How to build a stellar bowel routine

Bowel problems are so frustrating. Let’s be real. Constipation remains the #1 GI complaint in the country and impacts millions of people (pun unintended, but I’ll take it!). I love writing about pooping, and we love treating poop problems at Southern Pelvic Health (both virtually & in-person!!). The cool thing about poop, is that often the smallest changes in our habits can make BIG differences. A lot of this is due to the physiology of the digestive tract. Our habits—what we do during the day—can hugely impact this physiology, and that’s what I want to talk with you about today.

How do you maximize the efficiency of your digestive system and build a stellar bowel routine so you can poop better?

To understand this, let’s look at the digestive system a little more closely.

When you eat food, digestion begins in the mouth. Chewing helps to break up the food, and your saliva begins to break down the nutrients. Chewing alone is an essential part of digestion. In fact, most of us don’t tend to chew enough. I’ve been there! Years of working as a physical therapist at busy practices, led to a habit of inhaling my food rather than eating slowly and actually enjoying the process. Did you know that in order to adequately digest an almond, you have to chew that almond over 20 times? I learned that a few years ago when I interviewed Jessica Drummond- an incredible clinical nutritionist who also happens to be a pelvic PT. You can see the whole interview here if you’re interested!

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After we swallow our food, the food travels down the esophagus into the stomach. Here, the stomach churns the food, mixing it with acid and juices and continues the process of digestion. When food enters the stomach, this triggers an important reflex called the gastrocolic reflex, which pushes prior meals and snacks through the rest of the digestive tract. This reflex is SUPER important to know to help stimulate regular movement in the GI system.

The food then exits the stomach and enters the small intestines. Did you know that if you uncoiled your small intestines, they would be 20 feet long? The intestines are where the majority of digestion occurs. Juices from the pancreas and gall bladder are added in here to aid in processing our nutrients. Food moves throughout these coils, then enters into the large intestine via the ileocecal valve.

The large intestine, or colon, is the major water recycling plant in the body. The colon recycles about 70% of the fluid we take in to use throughout the body. It continuously removes fluid from our stool…. So, what do you think happens if you don’t drink enough fluid? Or what do you think happens if your colon moves a little too slowly? Yep, that’s right. You end up with hard and dehydrated stool. When stool enters into the last part of the colon, the rectum, the stretching of the walls of the rectum trigger another reflex. First, an incredible reflex called the “sampling response” takes place. In this reflex, a small amount of contents are allowed to enter the anal canal. Your nerves here sense what is present, and tell your brain if the contents are liquid, gas or solid. (Amazing, right?!) Now, this reflex can sometimes be dysfunctional. So, if you struggle with feeling a strong need to poop, and when you get to the bathroom, it’s only gas? That’s this reflex. OR, if you feel like you have some gas to release, and when you release it, it’s actually a little bit of stool? That’s a sampling problem as well. And guess what—we can actually do things to retrain and improve this reflex.

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As the stool is filling the rectum, and stretch occurs, the brain will receive the message of what is in the rectum, and gets to decide what to do about it. If there is just gas, you may choose to release it or wait a bit to release it. If it is liquid, your brain knows you better get to the bathroom QUICK! Liquid stool is hard to hold back for too long—the muscles fatigue—THIS is why chronic diarrhea can lead so often to bowel accidents! And if the stool is solid, you can actually defer and postpone the urge, until an appropriate time to go. The challenge there is that postponing frequently can make it so the muscular walls of the colon help you less when it is actually time to go to the bathroom.

When it is an appropriate time to go, you then sit on the toilet, relax your pelvic floor muscles, and this stimulates a defecation reflex which will allow the rectum to empty via the anal canal. Sometimes, we need to generate some pressure to assist this process, and sometimes, the muscular walls of the colon take care of it themselves.

So, let’s get down to it.

How do you use the process of digestion to build your bowel routine?

Step 1: Eat at regular intervals during the day to regularly stimulate your gastrocolic reflex.

Remember, this pushes things through the system, so it needs to happen often. The colon LOVES consistency, and HATES change. So, skipping meals? Eating really large meals sometimes, then nothing the rest of the day? All of this can impact your bowel function.

Step 2: Slow down & chew your meals.

Remember, chewing begins digestion, so, stop what you’re doing and eat mindfully and peacefully. Also, digestion requires a lot of parasympathetic activity—this is your resting & relaxing nervous system—so, slowing down and making time to eat can help stimulate that too.

Step 3: If you need the bowels to move better, eat “bowel stimulating” foods/drinks around the time of day you normally go to the bathroom.

What stimulates the bowels? Warm drinks (especially coffee—because the caffeine is actually an irritant to the GI tract!) are a great place to start. Also, spicy foods can help stimulate the GI system to move.

Step 4: Sit on the toilet around the same time each day, preferably, after a meal.

Remember that gastrocolic reflex? That reflex is helping to move things through the system, so after a meal is a great time to spend a few minutes relaxing on the toilet.

Step 5: Exercise!

Yep, exercise also stimulates the peristalsis of the GI tract! So, aim to get in regular bouts of exercise. And, it doesn’t need to be too extreme? Even going on a 10 minute walk can help get things moving.

What does this actually look like in practice? Here’s a sample routine!

Jane wakes up in the morning and takes the dogs on a short 10 minute walk. She gets home and makes a cup of coffee and her breakfast. She eats breakfast slowly, taking time to chew her food. (Jane also makes sure that she is getting plenty of fiber and whole fruits/veggies in her diet—because this matters too for her stool consistency!). After breakfast, Jane goes and sits on the toilet. She sits in a nice comfortable position, relaxes, breathes, and thinks about her day—spending 5 minutes without trying to force anything to happen. After a few minutes, she starts to feel the need to have a bowel movement. She uses what she learned in the “How to Poop” article, and gently pushes with good mechanics to assist her rectum in emptying her bowels. Jane then goes about her day, eating small amounts every few hours to stimulate her GI system.  

Now, it’s your turn my friend! How is your bowel routine? What can you change to actually use your physiology and poop better?

Want more on pooping? Check out these articles:

How to Poop 

Dyssynergic Defecation or When the Poop Won’t Come Out 

Sex, Drugs…& No Poop? 

Have a great rest of your week!

~ Jessica

 

 

For Pros: Expert Panel Discussion on Virtual Pelvic Health Tomorrow 3/20 at 9PM EST!

Hello my friends,

Wow- what a few weeks it has been! I don’t know about you, but it has felt completely surreal to me. My practice, Southern Pelvic Health, which has been steadily growing and serving people around Atlanta was suddenly put on hold, and many of my patients shifted to working with me in a virtual setting. Now, I know you may be thinking– how can you help people without actually touching them? I hope to expand on this in some future posts, because, honestly, I believe this is where we are going to be for a while (SO, WASH YOUR HANDS, and SOCIALLY DISTANCE, my friends!). But, this is heavy on the minds of pelvic PTs across the country. Thinking– how can we, as a profession, still help the people who need it? Make a difference in their lives? Help people control their bowels & bladder, have better and pain-free sex, live their lives without pelvic pain?

So, this post is for all of you PTs out there asking yourselves that! Earlier this week, I partnered together with some of the smartest, most innovative PTs I know– who are leaders in our field, and ALREADY practicing pelvic health in a virtual setting– and we are hosting a webinar to teach all of you how to do just that! So, join us tomorrow for this important event:

TAKING PELVIC HEALTH ONLINE!

LIVE Webinar Event: FRIDAY 3/20 AT 9PM EST

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We are bringing an expert panel together to discuss how best to screen, examine, and treat patients with pelvic floor diagnoses—without actually being able to touch our patients! These experts have been ALREADY DOING THIS, with success, and we are so pleased to bring this to all of you!

Join me, Jessica Reale, PT, DPT, WCS, as I lead a discussion with Antony Lo of the Physio Detective and the Women’s Health Podcast, Sara Reardon- the Vagina Whisperer, Juan Michelle Martin- founder of the Zero to Telehealth Program, Julie Granger- virtual health and biz coach, and Susie Gronski- author and educator. We will discuss:

How to get your ideal clients to see the value in virtual Pelvic PT care and convert in-person clients to virtual clients

How to evaluate, screen, and provide pelvic health treatments without being able to physically touch or be present with clients.

How to effectively help your virtual clients without manual therapy or internal examinations

How to market your services in a growing and busy online market and build a practice that is sustainable in the long run.

Plus, Antony Lo has graciously allowed all participants to receive a BONUS link to a recorded virtual session of one of his clients with diastasis recti!

JOIN US FRIDAY 3/20 at 9p.m. EST! Registration is $49.

Register today! 

Do you have topics you are hoping we discuss? Please let me know and I’ll be happy to bring them into the conversation?

Stay healthy and stay safe my friends. We are all in this together!

~ Jessica

Virtual Pelvic Floor Physical Therapy

We are in an unusual time. Like many of you, I have been reading way too many articles and watched way too many news stories. COVID-19 is sweeping the world, and all of us have this immense responsibility to act, where we are, to do what we can to prevent the spread of this virus. Everyone is impacted, and everyone (hopefully) is trying to make the best decisions for themselves, their families, and society at large.

Healthcare is also seeing a shift—away from in-person care and toward virtual platforms. Right now, this is essential for so many reasons. The interesting thing is that at Southern Pelvic Health, virtual sessions have always been a part of what we do. And now, more than ever, we are working to be sure this service is available for anyone who needs it. Because, the reality is, pelvic floor problems don’t stop during a pandemic. In fact, for many, they can be exacerbated. Social distancing also offers the opportunity to stop and care for yourself, your health (along with your family & the community by flattening that curve!).

So, what is virtual pelvic floor physical therapy and what can it do for you?

The initial visit starts the same as an in-person session. We spend time discussing what is bothering you, in likely more detail than you thought we’d be discussing. We talk about your history, what happened when all of this started, what changed along the way, what is happening now. We discuss any pain or orthopedic problems you are having, your bladder health, bowel movements and sexual function. And most importantly, we discuss your goals—what you want to achieve how you hope to feel.

Next, we provide an exam. Now, here’s the difference in the virtual session. The components of the exam during which your PT would palpate your muscles or feel you move—we can’t do that. So, the exam takes on a different flare. We still watch you move from head to toe to identify how your body is working for or against itself. We may ask you to do different self-tests, feel different areas and see if you have soreness/sensitivity. We will give you additional information to see if you can activate certain muscles. And, from here, we can actually glean quite a bit of information. You see, the pelvic floor does not work in isolation. So, watching a person move alone can give us so much information about your function. I’ve written about this before, and here are a few that address this:

Head, Shoulders, Knees and Pelvic Floor!

6 Reasons Why the Diaphragm May Be the Coolest Muscle in the Body

Pelvic Floor Problems in the Adult Athlete

Next, just like in-person sessions, we start you on a plan to address the problem areas we have identified. This likely includes specific exercises for you to get started on, and some educational pieces to start improving your habits. We will also make a plan for the future—which could include virtual sessions only, recommendations for in-person consultations, or perhaps a hybrid! At our practice, we already have much of our content and exercises in a digital format. Any exercises we recommend will be given to you via video instruction in your patient portal. Behavioral education and other pieces like that will be provided for you both in our virtual session, but also via handouts e-mailed to you after.

Already an established patient?

This is even better. We have already done a comprehensive exam (or perhaps, another PT has already done this exam!), so we will have a complete picture of your situation.  We will be able to discuss your progress, modify and progress your exercises, continue providing specific education, and help you continue to move forward to improve your function.

Live out of state?

This one is a little tricky. Technically, we are not able to see patients for physical therapy services if they do not live in Georgia. BUT, that does not mean we are not able to help you. We regularly offer virtual consultations and coaching services for people all around the country. This has been an amazing service to provide to play a critical role in helping to guide people to the services they need to get better. Our virtual consultations offer a similar format as our initial telehealth sessions. The difference here is that we would not be able to examine you and progress you in a program. We can offer some general guidance based on your symptoms, and very importantly, we can help you connect with more local practitioners to be on your healing team. We do the legwork for you—we find you resources, skilled practitioners (yes, we help you decide who your best options are!), and coach you along the way.

Are you ready to take the virtual leap? E-mail us today to arrange your first session at info@southernpelvichealth.com!  

Stay healthy my friends! And please, wash your hands!

~Jessica

Podcast Interview: Real Talk with the Pelvic Docs

Happy Monday Everyone!

I am 2 weeks in to my new practice, and absolutely loving it! I was fortunate this past week to be a guest on the podcast series, Real Talk with the Pelvic Docs. Jenny LaCross has been a friend for a few years (we connected when she was in her residency program), and she’s doing amazing things for the pelvic health community! It was such a pleasure to talk with her about my experiences with pregnancy, childbirth and my own postpartum recovery. You’ll also hear more about my journey to private practice and my hopes and dreams for the future! I hope you enjoy this podcast as much as I enjoyed recording it!

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Click here to listen to my guest interview on Real Talk with the Pelvic Docs!

We’re live and going social!

Hi everyone! I’ve been staying up till midnight nearly every night, and no, it’s not because of my baby (she’s an amazing sleeper!). It’s because TODAY is move-in day at Southern Pelvic Health! My garage is packed with furniture, and I can’t wait to get this space ready!

Along with that, I am finally ready to launch my website!! Check out www.southernpelvichealth.com and see what you think!

We are also getting social!! I love blogging here, and I’m excited to bring smaller bits of content, tips, and pelvic floor love to the social media scene! Check out our Instagram and follow @southernpelvichealth! You can also find us on Facebook!

We will begin seeing patients on Monday September 30! If you’d like to set up an appointment, you can register as a new patient online!

Can’t wait to get started! Thank you for the outpouring of love and support as I’m starting this journey!

❤️ Jessica