Tag: Dyssynergic Defecation

How to build a stellar bowel routine

~ jesspreale ~ Leave a comment

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

 

 

5 Ways Pelvic PTs Can Help with IBS

~ jesspreale ~ 3 Comments

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This month is IBS Awareness Month!

Irritable Bowel Syndrome (IBS) can be an incredibly life-impacting condition, affecting around 10-20% of the population (80% of those individuals being female!). The exact cause of IBS is unknown, but it is thought to likely be multifactorial.

IBS is characterized by abdominal pain paired with constipation and/or diarrhea. When many people hear about IBS, they may not automatically think that working with a physical therapist could be useful; however, there is so much that physical therapists can do to help improve symptoms related to IBS. Here are a few!

1.) Assist the client in developing optimal bowel habits.

We’ve discussed in detail several times how our habits can be extremely connected to our bowel function. This is also very true for individuals dealing with IBS–whether struggling with constipation, diarrhea or both! Training bowel habits includes developing a consistent bowel routine, optimizing dietary habits, and even toilet positioning/defecation strategies. These factors basically aim to help make sure your habits are working for you instead of against you. Sometimes these components require a more multidisciplinary team. This can include working with your GI physician, pelvic PT, as well as a dietician, functional medicine provider, and other specialties.

2.) Global downtraining and stress management.

Did you know you have an extensive neural network throughout your GI system? This network has been termed “the second brain” due to its ability to function even when cut off from the rest of the system. It’s also often called “the emotional brain of the body,” which makes sense when we think about how often we feel our emotions in our gut (i.e. “butterflies in your stomach” or “my gut reaction”) All is this means that our GI function can often be influenced by our stress, emotional regulation, and general psychological well being.

Qin et al. (2014) stated, “More and more clinical and experimental evidence showed that IBS is a combination of irritable bowel and irritable brain.”  They went on to add that psychological stress can impact intestinal mobility, motility, secretions and permeability. They concluded that, “IBS is a stress-sensitive disorder, therefore, the treatment of IBS should focus on managing stress and stress-induced responses.”

Pelvic PTs utilize strategies promoting downtraining and neuromuscular relaxation to help calm the nervous system and promote a more parasympathetic dominant state.  This can be done through movement, relaxation strategies, mindfulness/meditation, and many other techniques. Want to get started on mindfulness now? Check out this prior post on Mindfulness, Meditation and Pain.

3.) Specific exercises aimed at promoting better movement.

This may not seem connected at first, but the reality is that when people aren’t feeling well or when someone is struggling with constipation/diarrhea, people tend to move less. This can often impact bowel function as regular exercise tends to stimulate more regular bowel movements. This 2019 review of 14 studies involving exercise interventions aimed at improving IBS symptoms found that exercise does seem to have a role in helping bowel function (Note: many of these studies were not so great, and found to have a high risk of bias, so more studies are definitely needed!)

Schuman et al. (2016) performed a review of 6 randomized-controlled trials looking at the role of yoga in helping people with IBS. I’ll be honest, I absolutely love yoga and find the pairing of breathing, mindfulness and movement to be so beneficial to myself and my patients. So, I was not surprised to see this review showing that the groups participating in yoga had decreased bowel symptoms, IBS severity and anxiety.

Additionally, it is common for someone with chronic constipation and/or diarrhea to have restrictions in the movement of their hips and spine. Restoring this movement through specific exercise can facilitate better function of the muscles around the pelvis, including those involved directly in bowel function.

4.) Treat the myofascial components of the problem.

We have discussed the viscerosomatic and somatovisceral reflexes in the past. Basically, when a person has an organ problem (in this case, IBS), we often will find that the myofascial tissues around the organ can become restricted and sensitive. This can be interconnected where myofascial dysfunction can worsen a visceral problem and a visceral problem worsens myofascial dysfunction. Thus, addressing both sides of the problem can often be very optimal. From a musculoskeletal standpoint, this means identifying structures around the abdomen and pelvis which may be sensitive or not moving as optimally. This can often include the abdominal wall, hip muscles, thigh muscles, buttocks muscles and the muscles around the low and mid back.

5.) Treat underlying or co-existing pelvic floor problems.

Prott et al. (2010) found that there were relationships between pelvic floor symptoms and anorectal function in individuals with IBS. Dysfunction of the muscles of the pelvic floor can present as weakness, which can lead to either difficulty holding back stool or poor support around the rectum. It can also include overactivity and poor relaxation of the pelvic floor muscles. This can contribute to pain, but also can influence how well the muscles can open for defecation , or hold back when they need to. Additionally, people can experience difficulties with coordination of the pelvic floor– basically, when the muscles do not contract or relax when they should. Dyssynergic defecation occurs when the pelvic floor muscles contract instead of relax when a person has a bowel movement. This can be a significant problem for those struggling with constipation. I wrote a whole article on that, and you can find it here. Sphinctor dyssynergia can occur in individuals with IBS as well as other types of constipation, and can be treated with pelvic PT (lots of treatment options, including SEMG biofeedback which has been found to be helpful for people with and without IBS).

IBS can be so impacting to a person’s life, and you don’t have to suffer alone! I encourage you to build your multidisciplinary team and start getting the help you need to get the most out of life!

What strategies have you found most helpful in dealing with IBS? As always, I’d love to hear from you!

~Jessica