Pelvic Health & Orthopedic Physical Therapy
Addressing your questions about pelvic, women's, and musculoskeletal health. Health is a journey. Movement is healing!
Here in the United States we sit on toilets where are legs are at 90 degrees or even larger angles. Guess what? That is not the ideal position for having a bowel movement in fact, if you are already straining being in this position will only make having a bowel movement more difficult. We have a muscle in our pelvis, the puborectalis, that runs from the front of the pelvis back around the rectum and then connects back to the front of the pelvis again. It forms a sling basically. When we sit at a 90 degree angle this muscle cannot fully relax allowing the contents of the rectum to pass through as picture below on the left side. It's as if you take a garden hose and kink it slightly, the contents won't pass through as readily. The solution is to get into a squatting position. How do you do this? Have you heard of a Squatty Potty? If you haven't you need to add it to your Amazon wish list ASAP. In the picture on the right you can see how the position of the puborectalis and the colon changes with the squatting position (hips are both bent and the back is bent forward slightly--not hunched). The colon can more easily empty in this position without you feeling like you need to strain to empty your bowel. You can also use a stool to elevate your feet on the toilet to assume the squatting position, but I think the Squatty Potty is pretty nifty because it's the perfect height, comes in different sizes, plus it slides right under the toilet when you are done. Some other tips to avoid straining: 1. Try to relax when on the toilet. It does no good to sit there just pushing continuously. 2. Keep your mouth open when you are breathing so that you don't increase the pressure in your abdomen. 3. Give yourself enough time, about 10 mins. If you don't go in 10 minutes get up and walk around, try again at a later time. This may not apply to all individuals if you are concerned about your ability to have a pain-free bowel movement please see your local pelvic health physical therapist. It's October again. I know the hospital I work at is all decked out in pink. Awareness regarding breast cancer is everywhere. It's in the grocery store, there are races, it's even worked into the media. Awareness about the risk of developing breast cancer and celebration of survivorship are pretty apparent. Some of the struggles of survivorship are not as readily discussed. One issue that some women can face after treatment for breast cancer is perineal discomfort, urinary incontinence, and even pain with intercourse.
One of the biggest challenges for those navigating survivorship is things can be very overwhelming. There are a lot of financial, emotional, physical, and physiological impacts of fighting and surviving breast cancer that these individuals must face. It is sometimes difficult to find where physical intimacy and pelvic issues fit into the picture. Treatment for this type of cancer targets hormones in the body which can impact the tissues in the pelvic region. As a result discomfort, loss of urine, or pain with physical intimacy may occur. The muscles of the pelvic floor need estrogen and progesterone to function so by quickly removing them, the muscles don't know how to properly react. The muscles of pelvic floor may begin to develop weaknesses or areas of tenderness. The tissue integrity may change as a result of previous treatment. So when you are ready to seek treatment pelvic health physical therapy can help to address the changes that these tissues have experienced. With this type of PT they will look to restore improved tissue quality and provide the individual techniques for improved control over those muscles. They can provide insight on different lubricants and ways to decrease irritation from dryness. The PT can help to improve strength, muscle control, and decrease point tenderness. They can also help to trouble shoot different biomechanical difficulties occurring and help develop a plan to decrease accidental loss of urine. Everybody poops and according to Harris et al 2006 approximately 20% of individuals in the United States suffer from constipation. That's 1 in 5 people you meet have trouble pooping. So I've decided to do a series about constipation! Wohoo! So let's dive right in. It's not really surprising that so many people suffer from issues with constipation. I mean let's just think about some of the things that can contribute to constipation. DIET. We eat a lot of sugar, carbohydrates, and processed foods in America. You know how it feels a little like glue when you are chewing it? That's how it is in your gut as well. Pairing hand in hand with what we eat is what we drink. We don't get nearly enough water throughout the day. If we are lucky we stop to sip on water occasionally or some people avoid water altogether for more caffeinated and sugar-filled alternatives. But our gut needs water. The colon pulls all of the water out whatever is in it, so pair that with your gluey mess from above and you have something that just isn't going to budge very easily when you are sitting there on the toilet. Beyond diet there are some other factors that can contribute to constipation. Certainly the anatomy and motility of the intestines can play a role, but not every person walking around has had some change in the ability of their organs to move food through the digestive system (which is the definition of motility). So what else is there? Your pelvic floor muscles play a large role in the development and continuation of constipation. The muscles can become tight and can have a difficult time relaxing in order to have a bowel movement. Which is where a pelvic health or women's health physical therapist can come in to help alleviate your symptoms. The physical therapist can help to release those muscles, give you relaxation techniques, and then ultimately work on proper positioning and toileting techniques to help alleviate your symptoms of constipation. Symptoms of constipation can influence your overall health and well-being. They can cause you anything from mild to severe discomfort in your low back, abdominal, and perineal areas. I mean it just doesn't feel good when you can't have a bowel movement and you are all backed up. There are changes to diet and techniques physical therapists can help you to implement to offer relief from these symptoms. Stay tuned for part 2 on constipation we'll plunge a little deeper (pun definitely intended). References:
Harris LA, Hansel S, DiBaise J, Crowell MD. Irritable bowel syndrome and chronic constipation: Emerging drugs, devices, and surgical treatments. Curr Gastroenterol Rep. 2006;8:282–90. Sorry for the hiatus from blogging! I've been settling into my new place and job, things have just been a little bit on the crazy side. Anyways, lots has been going on.
So what's new? I recently went to another continuing education course on pelvic health physical therapy. We dove deeper into more complicated topics on gastrointestinal pathologies and pelvic pain. Remember all of those important muscles of the pelvic floor? They can impact your ability to have normal bowel movements. They have to lengthen for pleasurable intercourse. They also play an important role in a variety of pain diagnoses felt in the perineum, back, and legs. Chronic Pelvic Pain is described as pain in your pelvic region lasting longer for 6 months. The Mayo Clinic tweeted just this past week that 39% of women will experience Chronic Pelvic Pain at some point during their lifetime. This is just the number of women currently reporting their symptoms, so the number of women actually experiencing pelvic pain could be much larger. Many women just don't know who exactly to turn to for help. I just want to say that there are a lot of ways to help manage that pain and Pelvic Floor or Women's Health Physical Therapists can help patients with not only this type of pelvic pain, but many diagnoses. You see when our body experiences pain A) the muscles form a muscle memory and B) the muscles tighten and guard against the pain. If that pain stimulus does not subside our body continues to become more sensitive to pain triggers so smaller triggers elicit a greater pain response. This is true for ANY aspect of our body, including the muscles of the pelvic floor. So what does mean for an individual experiencing pelvic pain? A Pelvic Floor or Women's Health Physical Therapist can help you lengthen and relax your pelvic floor musculature, give you techniques to encourage more positive connections between the brain and muscles, and help to desensitize the area. |
AuthorHello! I am Caitlyn, Doctor of Physical Therapy and Board Certified Women's Health Physical Therapist working in St Louis, Missouri. Faculty in developing residency program. Endowarrior Categories
All
Archives
July 2021
|