Pelvic Floor Physical Therapy

• Many LGBTQ+ individuals with IBD and IBS experience pelvic floor symptoms related to anoreceptive (anal) sex, such as pain, tightness, or difficulty with bowel movements.

• Pelvic Floor Physical Therapy (PFPT) can offer affirming, evidence-based care that improves both function and comfort and enable you to enjoy things you like (whether that is bottoming or whatever you want to do), and daily life as well without painful anal spasms and such.

• Pelvic Floor Physical Therapy (PFPT) is a specialized form of physical therapy focused on the muscles of the pelvic floor, including those involved in bowel function, sexual activity, and core stability.

• More information on pelvic floor PT, with perspectives from both patients with IBD and IBD doctors (as well as IBD doctors who specialize in LGBTQ+ health - here!)

  It can address….

  • Anal pain or tightness.

  • Constipation or incomplete evacuation.

  • Fecal incontinence or leakage.

  • Pain during or after anal sex.

  • Spasm or overactivity of the pelvic floor muscles.

    What does pelvic floor physical therapy do?

  • Pelvic Floor Physical Therapy focuses on the muscles that support the rectum, bladder, and genitals.

  • For LGBTQ+ people, especially those engaging in receptive anal sex or managing gastrointestinal disorders, these muscles can become:

  • Overactive or tight (causing pain, spasm, or difficulty with bowel movements)

  • Weak or poorly coordinated (causing incontinence or urgency)

  • Sensitive to touch, trauma, or dysphoria.

  What happens during pelvic floor physical therapy for anal concerns (particularly from bottoming)?

• They will do an intake, and see what is going on, and discuss what you are needing.

• This assessment may involve (all done with consent and your permission)

• Questions about gender identity, anatomy, and sexual practices.

• Screening for muscle overactivity, dyssynergia, or pelvic floor trauma.

  • An optional external and/or internal (anal) pelvic exam using a gloved finger - you can choose what you want to allow, it is all up to you and under your control.

  • Evaluation of muscle tone, strength, coordination, and trigger points.

  What can it help with?

• Pelvic floor physical therapy can offer a lot of benefits, depending on what you are going into it for!

• Manual therapy: Releasing tight or spastic muscles.

• Breath work and relaxation strategies.

• Biofeedback to retrain pelvic floor coordination.

• Dilator education or re-introduction to pleasurable anal touch.

• Bowel training and toileting mechanics.

• Relief from pain, spasm, and tightness.

• Improved bowel control and ease.

• More confident, pleasurable anal sex.

• Better communication with partners about comfort and boundaries.

• Empowerment in knowing your body and options.

• They can also provide education, including….

  • Tips for comfortable, safer sex (lubrication, warm-up, positioning)

  • Anatomy-affirming strategies for trans patients (e.g., tucking, packing considerations)

  Concerns Pelvic Floor Therapy Can Treat or Help With

• Persistent tightness or burning.

• Painful bowel movements or constipation.

• Fecal incontinence or leakage.

• Loss of comfort or confidence with anal play.

• Discomfort after gender-affirming surgery.

Who Can Benefit?

• People experiencing anal discomfort after sex.

• People with IBD, IBS-C, hemorrhoids, or fissures.

• Trans and nonbinary people navigating pelvic health changes.

• Anyone seeking more confidence and comfort with anal intimacy.

Pelvic floor physical therapy is an effective, affirming approach for LGBTQ+ individuals experiencing pelvic or anal dysfunction, especially post-anal sex. It restores both physical function and sexual wellbeing, respecting personal identity and active consent.
When seeking or referring for PFPT, prioritize providers with expertise in pelvic muscle rehabilitation, anal health, and cultural competence in LGBTQ+ health.