieve tension, and reduce symptoms related to constipation and prolapse.
2. IBS, IBD, and Bowel Irregularities
Conditions like Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (IBD), including Crohn’s or Ulcerative Colitis, can cause frequent loose stools or unpredictable bowel movements. When this happens, many people subconsciously clench their pelvic floor all day, trying to maintain control.
Over time, this leads to an overactive and tense pelvic floor, which can cause pain, urinary urgency, and discomfort with sex or bowel movements. A pelvic floor PT can help restore balance and coordination to these muscles.
3. Pain Sensitivity and the Gut-Brain Loop
Chronic gut inflammation or discomfort can actually change or “rewire” our brain’s pain response over time. This phenomenon, known as central sensitization, means that minor pain signals from the pelvic floor may be interpreted as much more intense. It can make the body more sensitive to things that wouldn’t usually be painful, and also have a more intense pain response than typical.
So, a little tightness in your pelvic muscles could feel like burning, stabbing, or deep aching. Managing gut health is key to managing chronic pelvic pain.
4. SIBO (Small Intestine Bacterial Overgrowth)
Another condition that often goes hand-in-hand with gut dysfunction is Small Intestine Bacterial Overgrowth (SIBO). SIBO occurs when excess bacteria build up in the small intestine, leading to bloating, gas, abdominal pain, and irregular bowel movements. These symptoms can put stress on the abdominal wall and pelvic floor, especially when bloating causes pressure or tightness in the core. SIBO is also linked with slowed motility, which increases the risk of constipation—a major contributor to pelvic floor dysfunction.
Inflammation Travels
Inflammation in the gut doesn’t stay in one place. It can spread through nearby tissues, affecting the bladder, uterus, ovaries, or rectum. That’s why unresolved chronic gut inflammation can contribute to pelvic pain, urinary symptoms, and menstrual changes.
TW: Disordered Eating and the Pelvic Floor*
*This section briefly discusses disordered eating and recovery. Please skip if this may be triggering for you.
Disordered eating and recovery can also affect the pelvic floor.
Think of your trunk like a canister: the pelvic floor is the bottom, and the abdominal wall and back are the sides. If someone habitually sucks in their stomach due to body image concerns, this increases pressure on the pelvic floor and limits diaphragmatic breathing. The pelvic floor will remain more clenched and overactive.
Purging or repeated laxative use is also associated with more pressure and strain on the pelvic floor and can lead to issues like pelvic organ prolapse or abnormal colon transit. Moreover, nutritional and fiber deficits associated with disordered eating are linked to slower gut motility and an increased risk of constipation. As someone goes through recovery work to increase food intake for weight restoration and nutrient intake, they may experience periods of abdominal bloating, distension, slow stomach emptying, and slow colon transit.
Pelvic floor physical therapy can be a valuable component of the healing process during recovery.
Microbiome and Hormonal Health
The gut microbiome is the collection of microorganisms and bacteria that live throughout the digestive system, but primarily in your intestines. The vaginal microbiome is separate, but just as important. Both play a vital role in immune health, hormone balance, and protecting against infection.
Inflammatory gut bacteria can increase pain sensitivity and inflammation, both of which affect pelvic floor function. This 2022 review looked at the relationship between certain gut bacteria and female gynecologic disorders. It was found that certain gut bacteria help metabolize and regulate estrogen, a hormone essential for overall body health, and particularly for vaginal tissue health. The review found that abnormalities of this particular gut bacteria can hurt the vaginal microbiome, leading to:
Vaginal infections (like bacterial vaginosis or recurrent UTIs)
Gynecologic/hormonal conditions (like PCOS, uterine fibroids, endometriosis, genitourinary syndrome of menopause)
Fertility issues
Increased risk of cervical and endometrial cancers
Supporting Your Gut and Pelvic Floor
If your gut and pelvic floor are this connected, how can you support them both? Start with these gut-friendly strategies:
Eat a wide variety of colorful fruits and vegetables
Add anti-inflammatory spices like garlic, turmeric, ginger, and cinnamon
Choose whole foods over processed foods
Include fermented foods in your diet (like yogurt, sauerkraut, kimchi)
Increase your fiber intake slowly and consistently
And don’t forget: stress management is essential. Try some of these stress-relief techniques to calm and soothe the body, activating the parasympathetic nervous system to support digestive and hormonal balance.
Gentle movement, such as walking, biking, or yoga
Breathing exercises
Meditation and other mindfulness practices, such as journaling
Self-massage
Pelvic floor therapy (which can help activate the parasympathetic nervous system and get digestion and healing back on track).
Recap: Gut & Pelvic Floor Key Takeaways
The gut and pelvic floor are closely connected through nerve pathways, pressure systems, and the microbiome.
Gut issues like constipation, IBS, IBD, SIBO, and inflammation can all impact pelvic floor function.
Supporting gut health through nutrition, stress relief, and pelvic floor therapy can reduce pain and improve quality of life.
The gut, brain, and pelvic floor are in constant communication with each other. If something is off in one area, it often shows up in the others. That’s why pelvic floor physical therapy doesn’t just focus on muscles—it takes your whole body and nervous system into account.
If you’re dealing with constipation, pelvic pain, prolapse, or bowel or bladder changes, working with a pelvic floor PT can help uncover the root cause and support lasting relief.
About Pelvic Health & Wellness
Pelvic Health & Wellness was built with you in mind. We practice whole-person, individualized pelvic floor physical therapy in a caring and safe environment. Our physical therapists specialize in treating pelvic health concerns such as pelvic floor dysfunction, bowel and gut health, pelvic pain, pelvic organ prolapse, constipation, incontinence, fertility, and various pregnancy and postpartum-related conditions.
We understand that being ready to talk about and address your pelvic floor wellness concerns comes from a place of strength. We are here to support and encourage you on your journey back to health so you can return to doing what you love! If you are ready to take the first step in reclaiming your pelvic health and wellness, don't hesitate to get in touch with us today.