BPPT Health Tip: Best Positioning Tips for Optimal Bowel Movements

By Sarah Paplanus, DPT, PT

Are you among the 4 million Americans who suffer from constipation? Or the 1 in 5 American adults with Irritable Bowel Syndrome? Do you occasionally experience the pain and itchy feeling associated with hemorrhoids? If so, the Squatty Potty or similar stool may be the perfect addition to your bathroom! Even if you haven’t been diagnosed with any of these conditions, it is important to note that straining or holding your breath to complete a bowel movement is never normal and is usually a sign of dysfunction. Colorectal medical conditions can vary in their cause, in their presentation and in their severity, but your pelvic floor muscles will always be affected.

null( Image via: squattypotty.com )

Anatomy!

 

Your colon carries waste out of your body, and where the colon meets your rectum is called your anorectal angle. This anorectal angle is an important factor in continence.

Your pelvic floor muscles work together to support the rectum, change the anorectal angle and control opening/closing. One of your pelvic floor muscles (the puborectalis) forms a sling around your rectum and works to maintain the anorectal angle. If that muscle is tight, it can essentially “choke” your rectum and contribute to straining.

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What does squatting do?

Squatting straightens the anorectal angle and helps to relax the puborectalis muscle, which helps to facilitate emptying. It also decreases the amount of pressure in the abdomen, which has been shown to decrease the time and effort needed for defecation. This all helps to reduce excessive pressure and strain on your pelvic floor muscles. In cultures where squatting is still prevalent for defecation, such as parts of Asia and Africa, it has been found that bowel movements tend to be more complete and that there is a decreased incidence of colorectal dysfunctions such as hemorrhoids, constipation and hernias.

Why is straining bad?

A principle of elementary mechanics states that “any system exposed to excessive pressures ultimately sustains injury”.These injuries can be in the form of a hemorrhoid, a hernia, a muscle strain or a chronic pelvic floor dysfunction. Straining also increases your risk of the Valsalva maneuver, which is exhaling against a closed airway. This causes a sudden increase in intra-abdominal pressure which can cause abrupt changes in blood pressure.

Toilet Posture

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Using a squatty potty, stool, or even two yoga blocks can help you assume a “squat” position. Lean forward and rest your elbows on your knees. Take deep breathes in, using your diaphragm. Place your hands on your belly and feel your breathe fill up your abdomen. Keep your mouth open and jaw relaxed!

Other Strategies to Improve Bowel Health

  • Cardiovascular exercise
  • Proper nutrition (see our previous post on fiber!)
  • Make sure you are drinking enough water
  • Relaxation training, diaphragmatic breathing

 

What to do if you are still suffering?

If the above tips are not helping defecate regularly and comfortably, you may be suffering from pelvic floor dysfunction. Pelvic floor dysfunction can occur when the muscles of the pelvic floor become too tight, weak, or both to do their job properly. Physical Therapy can help! Visit us at Beyond Basics Physical Therapy to help better your BM’s.

PH101: Running to the bathroom, again?

By Fiona McMahon, DPT

Gotta_Pee_Toilet_signs

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 23 at 7pm, join Stephanie Stamas, physical therapist 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 refreshments will be served.

Register at pelvichealth-101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

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PH101: Something’s Wrong with my What?

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Image via PlayBuzz

On March 16, 2017 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.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth-101.eventbrite.com

Here is our line up of this and future classes:

pelvic-health-101-spring-2017

Yeast the Inflammation Beast

 

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Fiona McMahon DPT, PT

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.

 

 

PillsThe 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

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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

doctorFind 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.

 

 

Sources:

Kamamoto C. Inflammation and gastrointestinal candida colonization. Cur Opin Microbiol. 2011;14(40): 386-391

BBPT Health Tip: Adding Pelvic Floor Relaxation to Deep Breathing

Amy Stein DPT, PT and Fiona McMahon DPT, PT

 

bookhppThis blog contains information adapted from Heal Pelvic Pain by Amy Stein. If you are interested in learning more about pelvic floor exercises you can do on your own, please visit http://www.healpelvicpain.com/ , http://amzn.to/2ioSz2J, or visit us at Beyond Basics Physical Therapy in New York City to get your copy today.

 

In an earlier post we discussed the positive benefits of adding diaphragmatic breathing to your routine to reduce stress. If you missed it, check it out here .

But why not go a step further. Did you know that you can add pelvic floor drops to your breathing routine to help relax a tight and painful pelvic floor.

 

What is a pelvic floor drop?

A pelvic floor drop is the relaxation of the muscles of the pelvic floor. It is like that feeling you have when you can finally relax the muscle in between your legs after holding urine in for a long time. It’s a great feeling of relaxation and here’s how you can mimic it when you don’t have to go.

 

But How do I do it?

 

  • Step 1: Get comfortable. Sit, stand, lay down, whatever suits you, relax your body and close your eyes
  • Step 2: Breathe deep. Inhale between 3 and 5 seconds
  • Step 3: Exhale. Exhale slowly, 5-6 seconds. As you exhale imagine your breath gently placing pressure on your pelvic floor into relaxation. Don’t push or strain.

Like diaphragmatic breathing, you can use this technique throughout the day to help reduce stress and pain in the pelvic floor. Happy breathing!

How to Improve Bladder Health

Fiona McMahon, DPT

The bladder, not super complex right? Just a tupperware for pee, holding your urine until an opportune time to go. The bladder is so much more than that, integrating information from the brain, muscles of the pelvic floor, and responding to stretch to efficiently serve its purpose. We never think of the bladder until something goes wrong with it.

In honor of bladder health month, we will be exploring the anatomy of the bladder, what is normal for the bladder, what can go wrong with the bladder, and how to best take care of your precious and hard working bladder.

Bladder Anatomy/ Physiology

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Male or female, we all have the same basic structure of the bladder, with a few exceptions. Here’s what everyone has in their lower urinary tract.

  • Detrusor Muscle: Forms the body of the bladder and is responsible for squeezing the bladder to empty its contents. It spends most of its time relaxed in order to allow for bladder filling.
  • Trigone Muscle: Forms the neck of the bladder, and is a powerful sensory organ. When the trigone stretches in response to the filling of the bladder, it sends a message to the brain that it’s time to pee.
  • Internal Urethral Sphincter: Smooth muscle (involuntary) which seals off the exit of the bladder and allows for continence.
  • External Urethral Sphincter: Striated or voluntary muscles which also seals the exit of the bladder.
  • Urethra: This is the tube that leads out of the bladder and is the pathway for urine into the outside world.

Sex differences:

Men have a prostate. The prostate is a sex organ and is responsible for keeping the semen at the right pH to fertilize a waiting egg. It wraps around the urethra and lives just under the bladder. It also provides a mechanical buttress or support for the bladder, lessening the load on the pelvic floor.  Because of its proximity to the urethra, problems with the prostate can cause problems with the bladder.  An enlarged prostate, which can be a benign part of aging, cancer, or infection, will restrict the flow of urine out of the urethra, resulting in weak stream, painful, burning urination, and difficulty urinating (the same thing happens with tight pelvic floor muscles). A prostate that has been surgically removed, most often has occurred for treatment of prostate cancer. For more information on prostate cancer click here (link to old content). Also keep your eyes peeled for a blog on non-bacterial prostatitis coming soon!

Another important difference between guys and gals are the respective length of their urethras. Male urethras are a lot longer than female urethras. This is one of the reasons women are more prone to bladder infections. In a female, bacteria have a lot easier time making the trek to the bladder because of the shorter urethra.  

Conditions of the Bladder

Gotta_Pee_Toilet_signsIncontinence

Incontinence is the involuntary leakage of urine. There are many causes of incontinence. It’s important to know why you are leaking in order to know how to appropriately remedy it. It is possible to have more than one type of incontinence, and when that occurs we call it mixed incontinence.  Let’s go through the types together.

  • Urge incontinence occurs when you leak urine  after a sudden urge to urinate. We call it, lock in key syndrome, because certain events like unlocking the door to your home can cause urge incontinence.  This is the type of incontinence, which should be treated first in cases of mixed urge/stress incontinence.
  • Stress incontinence is the result of pelvic floor weakness that prevents the closure of the external urethral sphincter with activities that increase the pressure on the bladder, like coughing, laughing, lifting or sneezing. Pelvic floor weakness can occur if the muscles and or connective tissues are too loose to create an efficient contraction and more commonly, especially with athletes, too tight or imbalanced, to fully close the external urethral sphincter. Read more about incontinence in athletes here (link to content)
  • Functional incontinence occurs when you physically can not get to the bathroom in time to urinate. This is common in the elderly or disabled, who may have trouble ambulating to the bathroom, removing clothing, or transferring from a chair into standing. It is imperative that this type of incontinence is treated aggressively by a physical therapist or occupational therapist as it increases the risk of potentially fatal or disabling falls.

Incomplete voiding

Incomplete voiding is when the bladder does not fully empty.

In a normally functioning patient, volitional effort should not be required to empty the bladder.  A pelvic floor that is unable to relax, will have a smaller opening for urine to pass through or the voluntary muscles involuntarily contract because of muscle spasming, resulting in hesitancy, or incomplete bladder emptying.   

Bladder Pain

Pain is our body’s way of telling us there is something wrong. With a new onset of bladder pain, it is important to rule out infection or an organic condition. Often times musculoskeletal conditions or general bladder irritation can mimic bladder infections.  In our practice, we often see patients who had been convinced they had an infection only to find out all of their tests for infection, where in fact, negative and the source of their pain was a tight or shortened pelvic floor.

It is important to understand the character of your bladder pain. Does your bladder hurt as it fills with urine and then feels better only shortly after voiding? If your answer is yes, you may have bladder irritation from urine that isn’t dilute enough (you are not drinking enough water), or you are consuming something irritating like spicy food, caffeine or alcohol. You may also have a condition known as painful bladder syndrome/interstitial cystitis which is contributing to your symptoms. It is important to get a handle on bladder filling pain right away, because it is the first step in treating other conditions such as frequency, urgency, incomplete emptying and retention.

If you have pain and burning during urination with no infection, it is likely the pelvic floor muscles and tissues cannot relax enough to allow urine to flow out without burning, (the pelvic floor also plays a role in bladder filling pain as well). Burning with urination that is not caused by an infection, is treatable with pelvic floor PT.

Frequency:

Everytime I hear someone say “I have a small bladder”, I have the uncontrollable urge to say, “No, you have a sensitive bladder, which can be trained to be better”. Saying you have a small bladder is 95% of the time fatalistic and just untrue. Most bladders, with few exceptions can hold 400-600 mL. Holding capacity can be diminished in cases of constipation, pregnancy and some neurological conditions, but most everyone is working with similarly sized equipment (the exception, being growing children).

Average intervoid interval, aka times between pees, is 2-3 hours, unless you chug a liter of fluid or cups of caffeine in one sitting. An example is being able to make it through James Cameron’s, Titanic, without having to excuse yourself. The trick with the bladder is it’s antsy. It informs you with the first urge to urinate when it is approximately 40% full. Over time, if you listen at that first urge, the bladder will begin to inform you earlier and earlier until you are going once every 20 minutes. Training your bladder to hold more is achieved with ignoring the urge or practicing various behavioral strategies, like deep diaphragmatic breathing with pelvic floor drops, to allow for longer intervals until your bladder capacity is within normal limits. This can be a longer process for those with a more sensitive bladder.  

Bladder training is complicated by pain. Pain usually must be treated simultaneously in order to truly get the most benefit from bladder retraining. It is also important to realize that substances like caffeine and alcohol increase urgency and make bladder training more difficult.    

How to Manage Bladder Issues:

Fortunately, there is a lot you can do, RIGHT now to manage your bladder symptoms. I find that in my practice and everyday life, there is a certain fatalism about bladder conditions. I can’t count how many times I’ve heard phrases like, “ I just have a small bladder”, “Women my age after babies just leak”, “I am older so I pee more at night” and “it’s always been like this”. The bladder is a trainable organ and the muscles influencing it can be stretched and strengthened like any other muscle in the body. The best part is there is so much you can do for yourself at home. It’s totally worth trying and in many cases is a life changer.

water-life-cropDiet and fluid intake:

It may sound counter intuitive, but drinking plenty of water is good for almost all bladder conditions. Yes I am talking about leaking, urgency, incomplete emptying and frequency. Drinking lots of water keeps your urine nice and dilute, minimizing the irritation of the bladder wall as well as the reactive spasm of the detrusor muscle. You should drink approximately half your bodyweight in ounces of water a day. For example: a 150 lbs person should consume 75 ounces of water a day. You should increase this amount if you are exercising, or experience a lot of sweating or drink a lot of caffeine and or alcohol, which are both dehydrating. It is also important to be mindful of bladder irritants which can worsen bladder issues. Big irritant culprits are alcohol, caffeine, citrus, and spicy food. In children, dairy milk is a common bladder irritant. Check out John’s Hopkin’s bladder irritant list here { hyper link ( navigate to seperate window)], Keep in mind that one person’s bladder irritant may not be your bladder irritant. It’s easy to look at lists of bladder irritants and get overwhelmed. Try eliminating a suspected offender for two to three days. If you feel better when you aren’t consuming that item and worse when you add it back in, consider eliminating that item from your diet.  It is also important to eat in a way that prevents constipation, as this worsens bladder symptoms and puts extra pressure on the bladder.  

Posture

If you are having problems fully emptying your bladder or you have post void leakage ( dribbles following going to the bathroom) consider your toileting posture. People with bladder issues should sit on the toilet ( even dudes), to allow the pelvic floor muscles to relax and allow the bladder to fully empty.

Bladder Training

If you have bladder frequency or leakage  now is the time to try and train your bladder to hold more urine. Keep in mind you should start treatment to address pain with physical therapy and in certain cases, with medication, to allow you to be successful with bladder training. I always tell my patients to start their bladder retraining at home, where a bathroom is available to take the stress out of possible leaks or not being able to find a bathroom. Start by simply waiting to go to the bathroom 5-10 minutes past your first urge to urinate. Use behavioral strategies, such as deep breathing and pelvic floor drops, mindfulness, distraction and others.  If you don’t have to go after 5-10 minutes, Great! If you do, go to the bathroom. As waiting 10 minutes becomes easy, stretch your time to 20 minutes and so on until you are able to go 2-3 hours in between urination.

Physical Therapy

Physical therapy is considered a mainstay and top treatment for musculoskeletal causes of bladder disorders and bladder pain.  Expert pelvic floor physical therapists are clinicians who can find the cause of your bladder issues and provide you with a customized plan that will provide you with the best results possible. PT’s can work to relax spasmed muscles, treat constipation contributing to bladder issues, improve your toilet posture, reduce tightness around the bladder, abdominal and thigh region that can contribute to bladder dysfunction, as well as strengthen weak muscles. If you are experiencing bladder issues, please come see us ( link to BBPT here). There is so much we can do to help!

Sources:

Berghmans L, Hendriks H, Van Waalwijk, et al. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int. 2000; 85: 254-63

Chancellor, M, Yoshimura N. Neurophysiology of stress incontinence. Rev Urol. 2004; 6(Suppl3)S19-S28

Chang H, Lynm C, Glass R, et al. Urinary incontinence in older women. JAMA, 2010; 303(21): 2208

FitzGerald M, Brensinger C, Brubaker L, et al. What is the pain of interstitial cystitis like?. International Urogynecology Journal Including Pelvic Floor Dysfunction. 2005

Shafik A, Shafik I. Overactive bladder inhibition in response to pelvic floor muscle exercises. World J Urol. 2003 May; 20(6):347-7. Epib. Apr 4

Tightly Wound: A film chronicaling one women’s experience with vaginismus

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At Beyond Basics Physical Therapy, we treat a lot of conditions that limit or entirely prevent someone from having sex. One of those conditions is Vaginismus. The frustration and physical toll can be tiring for patients with this condition. One of the sentiments echoed time and time again by different patients, is how isolating the whole experience can be. Not many people talk about their sex life, let alone medical conditions affecting their ability to have sex. Shelby Hadden is looking to break the stigma by making her own film chronicling her experience with vaginismus. You can read her story and support her Kickstarter campaign {hyper link to page} to fund her movie, here:

I was 24 and had never had sex. I had been dating Gadi for a few weeks and I couldn’t play defense to his advances any longer. It was time to tell him about my vaginismus.

Vaginismus was always the big black cloud of a secret looming over me.

But he surprised me. When I told him about it, he said, “I like you a lot, and we can figure this out. I still want to see you.” My heart soared. No guy I had dated up to that point had showed me an ounce of empathy, patience, or understanding. One guy walked out of my apartment, promised to call me, and never spoke to me again. Another laughed in my face and said, “That’s hilarious.” Finally, someone liked me as a whole person, not just the functionality of one body part.

The next day, he texted me this: “I’ve been thinking about what you shared with me the other night. I feel like it may be a bit more than I am ready for in a relationship. Sex is too important to me.”

He couldn’t even bother to consider what else we could do or ask how my progress in physical therapy was going. I couldn’t do it RIGHT THEN so I was “too much” for him – which in reality, in situations like these, it means that I wasn’t enough.

I was angry. I’ve been angry before – at other guys, at my body, at doctors, at Shonda Rhimes shows for making sex look so easy, fast, and fun – but this time I was absolutely furious. He gave me the reaction I had always hoped for, only to take it all back. I was just a vagina to him too. In addition, he never considered how important sex was to me. I had gone to a dozen doctors over the course of seven years. I had been going pelvic floor physical therapy every week for over a year. I had been using dilators every day for three years. No one was working harder to have sex than I was.

I needed to take action. As a filmmaker, the only way I knew how to take control over it was to make a film. So I wrote an essay, which I later turned into a script for a short animated film called, Tightly Wound.

Tightly Wound follows my journey from when I started my period and realized I couldn’t use a tampon. It chronicles the various doctors I saw and treatments I tried, the ways I hid my secret. I delve into my unsuccessful attempts at dating and explore what it means to be a virgin in today’s society.

It’s been a year since Gadi broke up with me. My essay has been published in BUST Magazine and I shared my experience at BedPost Confessions – an Austin, TX based storytelling series on sex, gender, and social change. I’ve assembled an extremely talented team of filmmakers to produce the film.

Animation is the perfect form for this film. It allows me to illustrate my internal thoughts and feelings in a metaphorical way rather than succumbing to the limitations of live-action. However, animation is an extremely time-consuming and labor-intensive process. The fastest my animator, producer, and friend, Sebastian Bisbal, can work is 5 seconds of animation per day!

 

We are raising $20,000 through Kickstarter. Kickstarter is a crowd-funding platform that allows people to support projects they believe in. Kickstarter is all-or-nothing – so if we don’t raise the $20,000, we don’t get any of it at the end of November.

It is estimated that 6% [ In a  study done by the World Health Organization, worldwide prevalence of pelvic pain has been estimated as being as high as 24%] of people with vaginas encounter pelvic pain/sexual dysfunction at some point of their lives. However, this is a difficult number to determine since shame and embarrassment keep so many people from seeking medical care.

Please join me in making this film and shining a light on pelvic pain/sexual dysfunction by donating to the Kickstarter. Thank you so much for your support!

Kickstarter link: http://kck.st/2dUTASv

Check out the trailer here: https://vimeo.com/188456092

Sincerely,

Shelby Hadden

 

Sources:

Latthe P, Latthe M, Say L, et al. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health  morbidity. BMB Public Health. 2006