Friday, 24 November 2017

There’s Physiotherapy for that? Constipation edition


Constipation is a common thing pelvic health physiotherapists try to address. Firstly, because the person suffering from it is uncomfortable, possibly bloated and in pain. It’s an unpleasant sensation when you need to go to the bathroom but can’t or it’s very difficult to do so. Secondly, constipation puts pressure on the pelvic floor muscles.

When someone suffers from chronic constipation, not only are they high risk for pelvic floor dysfunction, but are higher risk for hemorrhoids, rectal bleeding or mega colon. A mega colon is when the walls of the rectum stretch causing you to store more stool and can lead to an inability to detect that you need to go to the bathroom.

Whether it’s an occasional occurrence or chronic, constipation is not good, period.
Let’s talk about tips to keep constipation away.

One. Never ignore the “Call to Stool”

                I’ll use a story I learned on one of my courses. Think of the sensation of needing to go  as a butler tapping you on the shoulder. The butler walks up to you, gently touches you on the shoulder and says, “dinner is ready.” You decide, no this is not a good time, I’m busy. The butler goes away. He comes back later and says, “dinner is ready” and again its not a good time and you ignore him. If this happens over and over again, eventually the butler will stop coming to tell you, “You need to go to the bathroom.”

So when the butler comes, it’s okay if obviously you are not in a place where you can go to the bathroom but you really don’t want to wait too long before you go. Every time you ignore the butler the stool goes back into the rectum and more water is drawn out. The more water that is drawn out of the stool, the harder it gets.

Two. Hydrate well. 

As I mentioned if too much water is pulled out of the stool it becomes hard. If you are not hydrated well, then you already have very little water. Then if you delay going to the washroom, it can really make pooping difficult.

Three. Eat Enough Fiber

It is recommended that we eat anywhere between 25-40 grams of fiber daily. I often times give my clients a fiber chart that provides a long list of foods, serving sizes and approx amount of fiber so they can make different food choices and track their fiber intake. Veggies, whole grains, fruits, nuts are all foods high in fiber excellent choices.

Not only is fiber good for constipation but making healthier choices can benefit digestion, reducing the risks of heart disease, diabetes, cholesterol and cancer.

This is important to note that when you increase your fiber, you need to increase your water intake. The two work hand in hand.

Four. Get physically active

30 minutes of physical activity daily can help to keep your bowels happy. This could be walking, dancing, weight training, zumba, spinning.

Five: Mindset

Focusing your attention to mindset is an important key to making changes. What is your mindset towards getting healthy? How do you think about it? How do you feel about it? Why do you want to get healthy? For whom do you want to get healthy? Having a positive attitude towards health and setting your mind to the task will help you achieve your goals. Also surrounding yourself around others who have a similar mindset towards health will help you.

So where does physiotherapy come in?

Well, the tips I just provided you are things I go over with my clients. Lots of education on healthy lifestyle changes and why addressing this issue will help with addressing other symptoms that may be a result of the constipation. I teach toilet exercises, positions and abdominal massage techniques to improve bowel movements. If needed I also use manual therapy techniques to stimulate the intestines, reduce tension around the intestines and tension around the pelvic floor.

Some individuals with mega colon or reduced sensations to go to the bathroom may benefit from rectal balloon therapy techniques. While other clients have trouble relaxing their pelvic floor when it comes time to have a bowel movement and these individuals may benefit from biofeedback therapy.

So there are many different techniques a pelvic health physiotherapist can utilize to treat bowel dysfunction but you want to make sure your therapist has taken the training to treat bowel dysfunction.

So yes, there is physiotherapy for constipation J


The Pelvic Health Lady

Friday, 10 November 2017

There's Physiotherapy For That? ED edition

There is an ever growing market for erectile dysfunction (ED) treatment, some legitimate and others not so much. More men are experiencing difficulties and may not be aware of the variety of treatment options available to them. The purpose of this blog is to overview erectile dysfunction, causes/risk factors, the role of physical therapy and other treatment options.

Erectile dysfunction (ED) is defined as a persistent inability to achieve an erection or maintain the rigidity required for sexual intercourse (1). A complete examination should be completed by your medical provider to look at hormones, nerves, circulation and psychological status. The reason for a full work up is so that appropriate treatment is provided (1).

How do erections happen? Well you start off by thinking, smelling, seeing, touching or imaging something arousing. That signals the brain to send chemical messages to the blood vessels in the penis. These messages tell the arteries in the penis to open and relax so blood can freely enter into 2 long chambers within the penis. The veins in the penis close, allowing the penis to become rigid as blood flows in (2). This mark the first phase of getting an erection: the Vascular Phase (3).

The second phase is marked by the muscular phase. Once the pressure in the penis reaches a certain point, it triggers a contraction of the ischiocavernosus muscles (3) which is located in the first layer of the pelvic floor muscles. The contraction of this muscle maintains rigidity and plays a role in ejaculation (3). The bulbospongiosus muscle also located in the first layer of the pelvic floor muscles and it compresses the deep dorsal vein of the penis to prevent the outflow of blood from the engorged penis (4).



To summarize. Blood flows in after the brain signals the arteries to open. As blood fills in, it creates pressure on the veins so blood cannot escape. The muscles in the first layer of the pelvic floor contract to support and ensure blood stays in the penis.

Causes/Risk Factors for ED (1)
  • ·         Alcohol and/or nicotine abuse
  • ·         Drug use
  • ·         Diabetes
  • ·         Arteriosclerosis
  • ·         Hypertension (Blood pressure)
  • ·         Renal Failure (kidney failure)
  • ·         Hyperlipemia (Cholesterol)
  • ·         Nerve Damage
  • ·         Psychological factors

Physiotherapy Treatment

Physiotherapy treatment should be considered as part of first line treatment along with medications and hormone therapy (5). It is non-invasive, painless, easy to do and inexpensive form of therapy (1).

Physiotherapy treatment focuses on teaching a variety of exercises targeting the pelvic floor muscles and training them in various positions. The client will be sent home with an exercise program to do between treatment sessions.

If the exercises alone do not improving symptoms of ED, the therapist may supplement exercise by using biofeedback. This is when a probe is inserted into the rectum and hooked up to a computer that will graph and track the strength, endurance and speed of muscle contraction. The visual cue often times helps individuals connect more effectively with the contraction. Patients will sometimes say, “I don’t know if I am doing the exercises correctly.” The biofeedback will show if what you are doing is actually registering as a pelvic floor contraction.

In line with biofeedback, the therapist may also supplement biofeedback training with an electrical stimulation that further aids in the muscles contracting. In cases where a probe may not be indicated electrical stimulation can be done through pads that are placed externally.

Typical treatment protocols as seen in various clinical studies includes treatment for 12-15 weeks, with in-clinic visits, once a week  (1, 3, 4, 5).

In addition to exercises, I often work with my clients to implement lifestyle changes. If we can also address the risk factors that will certainly impact the experience of erectile dysfunction. A few key areas for change may include; diet, aerobic exercise, weight loss, sleep hygiene, smoking cessation, alcohol intake and psychological factors. Typically this is achieved through a multi-disciplinary approach.

Physiotherapy does not replace other forms of treatment.

Other therapies

Other forms of therapy may include: medications, vacuum devices, constriction bands (cock rings), counseling/sex therapy, intracavernosus injections, intra-urethral medications, topical therapy. If these fail to produce results the third line of treatment may include: vascular surgery or prosthetic implant. Of course, speak with your health care provider when considering which route to go.

If you are having problems in this area or know someone who is, please share.

The Pelvic Health Lady

References:
  1.  Van Kampen et al. 2003. Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation. Physical Therapy 83L6): 536-542.
  2. WebMD. 2017. How the Penis Works: Erection and Ejaculation. Accessed on Oct 29, 2017 from https://www.webmd.com/erectile-dysfunction/how-an-erection-occurs.
  3. Lavoisier et al. 2014. Pelvic floor muscle rehabilitation in erectile dysfunction and premature ejaculation. Physical Therapy 94(12): 1731-1743.
  4. Dorey et al. 2004. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. British Journal of General Practice 54: 819-825.
  5. Dorey et al. 2005. BJU International 96: 595-597.