In my clinic, I've been hearing people's increasing awareness and concurrent increasing anxiety regarding the science of climate change and our response to that. The International Panel on Climate Change 2019 is the most recent comprehensive assessment report about knowledge on climate change, its causes, potential impacts and response options. This article is a collection of how we can live a climate aware life and, at the same time, a personally healthier life too!
By living a climate change aware life……
You'd breathe in cleaner air, rushing around a little less, enjoy better work-life balance by reducing your travel in our vehicles to needs based travel only.
You'd have a level body weight, listen to the birds, the wind, the scents and notice your neighbourhood and neighbours by biking or walking.
You'd enjoy a staycation, a local, stress-free holiday, a weekend or picnic at one of our beautiful Kootenay locations, spend less and have less travel stress by stopping flying and planning a holiday near home.
You'd eat real food, mostly plants, not too much, Michael Pollan's prescription for a healthier planet and a healthier you.
You'd enjoy seasonal and local food, aware of the food miles in your meals, preserve rainforests faraway and enjoying creative cooking, food growing and storing in your own kitchen.
You'd grow some of your own food in the Victory Garden kind of way, proud of what you produce yourself with your home soil and your own hands, making the meal on the table even yummier!
You'd get to know your farmer and how they farm, supporting organic, soil restoration practices, aware of our precious pollinators and providing carbon capture by eliminating tillage/carbon loss!
If you continue to eat meat, you'd enjoy an occasional meal of grass fed, pastured beef which (check the research) contributes to soil health and is a carbon capture system, like the buffalo that roamed our prairies and the elephants on the savanna in Africa!
You'd simplify your home, manage less clutter, less stuff, less purchasing, less maintaining, less storing and dusting. Your needs reduce and there's a little more money in the bank and/or a need to earn less!
You'd reduce the plastic load in the world by reducing the plastic purchase and use in your life, from straws to shopping bags to storage items…..perhaps even not buying groceries or "things" that come in plastic packaging. Finding your personal care/cosmetics/toothpaste that have plastic microbeads in them in a next step and choosing other options.
You'd reduce your busyness, lie in a hammock more, read a book, attending to today's gift of being truly present, grateful for living in this amazingly beautiful valley!
You'd feel a renewed sense of hope by acting with compassion for those who are suffering most from weather weirding/floods/fires, especially those in the developing world and our next generations.
You'd lower your energy demands and costs by turning off lights, mowing your lawn minimally, electrifying your tools (lawnmower, chainsaw, car) insodoing making the jobs more enjoyable and less noisy, drying your clothes on a clothesline or rack, washing dishes by hands with your kids, using all your food wisely and having less food waste,
You'd help your neighbour who works in the fossil fuel industry transition over to working in alternative energy by buying less gas and oil yourself, eating locally and employing them to add alternative energy (solar, wind, microhydro, upgrading your house efficiency) to your own home.
You'd experience a sense of wonder by slowing down, walking mindfully, breathing in some clean air deeply, less rushing, consuming and spending, visiting more, enjoying life more.
You'd enjoy a sense of partnership in a healthy future, rather than living in fear of the climate crisis, leaning into a healthier future for your body, your family, our town, in our region. RDCK has signed onto the 100% Renewable Kootenays commitment by 2050 and we can enjoy being part of a climate aware region!
We live in such a beautiful corner of the world. Becoming an active force, taking personal actions, will help you have a sense of hope and a commitment to the future for our children and grandchildren.
In the previous articles in this series, we've journeyed from diagnosis to testing, surgery, chemo, radiation and now……we're onto life. How do you go onward from survivorship to thrivorship?
If you have had lymphatic challenges, remember that any exercise or exertion requires that you wear your pressure garments. It's important not to push the lymph vessels beyond their comfort level, so don't let yourself overheat. Remember to protect your skin (and the lymphatic vessels who live just under your skin) from sun, bug bites, scratches and hot tubs/steam rooms. When you're exercising, choose loose and comfortable clothing and make sure you never have a bra line visible on your skin when you take it off! "No restrictions" is the rule, so check your skin. The sensation around your bra line may be reduced from surgery, so check in a mirror. Always keep mindful of your "daily arm load", never pushing past today's budget. And keep your energy tank at least ¼ full.
Breathing is natural, right? You take 23,000 breaths per day. Some of your respiratory muscles have been interrupted by surgery and furthermore by radiation. Learning to breathe in varied ways, fully and completely can be helpful. How you breathe, how your ribs and 3 diaphragms (your throat, breathing and pelvic diaphragms) move is an intricate ballet. Asking your physio or yoga therapist/teacher to help you learn to breathe well again is wonderful!
Shoulder and arm movement is a focus during your post-surgical time. The muscles that both guide and move the shoulder are on your chest and back. You'll need some nudges to learn to find, time and strengthen the shoulder (the spine, shoulder blade, collarbone and shoulder joint). Keep in mind that your body wants to restore to beautiful movement and function.
Pelvic function (bladder, bowel, sexual, pelvic organ support) may need some attention through this time. The posture that you may find comfortable after surgery (leaning forward + curling inward) puts pressure on your pelvis. Some of the hormonal therapies reduce estrogen's lovely bouncy support of the pelvic systems. If you're struggling with pelvic function, ask a pelvic certified physiotherapist to assess you and help you along. It usually only requires a few appointments.
Are you taking time for restoration? In really big studies, 30-90% of women report loss of sleep through the first year of breast cancer. You need sleep for recovery, sleep to reduce "chemo brain", sleep to support's brain's own lymphatic (called the glymphatic) system, sleep to help your body heal and sleep to help you find the "new you". Practice consistent, sleep-supporting strategies and rest before you're exhausted. Daily calming practices may also reduce any pain you may be experiencing by reducing the general threat level under which your body is living. Know your limits and respect that your body may be on high alert. Practice deeply compassionate self care. Meditate or pray for 10 - 15 minutes per day, sitting quietly and listen to your breath. Think back on all you've been through and the resilience that you've discovered. Be open and vulnerable with your MIPs (most important people), ask for understanding and help when you need to, find peace with downtime and rest….these are new skills for many of us. Play a little and enjoy today.
Women with breast cancer have undergone surgery, experienced radiation and/or chemotherapy, then have begun hormonal therapy. Reconstruction surgery may be a next step.
How do you press restart button with this new body, new awareness, new priorities?
How to you go from survive to thrive?
We'll begin by looking at exercise in all its forms. Exercise is a key part of survivorship, reducing recurrence of breast cancer by 50% thereby boosting thrivorship, that brilliant skill of learning to live a joyful life again! A key to remember is that breast cancer survival rates, since 2010, have grown beautifully. It is now considered a chronic disease, different from diabetes and arthritis for sure, but breast cancer is a disease to live with and manage.
Research has shown that strength training is key. It must be wisely employed in order to avoid overwhelming Cancer Related Fatigue (CRF), to respect the surgical/structural changes in your body and posture and to help stave off lymphedema. While you're undergoing chemotherapy, we know that better oxygenation from strength training improves the therapy's effect, so it's good to exercise gently and consistently while undergoing chemo treatment. However, with radiation it's a time to maintain and not gain; you'll be working at holding your own through that time.
Strength training is two simple words, but do you have to go to a gym when you may be immune-compromised and overwhelmed with social interaction? No. You can do this all at home with a structured programme, some knowledge about the how-to's and some awareness around wise limitations. The first words to repeat are start low, progress slow. Learn how to strengthen your dorsal self (think dorsal fin) that has become long and weak. Learn how to stretch (gently, carefully and consistently) your front body where all the attention, surgery and radiation took place. Learn how to build your bone health again through weight bearing activities and exercises.
Your bones have been challenged by reduced activity while you went through medical/surgical interventions and rested, age/stage (menopause reduces your estrogen which is a bone-protective hormone), chemotherapy (which may have reduced your estrogen even more), radiation (to your upper arm and mid spine), corticosteroids (for nausea and inflammation) and reduced nutrition because is was difficult to eat well through this time. Bone loss can be reversible. Improve your awareness of balance and intentional movement so that you are protected from a broken bone due to a fall. Attending to bone supporting exercises and balance challenging exercises can be simple and fun. You can use your body weight, a wall, the floor or your bed to perform all the exercises that you need.
In respect of CRF, remember that you must be aware always to only reduce your energy "tank" to ¼ full. Check in with yourself, stop at ¼ tank, respect your limitations and begin again tomorrow. If you have a week off for a holiday, illness or treatment, reduce the intensity when you take exercising up again. We talk about increasing your "exercise markers": cardio (huff and puff), strength, flexibility and endurance, remembering always that slow and steady is the key.
Overexercising can bring on overwhelming fatigue, stressful inflammation and put you at risk of lymphedema. Remember we want to keep lymphedema at Stage 0, practice an immediate response to cording or Axillary Web Syndrome and awareness of those almost imperceptible symptoms of lymphedema (tingling, heaviness, density or weightiness of an arm).
An amazing resource is the APP "Untire", offered free of charge online through your favourite app store from 2 Danish researchers. It helps you navigate whether to rest or be active, to support sleep and calm your body, to be social or pull inward.....great recommendation from many in the cancer world!
Uncomfortable conversation? Toileting is an activity that we engage in about 10x per day and, yes, it's private but it's still important to talk about! There are good and bad ways to spend your time on the toilet and some of them depend on your particular body, your particular resting and active tone, patterns of movement and breath and the health of your digestive system. It depends on whether or not you've had surgery, have scar tissue, are rushing, have privacy, how you were taught about toileting as a child….so many factors.
Let's start with "normals":
It's normal to void (release your bladder, urinate or pee) 6 - 8 x per day, including night time voids. You shouldn't be voiding at night unless you're over 60 and then only once. After 80, twice is acceptable. You should never need to rush and you shouldn't leak en route. You should also be able to tell your bladder to wait. Traveling to the toilet to void every 3 ½ to 4 hours in a calm, controlled and easy manner is awesome. You should enjoy a painfree exit of clear unscented urine and never needing to push or be effortful. It should take 15 - 18 seconds and be in a Bell Curve, starting slow, building to a crescendo and ending with ease. There should be no post-void dribble, no double voiding…..wipe and go dry until next time!
It's normal to empty your bowels (BMs or pooping) 1 - 3x per day up to every 3 days. Optimum is a full, complete and satisfying BM soon after waking up/eating your breakfast. Again, you shouldn't need to rush, but you should pay attention to the nudge to go to the loo for your morning BM. Don't ignore it and don't delay it. Spend 5 - 10 minutes enjoying bowel release. Toilet position for bowel release is seated comfortably, with support, either in a slouched posture or with your elbows on your knees as if you're reading a newspaper on the floor. The posture that's just right for you is dependent on the angle of the Puborectalis muscle that slings around the Anorectal Canal. Are your knees slightly higher than your hips with a raise under your feet? Squatty Potties are trendy, but for some people they raise the knees too high, tightening up their pelvic system making release of BMs more difficult. In addition, the consistency of your BMs matters. If you have loose, liquidy BMs (5 to 7 on the Bristol Stool Chart), the message that your internal anal sphincter sends to your brain when stool lands in the rectum is "Run!". If you have normal BMs (3 and 4), the message will be a calm nudge, "It's time now." If you have stodgy, dried out stool (1 and 2), the message gets distant…..it's your job to waken it up and pay attention to the faraway call, "It might be time soon.". You can waken this up with gentle heat on your lower tummy and belly massage upon awakening/during breakfast. This doesn't move stool along the passageway, but it does awaken peristalsis, the gentle squeezes that move stool through the colon. Having a tap-hot glass of water at night while you do your last tooth brushing just before bed can keep your stool hydrated overnight. A shot glass (2 T.) of prune juice along with your water may help. Avoiding all dairy, especially cheese, can help some people, along with reducing meat and increasing nuts and beans. Increasing fibre needs to be applied with caution. Recent studies show that increasing your fibre (leafy green vegies, ground flax seeds, psyllium, whole grains) needs to be done in 10% increments per week. Too much fibre makes for sticky stool, making exit more challenging and wiping truly "a pain". Not rushing is important. Take time to breathe into your belly, teaching your pelvic floor to release, opening your anal sphincters, creating ease. If you're sensitive to sound, turn on the fan or music. If you're sensitive to smell, keep a candle/scented spray nearby.
There is no one answer to happy toileting, but it pays in good longterm health to find yours!
The bossiest, most demanding part of our pelvis is our "back passage" (our anorectal function, BMs or pooping). If your bowels aren't emptying well (full, complete and satisfying daily BMs), then your bladder, your pelvic organ support, your intimate function and your general sense of wellbeing won't be thriving either. "Back Passage First" is a rule in pelvic physiotherapy. Once you learn and/or relearn wonderful bowel release, your other pelvic issues may be addressed with ease.
What is normal for your BMs? The rule is that you enjoy a full, complete and satisfying BM at least every 2nd or in rare people, every 3rd day or as frequent as 2 - 3x per day for some people. There should always be a sense of full evacuation of your stool, not a sense of "there's still some left behind". There should be ease in release, not pushing, forcing, breath-holding or grunting. There should be ample time to get to the toilet, not making a mad dash to get there in time. There should be a clean exit with tidy wiping with ease, no skid marks in your undies or loss of stool without you being aware. There should be no straining or pushing or pain. And it should end with a sense of satisfaction of a job well done!
What should a normal bowel movement be? Perhaps surprisingly, we talk about this a lot and the smart folks in Bristol, England developed the Bristol Stool Chart. It's a handy guide to give both you and your health care providers a simple way to talk the same language about our bowel function. The scale goes from 1 to 7. Numbers 1 and 2 describe hard lumps, either separate or together…..think deer droppings and indicate a level of constipation. 3 and 4 are sausage-y like shapes, sometimes dry and cracked or smooth and snake-like. If your bowel movements look like 3 and 4, that's great as long as they're the width of a sausage, not a pencil. That indicates other issues. 5 is soft and blobby with clear edges and indicates a lack of fibre in your diet. 6 is the beginning of diarrhea, soft and blobby but with ragged, frayed edges. 7 describes full-on diarrhea….loose, watery, liquid poop with nothing solid visible. Understanding and getting familiar with the Bristol Stool Chart can help you describe to your health care providers what's going on inside you.
It's not normal to have blood or mucous. Blood can appear from a hemorrhoid and enthusiastic wiping or can be an indicator that there are more challenging problems. Mucous shouldn't be in our digestive tract and suggests that your body is fighting an infection. You need to see your doc, either way.
Your BMs should be brown, with no undigested food visible, not chalky or blackish or have a truly foul or different-from-normal odour. We're not talking smelling like roses, but healthy BMs don't smell awful! Stop and have a gander…..this is digested food that's done its job for you, feeding you and giving you nutrition, energy for your life and yumminess….be grateful and pay attention. Your BMs give you cues about your health.
Your toileting habits matter. Firstly, it's important to understand the gastrocolic reflex. This is the nudge that you receive (thanks to your lower esophageal sphincter chatting with your lower colon) when you start your day with a warm, caffeinated drink. As you swallow, your colon gets the message, "Empty out yesterday's food…..today's is coming!" Paying attention at that moment will help you establish beautiful bowel habits. Go to the loo. Spend some relaxed time, not rushing, calmly breathing into your belly, with your knees slightly higher than your hips on support, massaging your tummy and enjoying effortless bowel release. It takes opening of the pelvic floor to accomplish this, so calm, unrushed presence is really helpful. Don't wipe right away. Take a few more breaths to be sure that you're done.
Toileting habits will be in our next "chat". Bladders and bowels ask different things of us on the toilet, so clarity around the messages you receive and your response is important.
We've talked about diagnosis, treatment and lymphedema in the last 3 articles. Now let's move onto two common, manageable secondary outcomes of breast cancer, CRF and Cording, "the other stuff". These conditions are so common that every woman going through breast cancer needs to become educated on what they are and how to address them. Read on!
Cancer Related Fatigue (CRF) is experienced by 70 - 100% going through breast cancer treatment. Women describe it as a whole-body tiredness that isn't relieved by rest or sleep. We think CRF is due to many factors, including the cancer itself, radiation, chemo and stress. It may come on suddenly, isn't associated with activities or exertion and may continue after treatment is over. The thyroid may become underactive especially if the lymph nodes in the neck have experienced radiation, causing increased fatigue by reducing your ability to metabolize. The combo of radiation and chemo may lead to anemia, increasing our fatigue by reducing the availability of oxygen in our blood. Our appetite may be reduced as well, making us less likely to eat nutritiously. Some medications that are prescribed during treatment may also cause fatigue. Then, there's our emotional health as we go through medical interventions and treatments, causing stress, fatigue and sometimes depression. We know that healthy lifestyle choices can hugely impact CRF. Energy conservation is important, wisely choosing where, when and what you'll in a day. Don't try to maintain your normal daily routines. Set gentler, kinder, more compassionate goals. The CRF Golden Rule is "Never Go Below 25% in Your Tank". If you feel fatigue coming on, recognize that you simply don't have a "reserve tank" on board. Stop at the first sign of fatigue, before you're depleted, or it may take days to recover. Talk with your doctor about your thyroid function and iron levels as you may need support in these areas. When eating is a challenge, choose only the most calorie dense, colourful and nutritious foods. One wise woman taught me that adding plain yogurt to her food made it more palatable as well as easier to chew, swallow and digest. Guard your sleep and rest time with dedication and ferocity! Recognize that you are in restoration and rebuilding mode. Exercise can help by cleverly changing your metabolism and giving you more energy. It's important to "start low and progress slow" and be consistent. An important proviso is that radiation treatment is a time to maintain rather than gain.
Axillary Web Syndrome or Cording is another common outcome from breast cancer surgery and treatment, seen in between 20 to 80% of women; its incidence depends on what kind of surgery and treatment you've had. Cords look like a guitar string that pops up under your skin anywhere from your chest to your armpit, elbow, wrist or palm. Women often see it for the first time when they stretch to put on their seatbelt or coat. A cord is your lymphatic vessel tightened up. They "mate once for life" and don't heal, so helping them release and get back to work is important. If you have cording, you also have a raised risk for lymphedema down the road. Your breast cancer physio can help you reduce or lose cording with lymphatic manual therapy, myofascial release and gentle stretching. You can regain full lymphatic function, release your lymph vessels/skin tissue and find full spinal and arm movement in the mix!
We began by introducing breast cancer, risk factors and how we find it. We went on to talk about surgery, radiation, chemotherapy and hormonal therapy. After all this medical intervention, we are still one in eight women in Canada, finding our way and living out the rest of our lives. What challenges may we still face?
Hormonal Therapies may be recommended; these are longer term medication, called Tamoxifen or Herceptin (and others). These are medications that are taken over a period of 5 - 10 years depending on the type of breast cancer that you have, how soon it was diagnosed, and your menopausal status. They offer some protection from cancer returning.
Lymphedema is a condition in which there is a reduction in the natural lymph flow somewhere in the body. After breast cancer surgery and/or radiation there may be an interruption of the lymph flow through its watershed. The lymph system's job is to support your immune system and to interact with your circulatory system; it should flow uninterrupted, like a river. During breast cancer surgery, the tumour and local lymph nodes may be injected with a tracer and some dye. The surgeon is then able follow the dye to see which lymph nodes may be communicating with your tumour and remove them. Once your lymph nodes have been impacted by surgery and/or radiation, you are at a lifetime risk of developing lymphedema. Your job is to pay attention to mild sensational changes of heaviness, density or tingling in the arm. Lymphedema can't be cured, but it can be managed and treated with manual lymph drainage, compression garments specially designed for you and excellent personal care. We used to use of a machine called a lymphopress. Although the lymphopress may reduce the volume of a limb, it also may cause tightening or hardening of the tissues over the long term. We've advanced in our knowledge and treatment, so prevention is the key!
Lymphedema Risk Reduction Practices are your job on a daily basis. You will know when and where to advocate for yourself and to ask for help.
CV Advance October 2018 Breast Cancer 201
Breast Cancer 201…..the details after diagnosis. We discussed how we develop breast cancer and how we might find it in Breast Cancer 101.
How do we understand the label on our diagnosis and how do we begin to sleuth through treatment options? After we've been told we have cancer, we need to become an instant expert. We have to make decisions based on the information that we're presented at each medical visit. I'm hoping this information will help us all learn now…..perhaps for ourselves or perhaps to compassionately support a woman that we know and love.
Numbers and Letters…
Each breast cancer has a name and a number and letter to help us understand the type, nature and potential spread of the disease.
Stage 0means that there are atypical cells, but no spread of the cancer into the ducts, lobules or surrounding tissues. It's early and non-invasive and accounts for around 20% of all breast cancer cases. Ductal or Lobular Carcinoma in Situ are in this category.
Stage 1means that the tumour is under 2 cm. and has not spread into the lymph nodes or outside the breast tissue.
Stage 2 (A and B)means the tumour is 2 - 5 cm. and may include up to 3 lymph nodes but has not spread further.
Stage 3 (A and B)means that the tumour is larger that 2 cm. and may include up to 9 underarm lymph nodes and, with B, may have spread into the skin, chest wall, muscles and ribs. Inflammatorybreast cancer is an aggressive type of Stage 3B cancer, which also involves a reddened, inflamed breast.
Stage 4tells us that the cancer has spread beyond the breast, chest and lymph nodes outwards to distant organs.
Recurrentbreast cancer is the name used when it has returned; it may appear in the breast or elsewhere in the body.
Now what? How do we go ahead?
Most women will choose some type of surgery, their choice dependent on their type of cancer, impact on recovery and long term prognosis. Surgery a "local" treatment, used to remove tumour cells, to inspect/remove lymph nodes and to reconstruct the breast.
Lumpectomyis a breast-conserving surgery and the least invasive procedure. The cancer is removed, along with some adjacent breast tissue and associated lymph nodes. Most women choosing this option will also need radiation.
Total Mastectomyinvolves the surgical removal of the breast and lymph nodes as needed but the tissue beneath the breast is left intact. This is the most common surgery used to treat breast cancer.
Radical Mastectomyis less common now, involving removal of the breast, pectoral/chest muscles and all of the lymph nodes.
Reconstruction Surgerymay be begun during the initial surgery or it may be delayed. It may involve silicone or saline (salt water) implants or tissue flap surgery. The latter, tissue flaps, may mean taking some of a tummy muscle, buttock muscle or a back/shoulder muscle to be transplanted over to form breast tissue. More commonly now, your surgeon may recruit some tummy fat and blood vessels, called a DIEP Flap Reconstruction. This reconstruction has a natural feel and look, ages more naturally but takes time and multiple medical visits over some months.
Radiation is a "regional" treatment, by directing high energy rays in order to destroy cancer cells. It can be given externally or internally (called brachytherapy). Most of the side effects of radiation (wait for the next article for more on this!) can be minimized and are not permanent.
Chemotherapyis a whole-body or "systemic" treatment in which drugs are given through an IV or by mouth when they travel through the bloodstream and impact cancer cells. It may take some months to complete a series of treatments.
Hormonal/Targeted Therapiesare a second form of systemic treatment. Hormonal therapy is used to reduce the risk of cancer returning or to treat cancer that has come back or spread. It changes the hormonal impact on the breast or simply reduces our hormonal load.
What make us make those life choices, those small daily decisions, that contribute to our own vibrant health. The average lifespan for a Canadian woman in 2017 is 81 years of age. It's not up to the medical professionals in your life; it's up to you to create your best health. Where you live, how you live, your work and play, your biology/genetic heritage, how you eat and drink, how you manage life's stress…….you can impact all these factors. It's up to you.
The Tomorrow Test is this: Each time you address something you'd like to change, commit to it. Then when you begin to waver (procrastinate, make excuses, defer), ask yourself how you'll feel about it tomorrow. We know that we only have today, but looking at the moment from tomorrow's perspective may add a lovely bit of motivation that you need to follow through.
How many changes at a time? If we make one change, we have an 80% chance of staying with it. If we make two changes at a time, we have a 30% chance; if we tackle three changes at once, we have less than a 5% chance to stick to our guns. Make one change, take six weeks to make it hold.
What changes in our life will provide us with our best health? For women, it's different than for men. We have a complicated body full of hormonal influences provided by our biology (like monthly cycles, pregnancies, baby-having, and menopause). We need to understand the impact of our amazingly unique bodies so that we can make lovely life choices.
Women's Health Rules are:
Now….women friends! Look at this list. What would be enjoyable, something you'll want to repeat? Only one. Six weeks. It's your health.
Written by Joanne Gailius, June 2018
Constipation. If your back passage (bowel release and anorectal action) isn't working well, nothing else in your pelvis (bladder, intimacy, pelvic organ support and core strength) will be working well. So, brace yourself, let's talk constipation!
Do you enjoy a consistent, full, complete and satisfying bowel movement every morning? BMs should be a minimum of every 2 - 3 days and a maximum of twice daily. You should never need to rush, have skidmarks in your undies or lose stool without you knowing or before you're ready. Ever. The stool should be firm but not dry or very cracked, smooth but not sticky and medium sized to pass with comfort. It should be brownish, of a consistent smell and without mucous or blood. It shouldn't be painful to release your stool nor should you bear down. Hemorrhoids can come with pregnancy or stress, but shouldn't be persistent. You should be able to travel or change your routine without upsetting your BMs. Your bowels are meant to digest your food and drink, transfer nutrition to your body, then get rid of the waste. It's a beautiful system!
How does it actually work? When you take that first warm drink in the morning, the sphincter between the esophagus (food tube) and the stomach sends a signal to the rectum that today's food is en route. Yesterday's waste is nudged along the colon, down the digestive tract and into the rectum. The sphincter at the end of the rectum opens up. Counterintuitive? Stool has just landed and it opens up to take a sample. It checks if it's gas, liquid or solid. If it's gas, it nudges you. If it's liquid, it slams shut and gives you to signal that you need to move! If it's solid, it shuts firmly and gives you the message, "Time to go to the toilet". Don't delay. It nudges, you calmly go.
Toileting habits are important. Sit comfortably and relax. Your knees should be slightly higher than your hips, supported on a stool or block. Breathe into your belly and sense your pelvic floor softening, descending, and the sphincters opening up to let stool pass. If you have the urge to push, don't! Just breathe into your belly and do a bass hum, low growl or pursed lip outbreath to protect your pelvic floor. Keep allowing your system to release and let go. Don't stop the stool until your body says you're done. Then belly breathe again, rock your pelvis and enjoy a few moments of quiet. When you're sure you're done, do a few gentle pelvic floor squeezes to help clear the anus so that wiping is gentler and more complete.
You can support your digestive system. Keep hydrated, drink mostly water, and enjoy a drink of warm water with tooth-brushing to help your stool stay hydrated overnight. Be cautious with fibre, adding a little at a time. Pay attention to the foods that your body finds a problem - what makes your stool too solid and/or what makes it too loose? What gives you gas? You're unique, so learn about you. Support your system with a heated wheat bag and a massage. Help your system release its waste products after all the work it's done for you. Depending on your issues, there are specific techniques, stretches, breathing patterns and habit changes that will help you enjoy lovely BMs that support your health.
If you have specific problems with your bowel release, a pelvic physiotherapist provide you with with an internal and external assessment and treatment plan just for you. Your digestion, bladder, pelvic organ support and intimate life will thank you!
Joanne is passionate about women finding brilliant health, from your pelvis to your bones to your heart, including cancer physiotherapy.