Irritable Bowel Syndrome: The Ins and Outs of Colon Health

Irritable-Bowel-Syndrome

April is Irritable Bowel Syndrome (IBS) awareness month. Most of us know that IBS can make one feel pretty uncomfortable, and how we can make our symptoms better can be a bit of a mystery. In this blog we will discuss what IBS is, what is the current thinking on what causes IBS, and what steps you can take now and over the course of your life to improve your symptoms.

So what’s IBS?

IBS is a condition affecting the large intestine aka the colon. The colon is the next to the last stop in the digestive system, before the anus, and its function is to draw out water from the feces, so we don’t get dehydrated. IBS is a dysfunction of the smooth (involuntary) muscles of the colon. The colon’s muscles in people with IBS may be too weak (causing constipation and bloating) or may be prone to frequent spasm (causing diarrhea). It is possible for people with IBS to alternate between uncomfortable bouts of constipation and diarrhea. Because IBS is a dysfunction of the smooth muscle of the colon and doesn’t actually change the colon itself, it can’t be seen with imaging such as CT scans or colonoscopies, which can be tremendously frustrating to people with IBS who are suffering with very real symptoms.

IBS is an extremely common condition in the United States and affects 1 in 5 Americans. IBS is a syndrome that disproportionately affects women, with women being twice as likely to suffer from the condition. A higher incidence of IBS is also associated with people who are under 45, have mental health issues, or who have a familial history of IBS.

What can one do about IBS?

The unfortunate truth about IBS, is that currently, no cure exists for IBS. There are, however, many management strategies and treatments that can alleviate symptoms and make life with IBS much more manageable.

There are many lifestyle changes you can make to ensure an easier life. You may find that eliminating high gas foods such as sodas, cabbage, broccoli, or cauliflower helpful. There is also some preliminary evidence suggesting that eliminating gluten is also helpful, other studies suggest that low FODMAP diets are helpful. Identifying your specific food triggers can be a daunting task, We at Beyond Basics have an excellent cadre of nutritionists, who we sometimes refer our patients to if they want extra help determining their triggers. Guidance from a good nutritionist can do wonders for IBS.

Managing stress effectively can also help to lessen your IBS symptoms. The American College of Gastroenterology has concluded that treatment, such as hypnotherapy, cognitive behavioral therapy, and dynamic psychotherapy for comorbid psychological conditions is more effective than placebo treatment for IBS.

Dysfunction in organs can also cause dysfunction in the skeletal muscles that are close by. This is called the visceral-somatic reflex. One of the most common examples is when someone feels left arm pain when they are having a heart attack. The dysfunction in the heart causes pain and spasm in nearby muscles. The same thing can happen when the gut is irritated in conditions like IBS. Typically, people with IBS will feel pain and spasm in the muscles of their abdomen and pelvic floor as a result of the irritation in their gut. To add insult to injury, spasm in the pelvic floor can adversely affect the passage of stool out of the body and make symptoms even worse.

Pelvic floor physical therapy can help symptoms caused by the visceral somatic reflex greatly. At Beyond Basics we have an excellent crew of pelvic floor physical therapists with expertise in visceral mobilization and pelvic floor dysfunction.  Our physical therapists can work to eliminate painful spasms, mobilize restrictions and teach self-management techniques to keep symptoms at bay in the future.

You may find that certain medications help. Definitely speak to your doctor for recommendations. In addition to medical and physical therapy treatments, alternative medicine practices such as acupuncture and herbal therapy have been shown to alleviate IBS symptoms.

Final Thoughts

IBS is an uncomfortable, sometimes painful, but manageable condition that affects many Americans. There are many options to explore to help with your symptoms. Take the time to find out what your triggers are and seek out the help of a healthcare professional to guide you through lifestyle changes to improve your symptoms and quality of life.

Sources:

Lehrer J. Irritable Bowel Syndrome. Medscape. Jun 16, 2015

Ward R. Foundations for Osteopathic MedicineLippincott Williams & Wilkins, 2003

Mayo Clinic. Diseases and conditions: irritable bowel syndrome. http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/definition/con-20024578. Accessed April 3, 2016

 

EndoWhat? Documentary

Amy Stein speaks in Endwhat? Documentary about the benefits that Physical Therapy can have in the management and treatment of Endometriosis in conjunction with other treatments/therapies/medical options.

If you have not watched the EndoWhat? Documentary about women with Endometriosis go to http://www.endowhat.com to find out more about the documentary.

 

PH101: Fertility the Role of PT and Nutrition

pregWe are so excited to announce our newest installment to Beyond Basics’ Pelvic Health 101 educational series. This Thursday we will be hosting a joint lecture on the effect physical therapy and proper nutrition can have to enable you to conceive.

Physical Therapist, Melissa Stendahl  will discuss many of the physical barriers that women face when trying to conceive, such as restrictions within the fallopian tubes, painful sex, and much more.

Did you know that what you eat can directly impact your ability to conceive and carry a healthy baby to term? In the second half of the class, nutritionist Jessica Drummond will discuss how nutrition can restore hormone balance and provide the perfect environment for conception and gestation.

Please join us at 7pm on Thursday, April 21st at Beyond Basics to discuss how you can optimize your fertility. As always, light refreshments will be served. Register at.  pelvichealth101.eventbrite.com.

 

A Fitbit for your Vagina?!

Fiona McMahon, DPT

Elvie

 

For a while you could find me strolling around the clinic with a little fitness tracker on my wrist. I used it to track my steps, sleep, and heart rate. I’m a girl who loves gadgets and apps. From Venmo to Spotify, technology enriches my life and makes it easier. So when Elvie sent their kegel trainer to Beyond Basics, I jumped at the chance to volunteer myself guinea pig, to try out this new fitness tracker.

 

Unboxing, Aesthetics, and Set Up

Man, oh man is the product design gorgeous on this one. It comes in a beautiful silver embossed box with the tagline “ your most personal trainer”  ( wink, wink, nudge, nudge). Inside there is an inch diameter cylinder “vessel” for lack of a better term, which houses the Elvie tracker. The vessel functions as both a carrying case and a charger. It’s pretty slick looking.

The Elvie itself looks like a little tadpole with a tail. It’s about an inch long and half an inch in diameter not counting its little tail. There is also an optional cover provided in the box, which may be more comfortable for some ladies.

The whole set up: The tracker had the feel of opening an iphone, in that the directions provided in the tracker were kept pretty minimal. There was a small pamphlet with cleaning instructions, on charging, how to insert, and exercise. As a pelvic floor physical therapist, I definitely felt that the instructions on how to properly kegel left a lot to be desired. The instructions were literally two bullet points instructing the user not to hold her breath or tighten her buttocks, while she lifts her “pelvic floor”. For many of my patients, I find that they come to me with little knowledge of how to properly kegel or are doing it wrong, “lift the pelvic floor” is rarely a cue that allows for a fully correct kegel.

My next step was to download the Elvie app. I have an iPhone 6. You need a smartphone to run the elvie. They recommend iPhone 5 or later or Android phones running version 4.3 or later. The app download was easy. It was time to get started.

 

Elvie: Day 1

The moment of truth had arrived. Time to insert one of the cuter inanimate objects I had come accross “up there”. “Bye, little guy. Safe travels” I thought as I bid Elvie adieu. Insertion was no problem. For me, it was pretty comfortable, the caveat being, I have a pretty healthy pelvic floor. The one thing I did not like was that Elvie’s tail kept bopping me in the clitoris, which wasn’t very comfortable. Other than that no complaints.

The first thing I did was try and trick Elvie into thinking I was kegeling when I wasn’t (I really want to ensure this thing is fool proof). Elvie is unfortunately a gullible little thing. Bulging my pelvic floor, ( mimicking the action you would do to have a bowel movement, essentially the opposite of a kegel) and thrusting my hips tricked Elvie into thinking I was doing a really good job when I wasn’t. My favorite activity to trick Elvie was to do a little dance around my bedroom, while wiggling my bottom. Thank goodness my doors lock.

But enough goofing off, it was time to give Elvie a good old honest college try. The package recommends either standing or lying to do your kegel exercises, but they say to pick a position and stick with it. I chose lying down.

The minute I got on the bed, Elvie’s connection was lost. Poor Elvie! It was deep inside a strange place with no connection to the outside world. The app instructed me to move my phone closer to my vagina, which restored the connection but was pretty awkward, kind of like my lady parts were trying to facetime someone.

Once I got through the technical difficulties, I loved the way the exercise program was set up. They have 3 different stages that work on pulsing or “quick flicks”, endurance, and pure power. I was mediocre at all three, but it gave me a good start to go with.

Screengrab
Screen grab from the Elvie App

 

Elvie Day 2:

Today was the day I decided to experiment with how distracted one can be while using Elvie. We all like to multitask, so I decided to try it out while continuing my current Netflix binge. It was a bad idea, I missed a lot of my targets and kept forgetting to keep my legs open to allow Elvie to stay connected. It was clear to me that Elvie requires your full attention to get any benefit from it. I did improve on my ability to pulse and my endurance, which was super gratifying.

After I was done with my workout I spent some time exploring the app. Nestled in the “help” section, were much more detailed and helpful directions for performing a correct pelvic floor contraction. I wish this was more easily accessible. I think the lack of concise directions was a major failing of this product.

 

Elvie Day 3:

I decided this would be my last day using Elvie. I run on the tighter side of things, and I know from my clinical experience that doing kegels on an already tight pelvic floor can cause a whole host of issues from constipation, fecal leakage, painful sex, even urgency urinary incontinence!

I decided to give my all out full attention to the vagina workout ahead of me, but first I would try and cheat again. Lying down I tried my old tricks, wiggling my butt, thrusting my hips, but Elvie was not fooled! It appears that lying on your back is a way better way to train your pelvic floor using Elvie.

My last day, I really had the hang of things. I had no connectivity issues and was able to complete the whole workout uninterrupted. The only bummer was that on two of the three measures, I regressed!

 

Thoughts on Elvie

My thoughts on this device are mixed. It is so rare that I see someone walk into the clinic only needing strengthening of the pelvic floor. Usually there is some component of tightness or boney (structural) malalignment that needs to be corrected before kegels can be done effectively or safely.

For those patients who only require strengthening, I think Elvie can make an excellent motivator to regularly do your kegel exercises. I would eliminate the pure power part of the Elvie exercise program. Doing a max contraction of the pelvic floor usually does more harm than good. In a perfect scenario, I see Elvie being used by patients under the guidance of a pelvic floor physical therapist and only doing the “pulse” and “hold” portions of the program. These are patients who have been screened for any tightness or trigger points that may need treatment before starting out with strengthening

 

Pros and Cons of Elvie

 

Cons

  • Not appropriate for everyone
  • Poor connectivity to iphone
  • Not always consistent in measuring a true kegel versus a fake one, especially in standing
  • Requires a later model smart phone
  • Only brief instructions easily accessible
  • Max contraction not very helpful

Pros

  • Charts on the App to track your progress
  • Incredibly adorable product design
  • Much more comfortable than many other biofeedback sensors
  • Structured training program to target many components of muscle function

Pro Tips for Elvie

  • Use Elvie lying down; it’s way more accurate that way
  • Use a water based lube for insertion, silicone lubricants usually don’t mix with instruments designed to go into the vagina
  • If you have pain, Elvie is definitely not for you. Even if you don’t have pain it is wise to consult with a pelvic floor physical therapist to ensure that your muscles are not in fact, too tight and that you are doing the exercise correctly.

Disclaimer: Product was provided by Elvie. No other form of compensation was provided by Elvie for this review.