Did you know kids can suffer from pelvic floor dysfunction too? Pelvic floor dysfunction in children can result in pain, bladder holding or constipation, embarrassing soiling accidents, frequent nighttime accidents, as well as trouble going potty. For most kids, there is an underlying physical component that needs to be addressed by an expert pediatric pelvic floor physical therapist.
It is very upsetting for a parent, guardian or caregiver to see a child suffer with pain or embarrassment, but there is so much that can be done to help out children with these issues. We use positive charts to develop short term and achievable goals to reinforce behaviors and steps towards healthy toileting. Simple techniques like using the improving toilet posture, practicing deep breathing with bubbles, using a timer to assist in times voiding, educating the parent/guardian/caregiver on the colon massage, developing a core stability and stretching program, and more can go a long way towards improving bowel and bladder symptoms.
If your child is suffering from urinary or fecal accidents, bed wetting, skidmarks, or painful defecation, join me on November 15, at 7pm , to discuss pelvic floor dysfunction in children, common conditions affecting pottying, and practical tips you can use to make potty time easier.
This is our last Pelvic Health 101 class of the spring series. We want to thank for an awesome season! Keep your eyes on the blog for the Fall’s PH101 classes!
Gluten free, soy free, low FODMAP. It’s amazing how many diets there are out there that really can provide people with symptom relief. If you are suffering with chronic pain you may be confused on where to start, or what is right for you. You also may have tried out a bunch of different ways of eating, not seen results and have gotten really frustrated. If this is the case for you, I highly encourage you to come to our next pelvic health seminar on October 4, at 7pm, “Does my diet really matter”.
This seminar will be hosted by a special guest speaker, nutritionist Jessica Drummond, MPT,CCN,CHC. Jessica Drummond is a former pelvic floor physical therapist who now specializes in nutrition for those suffering with pelvic floor dysfunction. This seminar has been a huge hit and is a great starting point for those considering adding nutrition as part of their healing journey.
Hello everyone! April was Irritable Bowel Syndrome(IBS) Awareness Month. Although, we are a bit late, we wanted to take some time to talk about IBS and what can be done to help with its symptoms. IBS can present in different ways. People with IBS may experience diarrhea or constipation, or both. At Beyond Basics, we work with issues associated with IBS, from ensuring that your digestive organs move well in order to function properly, to toilet posture, to training the pelvic floor to have the coordination to help you toilet comfortably.
Tips for living with irritable bowel and other digestive symptoms
Over the years we have used our blog to discuss many different tips, tricks, and techniques you can use at home to make the process of having a bowel movement just a bit easier. The first thing you can do is super simple: sit on the toilet with good posture. There are heaps of ways to sit on the toilet and believe it or not, there is an optimal way to sit and poop. The reason why the way we sit is so important is the anal rectal angle. The anal rectal angle refers to the angle of your rectum. When we stand and sit our angle is more bent or acute, which makes it harder for poop to drop out of out of our rectums (yay!), which increases our chances of continence. But when we are trying to poop, we want our anal rectal angle to straighten out so it is easier to poop and we don’t have to strain. The position that best allows us to do that is squatting, the way one would over an eastern style toilet. Most of us have western style commodes that don’t allow for a nice anal rectal angle opening squat. So we have to get creative. By placing a stool or the now ubiquitous squatty potty under your feet you can simulate a squat and allow for easier passage of stool. For more on posture, check out Sara Paplanus’s blog on posture and bowel movements.
Diet is a very important thing to consider when trying to optimize your bowel movements. The first thing we usually consider is fiber. There are two types of fiber. Soluable and insoluable. Soluble dissolve in water and allows the stool to absorb water and adds mass and heft ( in a good way) to your feces. Insoluble fiber does not dissolve in water and can help push the poo out. The fact is we need to balance both types and most of us aren’t getting enough. In addition, some people need more of one type and some need more of the other or else you can end up with increased gas and bloating. Read how you can increase your fiber intake here. If you are having difficulty balancing the two or are not sure which to add, it is best to seek advice from an expert nutritionist in abdomino-pelvic pain and IBS.
The colon, the last stop for poop before it enters your rectum is the place where water is absorbed from the stool. In cases where you are too dehydrated, your body will recycle water anywhere it can, including your stool. If too much water is taken from your stool, it can be dry and hard to push out. We suggest drinking about one half your body weight in ounces of water daily and even slightly more if you are constipated, sweat a lot or suffer from IBS. For example, if you weigh 200 lbs, drink 100 ounces of water to make sure to ease your bowel movements.
Pelvic floor physical therapy can help a lot with issues with IBS. In last year’s IBS awareness blog, we discussed the benefits of pelvic floor PT
“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 repeated irritation in their gut. To add insult to injury, spasm in the pelvic floor, (specifically the levator ani and sphincter muscles) 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, retrain the muscles and teach self-management techniques to keep symptoms at bay, or to eliminate some of the symptoms in the future.”
IBS is an important condition that affects many different people. Although there currently is no cure for IBS, there is a lot you can do to make living with this condition more manageable. If part, or all, of the symptoms are from musculoskeletal dysfunctions of the pelvic floor and abdomen, than there IS a cure and we are here to help! If you are suffering, please make an appointment with us today.
R Saeed. Impact of Ethnic habits on defecographic measurements. Arch Iranian Med 2002; 5(2) 115-16
Gluten free, soy free, low FODMAP. It’s amazing how many diets there are out there that really can provide people with symptom relief. If you are suffering with chronic pain you may be confused on where to start, or what is right for you. You also may have tried out a bunch of different ways of eating, not seen results and have gotten really frustrated. If this is the case for you, I highly encourage you to come to our next pelvic health seminar on April 6th at 7pm, “Does my diet really matter”.
This seminar will be hosted by a special guest speaker, nutritionist Jessica Drummond. Jessica Drummond is a former pelvic floor physical therapist who now specializes in nutrition for those suffering with pelvic floor dysfunction. This seminar was a hit last year and is a great starting point for those considering adding nutrition as part of their healing journey.
March is Endometriosis Awareness Month. Endometriosis is a condition that is near and dear to our hearts at Beyond Basics Physical therapy. Endometriosis is a gynecological disease that occurs when a tissue similar to the lining of the uterus implants itself outside of the uterus in the abdominal and pelvic cavity. It is an inflammatory condition, whose symptoms can vary from mild to severe. Most commonly endo is seen as causing painful periods, but it can also cause bowel and bladder symptoms, issues with fertility, pain with sexual activities and general pain. For the past two years we have done a post about endometriosis during endometriosis awareness month on how musculoskeletal pain can be a contributor or the primary cause of abdomino-pelvic pain condition. To learn more about how the disease affects the body and its symptoms as well as how we treat the condition at BBPT click here:
The article by Fabio Parazzini and his colleagues is a literature review. The point of a literature review is to aggregate many studies on one topic and determine a general trend in the data in one place. A literature review is not as powerful as its cousin a meta-analysis, in which more powerful statistical tools can be applied to interpret the data. Nonetheless, literature reviews can provide us with a general sense of what is going on in a certain field of research.
First things first, let’s talk about the limitations of this review. Designing a single study on endo and diet can be rather difficult. First of all, not all endo is the same. Women with endo can experience vastly different symptoms that don’t always correspond to the amount of endometrial deposits seen on laparoscopy. It can be really difficult for researchers to ensure they have a homogeneous (or similar) study population. Secondly, studying something like diet it usually correlational and not causal. Diet can reflect a lot of other components besides the nutrients going into one’s body. Diet may reflect factors such as culture, wealth, education, geographic region, which all may play independent roles in the diagnosis and progression of endo. Most of the studies examined were based on self-report, which also may not be entirely accurate.
Now that we have the caveats out in the open, let’s talk about why a study like this is useful. Like I said before, this article is an aggregation of multiple other publications. When we see similar results produced by different authors in different groups of people, it lends a little more weight to the individual study’s findings. Most importantly Parazzini is also careful to include information on why a particular food group may be more beneficial or even harmful in the progression of endometriosis.
What the Article Found
Green Vegetables and Fruit
The authors found two studies that show that a higher intake of green fruits and vegetables reduce the risk of endometriosis. They found that the higher the intake of green fruits, specifically (think okra, etc) caused the decreased risk of endometriosis and did not find the same relationship with green vegetables (think kale, spinach, and lettuce). Parazzini notes that green vegetables and particularly fruit are high in a compound called organochlorine, which has been shown in other studies to reduce the risk of endometriosis. Organochlorines are a particularly broad class of molecules and can be found in healthy things but also make up compounds used in industrial purposes. This study is referring to those occurring naturally in vegetables and fruits.
Vitamin A is found in animal products like fatty fish, dairy, and animal kidneys and livers. Its building blocks are found in green and orange vegetables and fruits and can be manufactured into vitamin A in the body. Parazzini and colleagues found mixed results some with no benefit for development of endo and some that did show benefit. No studies showed harm.
Vitamin C and E
These vitamins were not consistently found to be helpful in reducing endometriosis risk. Some studies reported that increased amounts of vitamin C and E intake reduced risk of endometriosis, while other studies failed to yield significant findings. Parazzinni did provide evidence from other studies which demonstrates the antioxidant properties of vitamins C and E. Parazinni purposes that because there may be a link between oxidative stress and disease, vitamin C and E may be helpful in reducing the inflammation associated with endometriosis.
Red Meat and Saturated Fat
Again, results were mixed. Saturated fat mainly occurs in animal products. Some studies found a correlation between red meat and endo risk, but no association with butter. In other the results were flipped.
Other items investigated
Fish and Omega 3
Minimal to no evidence supporting associations between endo and dietary intake for any of these products were found.
What’s it All Mean?
One of my patients once told me she was instructed to finish every study, with the phrase, “more research is needed.” This is certainly the case in the field of endometriosis treatment. There’s a lot about endometriosis that we don’t understand We need well constructed studies that will allow researchers to do more powerful meta-analysis to help guide our treatment. This review was only able to include 11 studies for review out of the 256 initially found.
With all that said, I do think there are some key takeaways from this study. There was a general trend in healthier foods and more promising results. Parazinni was also diligent to include mechanisms by which these healthy foods could be helpful. Secondly, there was no harm found by eating what is considered a healthy diet, (high in greens and vitamins). These findings, although small, in combination with the general benefits of a healthy diet, should encourage patients with endo to explore in more depth how eating certain foods affects their symptoms.
At Beyond Basics we take pride in treating our patients from a holistic perspective and we appreciate that we can collaborate with other healthcare providers in our community, including expert nutritionists, naturopaths, functional medicine doctors and mental health therapists. We find that the combination of diet, specific physical therapy techniques, mental health and self-care, can significantly reduce pain and other symptoms and improve function in many patients. Our clinicians specifically are experts in manual therapy techniques such as visceral and connective tissue mobilization techniques, myofascial release and other soft tissue mobilization techniques discussed in the previously mentioned endometriosis blogs. If you are suffering from endometriosis, come visit us today.
Learn more about what we do at BBPT with our upcoming PH101 classes, which are free to the public. Here are some you may find interesting:
April 6th: Does my diet really matter?
April 13th: Pain & Sexuality: Is it all in my head? No, it is not!
You are what you eat. Trash in equals trash out. You can’t exercise yourself away from an unhealthy diet. These adages are often on my mind as I make my food choices because of the myriad of health professionals who have taken time to come to our practice to tell us how we can improve our own and our patients’ health by taking more time to look at what we are consuming in our diet. Lately many of these clinicians have been focusing on candida overgrowth and diet, which can contribute to pain and inflammation conditions.
What we eat can directly affect the bacterial and fungal make up of the gut, AKA the gut microbiome.The gut requires a certain level of good bacteria to help us digest what we eat. Over time a poor gut microbiome can affect how efficiently the gut works. The function of the gut goes beyond just digesting food, but also is vitally important for the production of neurotransmitters, which help to spread messages within the brain and throughout the whole body. The microbiome also plays an important role in our hormones, and immune system. When the microbiome of the gut is not balanced, it is called dysbiosis.
One of the most common culprits in gut microbiota dysbiosis is candida, (Yeast!). Candida is a naturally occurring inhabitant of the body and when it’s at appropriate levels, it doesn’t tend to be noticed, but anyone who has experienced a yeast infection knows that if this little guy is allowed to go unchecked, it can do a lot to make you miserable. Besides plaguing women with itching, burning vulvas, yeast overgrowth may cause many other ailments.
Science has pointed to the role candida can play in contributing to chronic and inflammatory conditions. In one study by Kumamoto in 2011, candida overgrowth was associated with delayed healing of inflammatory lesions and were associated with pro-inflammatory cytokines (chemicals) and increased incidence of inflammatory bowel disease like ulcerative colitis and Crohn’s disease.
Yeast overgrowth can also affect the bladder along with over colonization of saccharomyces (another form of fungus). In fact yeast and saccharomyces was found to be higher in women during a flare of interstitial cystitis than when their symptoms were low.
Yeast is not the only organism that can get out of balance and affect our bodies in harmful ways. There are many other players that can get out of balance. Some signs of an altered gut microbiome is a history of allergies, eczema, or repeated fungal infection.
What to do?
It all seems pretty dire, right. How do you control who is colonizing your gut, when you barely have enough time to make it to the gym after work? There are a few simple steps you can start with.
Avoid antibiotics, unless your doctor thinks you need them.
The medical community has become a lot more aware of the dangers of over prescribing antibiotics from their perspective, but it is important to keep in mind that a powerful antibiotic can wipe out good bacteria and bad bacteria in one fell swoop. If the good guys in your gut are reduced, the bad bacteria have a better chance of taking over. Take antibiotics only when recommended. Keep in mind antibiotics will not help treat viruses like the flu, they can only treat bacterial infections.
Modify your diet
Increase your consumption of good fats (omega 3’s) to help reduce inflammation.
Food high in omega 3’s include flax and hemp seed/oils, fish (the fishier the fish, usually means more omega 3’s, for example herring is higher in omega 3 than a milder fish like snapper). Also reduce your consumption of processed foods which can increase inflammation levels and eliminate simple sugars and fried foods. If this is only minimally successful, try a gluten and dairy free diet.
If simple changes are not helping consider seeing a professional
Find a naturopath, functional or integrated MD, or nutritionist who can investigate more fully whether or not you have SIBO (Small intestinal bacterial overgrowth), candida overgrowth, or other gut microbiome disorder. Or perhaps you are lacking certain ingredients, vitamins or mineral. These professionals can tailor a diet and medication regimen to help return your gut microbiome to tip top shape.
Kamamoto C. Inflammation and gastrointestinal candida colonization. Cur Opin Microbiol. 2011;14(40): 386-391
Fiber, it’s the hot ticket. It is being marketed to us like crazy. But why is fiber is so important? What fiber is best? Should you get more fiber with supplements? Let’s take a closer look into the benefits of fiber in this edition of BBPT’s Health tips.
Fiber is the part of food that we cannot digest. It is separated into two types, soluble and insoluble. Both bulk up the contents of your stomach and colon, which can help you feel more full but after that, the similarities end.
As the name implies, soluble fiber dissolves in water but insoluble does not. Insoluble fiber increases the mass of the stool and helps to get things moving, in terms of passing feces. Soluble fiber absorbs water. The truth is, most people are not getting enough fiber. Less than half of people in the United States consume the recommended amount of fiber. Let’s discuss the benefits of fiber and how to make sure you are getting enough.
So what if you don’t have issues going number 2? What else can fiber help you with?
Fiber has been shown to help with reducing the risk of the following conditions:
Coronary artery disease
High blood pressure
Fiber has also been shown to:
Improve insulin sensitivity in people who have diabetes
Enhance weight loss
Improve GI conditions like acid reflux, duodenal ulcers, diverticulitis, constipation, and hemorrhoids
Enhance the function of the immune system
How much to eat and where to get it?
Men under 50 years and under should consume at least 38 grams of fiber daily, Women under 50 should consume at least 25 grams of fiber daily. Women over 50 should eat at least 21 grams and men over 50 should get 30. Those who suffer from constipation may add more to your diet. We suggest contacting a nutritionist for proper amounts of soluble versus insoluble in these cases and anyone with a history of GI issues. Also, please discuss with your doctor before making any drastic changes to your diet.
Adding fiber to your diet when you are not used to it can sometimes be a little difficult. If you add too much too quickly, you may experience gas and bloating. Start slow and work your way up. Also, drink plenty of water.
Start by adding in whole wheat items (unless you have a gluten sensitivity), legumes, fruits, and vegetables slowly to your diet. Check out the Mayo Clinic’s full list of fiber rich foods here .
Anderson J, Baird P, Davis R, et al. Health benefits of dietary fiber. Nutr Rev. 2009. 67(4)188-205