March Is Endometriosis Awareness Month. Treating endometriosis and improving the lives of people with endometriosis has long been a passion of Dr. Amy Stein, founder of Beyond Basics Physical Therapy, so much so, that she teamed up with Dr. Iris Orbuch and wrote a book about it! This month we are reviewing some of the major talking points in their book, Beating Endo .For more on endometriosis, check out our past blogs as well as Beating Endo.
This week we are continuing our series on endometriosis. We are highlighting how endo can affect your gastrointestinal system (your tummy) and what you can do about it. As you may recall from our previous blog posts, endo occurs when endometrial like cells occur outside the uterus. These cells can implant themselves within the abdomino-pelvic cavities and its organs causing inflammation and reducing the movement of the organs therein. The symptoms caused by endo in the gut are myriad. These symptoms can often be unpredictable and incredibly frustrating to those experiencing them. These symptoms may also occur regularly or at various points during one’s cycle and can be just as frustrating.
GI symptoms commonly associated with endo include:
Bloating
Diarrhea
Constipation
Painful bowel movements
Abdominal pain
With all this going on in the gut, there are still some things you can do. The pelvic floor is the “governor” of bowel function. When it contracts, it holds bowel movements in, and when it relaxes, it allows bowel movements out. With endometriosis, and the inflammation and pain it can cause, the pelvic floor muscles often get very tight, which worsens the problems outlined above. Pelvic floor PT can help reteach those muscles to relax and let go, thereby improving your GI symptoms!
How to help your tummy at home:
The I Love You Massage
How to do it:
Flatten your palm, make a fist, or use your fingers, first to trace the letter I in a descending movement from just under your left rib cage to your pelvic bone. Do this ten to fifteen times. Then place your palm, fist, or fingers under the right rib cage and draw the L— right to left horizontally, then straight down to the pubic bone. Again, do this ten to fifteen times. Finally, the U: Start on the right, at the top edge of the pelvic bone, and massage up toward the rib cage, then left across the body, then down to the top of the pelvic bone. Do this ten to fifteen times as well. What you have done is massage the descending colon, the transverse colon, and the ascending colon, thus stimulating the involuntary contractions that actually move the stool. Use moderate pressure; if it hurts, lighten the pressure. If it still hurts, stop—although even a light massage may cause some soreness at first.
***In light of current events, and in an effort to keep our community as healthy as possible, we have moved our Pelvic Health 101 (PH 101) seminars from in person to online. Although we regret not being able to meet everyone in person, we are excited for the opportunity to broadcast information about pelvic floor disorders and how to treat them fair and wide. Please keep an eye on our social media as well as the blog to find out how you can learn more about the pelvic floor.***
Warmly,
The Team at Beyond Basics
The number of Americans who deal with constipation issues is massive (4 million!)! It seems like every time I mention that I’m a pelvic floor physical therapist, another friend of a friend pulls me aside with bowel movement concerns. Why is it that so many people have issues? And more importantly – what can we do about it? This is the topic of our next Pelvic Health 101 seminar on April 2nd st, at 7pm
Not only will constipation be discussed but other bowel conditions, such as irritable bowel syndrome, fecal incontinence, bloating, and hemorrhoids will be addressed. The lecture will also go in depth on the role of fiber, water intake, toilet posture and pelvic floor muscles in having a successful bowel movement. You will even go home with easy techniques that you can implement immediately to help you get that smooth move! Don’t miss out on this FREE event – it’s a MUST for anyone who struggles on the porcelain throne. Seats are going fast! Light snacks and refreshments will be served.
If you want to learn more about bowel conditions, check out some of our past blogs, here!
***In light of current events, and in an effort to keep our community as healthy as possible, we have moved our Pelvic Health 101 (PH 101) seminars from in person to online. Although we regret not being able to meet everyone in person, we are excited for the opportunity to broadcast information about pelvic floor disorders and how to treat them fair and wide. Please keep an eye on our social media as well as the blog to find out how you can learn more about the pelvic floor.****
Warmly,
The Team at Beyond Basics
By Fiona McMahon, DPT
Do you find yourself with a full map of every public restroom along your daily commute in your head? Do you find yourself competing for the aisle seat at movies so you can sneak away to the bathroom? Does it hurt to go? Do you get up multiple times a night? If you answered yes to any of these questions, this week’s Pelvic Health 101 is for you.
On Thursday, March 26 join us at Beyond Basics Physical Therapy, for all of the ins and outs of bladder health. Learn how the bladder works, common bladder disorders, and practical tips for helping your bladder symptoms. Light snacks and wine will be served.
In recent years, with the advancement of social media, self-care has taken on a life and meaning of its own. Self-care is more than a face mask on a Friday night; it includes a variety of strategies that people undertake to establish and maintain their own physical and mental health. The World Health Organization defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider, based on their knowledge and the information available.” It encompasses many different categories, which includes hygiene, nutrition, lifestyle, environmental and socio-economic factors, and self-medication.
Now that we understand the bigger meaning of self-care, this brings us to the topic of sleep. Sleep is the ultimate self-care act. Poor sleep has been implicated in a number of negative health consequences. But as individuals, we can empower ourselves to take the responsibility to make changes to ensure a good night’s sleep. Self-care is also not just something that the healthy do to stay healthy, but also something that is essential for those with chronic disease to be able to self-manage their condition and symptoms.
More and more evidence supports the importance of sleep and its effect on our well-being, physical health and ability to heal, cognition, and how much pain we feel. This makes sleep the ultimate self-care act because it is something we do every day. There are so many ways to improve the quality of our sleep and reap the benefits of a full night of zzz’s.
Sleep is needed to sustain life. We sleep, or we die, and studies show that poor sleep actually shaves years off of our lives. There are also a number of conditions that are affected by insomnia. A study of 1,869 cases of migraines showed that sleep protects against migraine attacks and that 29% of migraines were directly related to insomnia. Another study in 2016 found a relationship between insomnia and absences from work due to illness, due to a connection between decreased sleep and decreased immune function. Numerous studies have shown that sleep disturbances are related to an increased prevalence of obesity, insulin resistance, type 2 diabetes, cardiovascular disease, metabolic syndrome. Metabolic syndrome is a subtle systemic inflammation which can occur when there is increased stress, anxiety, depression, insomnia, as well as obesity and inactivity, which may be a driver of chronic pain. Insomnia preceded 40% of psychiatric mood disorders and sets in at the same time as another 20% of mood disorders. Lack of sleep can affect athletic performance, whereas better sleep improves it, and there is a negative impact on healing and recovery as well.
A 2019 study found that sleep deprivation boosts responses to pain in the areas of the brain that sense pain, and it suppresses activity in areas that modulate pain experiences. This means the brain perceives more pain coming from our nerves, and has less ability to dampen the response. A study in 2016 on 133 patients with knee arthritis compared to those who slept well versus those who did not, and it found a high degree of certainty that decreased sleep, or fragmented sleep, strongly affected the pain and central nervous system relationship.
There are two types of sleep: REM (Rapid eye movement) and non-REM sleep. During the night, we cycle between these two types of sleep, completing on average four to six cycles. The type of sleep one gets is more important than the amount of sleep. You could sleep for eight hours, but if you are not entering REM sleep, the benefits will not be the same. There are a number of factors that determine our daily rhythm of being awake and sleeping, as well as other body functions, otherwise known as our circadian rhythm. Light stimulates this rhythm as well as hormones. It is generally recommended that we get about 6-10 hours of sleep, but it varies between individuals. Most adults need about 7-8 hours to feel fully rested.
The major factors that disrupt sleep are acute stress (major life changes), physical illness (that causes pain) and psychological problems (depression/anxiety), but a number of specific habits or activities also can affect sleep.
These include:
-Going to bed and waking up at different times every day
-Taking naps during the daytime or in the evening
-Drinking caffeinated beverages after 3 PM
-Smoking nicotine, which is a stimulant;
-Sleeping in a noisy bedroom
-Sleeping in a room that gets a lot of light (good luck New Yorkers!)
-Drinking alcohol in the evening may relax you at first, but alcohol does lead to disturbed sleep
-Having heated arguments with significant others or roommates before bed
-Using the bedroom for working or watching TV
-Sharing the bed with a snorer or restless partner.
The question to ask yourself is, which of these activities do you feel you have control over and you can change? There may not be much you can do, for example, if you have a snoring, kicking bed mate, besides urging them to seek medical help, getting ear plugs, or trying one of those mattresses that claim to minimize movement (anyone remember the wine glass and the bowling ball commercial?)
What helps sleep?
-Getting exercise every day
-Taking a warm bath 45 minutes before bedtime
-Drinking a caffeine-free herbal tea 30 minutes before bedtime
-Learning relaxation/tension release exercises like deep breathing or progressive muscle relaxation
-Unplug an hour before bed
-Get up if you can’t fall asleep within 20 mins and return to bed when you are sleepy
-Set the alarm for the same time every morning
-Dim the lights before bed
-Try lavender aromas and self-massage for relaxation
-Unwind by doing something relaxing like reading a good book (no thrillers, people!)
-Write a journal to get all the things in your head that are running around and causing you more stress on paper and out of your brain; meditate.
We can all also benefit from locating the stressors we can eliminate. If we are still having problems we can’t overcome on our own, it could be time to talk to a mental health professional.
In addition, if there is musculoskeletal pain that is prohibiting you from getting enough sleep or finding a comfortable position to sleep is a problem, a physical therapist is a good place to start. A physical therapist can work with you to decrease musculoskeletal pain and help with strategies to find a postures and alignment to decrease strain to your body, which will help to promote better sleep by allowing your body to relax and decreasing pain.
References:
-What is Self-Care?-ISF isfglobal.org/what-is-Self-Care/
-Sleep Self Care University Health Services Tang Center S:/handouts/Clinical/Insomnia.doc 6/23/16 12:16PM
-10 Self Care Habits to Relieve Stress Before Bed-Awake & Mindful. Awake & Mindful (httyps://awakeandmindful.com/)
-Jo Nijs, et al. Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice. Physical Therapy, Volume 98, Issue 5, May 2018: 325-335.
-Barbara Rigel, et al. Poor Sleep and Impaired Self-Care: Towards a Comprehensive Model Linking Sleep, Cognition, and Heart Failure Outcomes. Eur J Cardiovasc Nurs. 2009 Dec; 8(5): 337-344.
-Patrick H. Finan, et al. The association of sleep and pain: An update and a path forward. J Pain. 2013 Dec; 14(12): 1539-1552.
***In light of current events, and in an effort to keep our community as healthy as possible, we have moved our Pelvic Health 101 (PH 101) seminars from in person to online. Although we regret not being able to meet everyone in person, we are excited for the opportunity to broadcast information about pelvic floor disorders and how to treat them fair and wide. Please keep an eye on our social media as well as the blog to find out how you can learn more about the pelvic floor.****
Warmly,
The Team at Beyond Basics
On March 19th, at 7pm we will be kicking off our spring semester of pelvic health education class, we call Pelvic Health 101 (PH101). In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health and function of your bowel, bladder, and sexual functioning. We will also be covering how things such as alignment, posture, muscle tone and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.
March Is Endometriosis Awareness Month. Treating endometriosis and improving the lives of people with endometriosis has long been a passion of Dr. Amy Stein, founder of Beyond Basics Physical Therapy, so much so, that she teamed up with Dr. Iris Orbuch and wrote a book about it! This month we are reviewing some of the major talking points in their book, Beating EndoFor more on endometriosis, check out our past blogs as well as Beating Endo.
For most who have heard of endometriosis, the defining symptom is extreme and painful menstrual cycles. Bladder dysfunction and pain is not necessarily top of mind, but for many with endometriosis it can be a very disruptive facet of this disease.
Common bladder complaints in people with endo include:
Increased urinary frequency
Sensation of incomplete bladder emptying
Burning urination
Pain within the bladder
Having to push urine out
For those of you experiencing painful bladder symptoms, there is a lot you can do to start managing symptoms. I write a lot about it in the following blogs; Pelvic Floor MythBusters! Don’t eat lemon to avoid bladder pain, true or false? and How to Improve Bladder Health. Changing your diet is a logical first step. There are some foods that in some people can cause an increase in bladder symptoms. In Amy and Iris’ book , Beating Endo they list the most common bladder irritants in endo patients as:
Sodas, both diet and regular
Tomatoes
Citrus fruits
Coffee- including deca
Alcohol
Chocolate
Green Tea
Spicy food
B complex vitamins
Cranberry Juice
Electrolyte waters
Amy and Iris recommend not consuming any of these irritants for 8 weeks and then slowly reintroducing these foods back into your diet. What I have written here represents a basic summary of what is discussed in Beating Endo. If researching bladder irritants intrigues you, I would highly recommend checking out the book.
These symptoms can also be caused by pelvic floor dysfunction. Tight pelvic floor muscles can irritate the bladder and the urethra, which is then processed by the brain as needing to go to the bathroom, resulting in disruptive frequency, pain, retention and hesitancy. Pelvic physical therapy can be exceedingly helpful at mitigating these symptoms and improving your comfort. If diet changes are simply not enough, I would highly recommend seeing your local pelvic floor therapist.
Check out our previous blogs on endo, if you missed them
March Is Endometriosis Awareness Month. Treating endometriosis and improving the lives of people with endometriosis, has long been a passion of Dr. Amy Stein, founder of Beyond Basics Physical Therapy, so much so, that she teamed up with Dr. Iris Orbuch and wrote a book about it! This month we are reviewing some of the major talking points in their book, Beating Endo.Available here. For more on endometriosis, check out our past blogs as well as Beating Endo.
Endometriosis is a condition that affects people born with female anatomy. It occurs when a tissue similar to that of lining of the uterus (known as the endometrium) grows outside of the uterus. Seems like a pretty simple definition, but it can cause a whole host of symptoms.
When something that doesn’t “belong” in the body is detected by the body, inflammation will occur. It is this inflammation that is believed to cause the myriad symptoms someone with endometriosis may experience. These symptoms can include
Irritable bowel syndrome (IBS)
Painful bladder syndrome
Pelvic floor dysfunction
One of the confusing things is, you don’t have to have all of these symptoms to have endo and the severity can range. This is Fiona writing, and I’m sure Amy would agree, no two endo patients are alike, and your pain is valid even if your symptoms do not necessarily look like someone else’s’ who is suffering with endo. It is this variability in presentation along with poor awareness within the medical field and public, leading to an average of 7 to 12 years to get a diagnosis.
Endometriosis can only be diagnosed by analyzing the suspected endometrial lesions removed during an excision surgery. There is no other test to confirm it, which can make diagnosis obviously, very difficult.
There is another condition that is called Adenomyosis. Similar to endo, adeno occurs when cells similar to the lining of the uterus occur within the muscular wall of the uterus. Most people with adeno have endo, but it is not always true that most people with endo have adeno. Adeno can show up as heavy periods, low back pain, and pelvic pressure.
Endometriosis is a chronic illness that affects millions of people. There is still a lot to figure out about endo and because of that fact there are many truths, half-truths, and myths floating around out there about endo. Check out some of the myths Amy and Iris busted together in Beating Endo.
Common Endo Myths
The abdominal and pelvic floor muscles are rarely affected by endometriosis.
False: Constipation, frequent urination or retention, pain with vaginal penetration from endometriosis causes tightening of the abdominal and pelvic floor muscles; So too does assuming the fetal position which is our go to pose when we are in pain. Both contribute to tight abdominal and pelvic floor muscles which causes pain.
The pelvic floor and abdominal muscles do not cause bladder, bowel, sexual dysfunction or abdominal-pelvic pain in patients with endometriosis.
False: Tight pelvic floor muscles caused by years of straining or reflexive tightening due to pain, often cause a severe amount of pain which results in further tightening and shortening of the pelvic floor muscles. Good news is that pelvic floor physical therapy benefits most people who have been experiencing abdomino-pelvic or sexual pain and/or are straining due to ongoing bladder and bowel symptoms.
Hysterectomy is a cure for endometriosis.
False: Hysterectomy is neither a treatment nor a cure. By definition endometriosis consists of cells similar to those in the lining of the uterus but found outside the uterus. Only surgical ‘excision’ removes endometriosis cells.
Medical menopause is a cure for endometriosis.
False: Just because your medicines give you hot flashes doesn’t mean your endometriosis is going away. The best treatment approach is to meet with an endo specialist to discuss options, and in most cases PT management. As well surgical excision has much better results than ablation of Endometriosis.
There is no correlation between quantity of endometriosis and severity of disease.
Truth: Even if you have a minimal amount of endometriosis, you can be in debilitating pain with lots of symptoms and in most cases dietary changes, physical therapy and mindfulness practices can help manage a lot of your symptoms.
Teenagers are too young to have endometriosis.
False: Teenagers can have endometriosis and their endometriosis can cause debilitating symptoms.
Pregnancy is a cure for endometriosis.
False: Just plain no. Pregnancy does not cure endometriosis.
Ablation surgery is the same as excision surgery.
False: Not even close. Excision surgery is the proper treatment for endometriosis. Ablation surgery, burns the surface of the endometriosis lesion but leaves the bulk of endometrial implants behind.
Surprising Endo Facts:
Fact: Physical therapy (pelvic PT) can help many suffering from the many pains and symptoms of Endo, including back, abdominal and pelvic pain, bladder, bowel and sexual function.
Fact: The majority of patients with Endometriosis require pelvic floor physical therapy. Pelvic floor PT can be instrumental in the healing process and can help abdominal-pelvic pain, bladder and bowel urgency, frequency, retention, incomplete emptying, and any sexual pain related to the musculoskeletal system.
Truth: Painful bowel movements, constipation, diarrhea and bloating are symptoms of endometriosis as well as symptoms of pelvic floor dysfunction .
Truth: Painful sex is a symptom of endometriosis as well as a symptom of pelvic floor dysfunction.
Truth: 40 to 50% of women with unexplained infertility is caused by Endometriosis.
Truth: Teens with endometriosis often have acyclic pain, that is, pain at other times of the month rather than only during their period, in addition to cyclic pain.
Truth: Back pain is a symptom of endometriosis.
Truth: If your ultrasound is normal you can still have endometriosis.
Truth: roughly 10% of women have endometriosis. That’s close to 200 million women worldwide. Endometriosis is much more than just bad period pain. 1 in 4 women have pelvic floor dysfunction.
Truth: Endometriosis commonly affects the musculoskeletal system, and in many cases can be a primary contributor to one’s pain and symptoms.
Orbuch I, Stein A. Beating Endo. New York. Harper Collins. 2019
