How to Fully and Completely Empty Your Bladder
or
How to Void Well (pee, tinkle, wee, widdle, micturate, go to the loo……)
 
First, what is normal, healthy voiding for an adult woman or man?
 
Think about each of these statements and ask yourself, "Does this describe me?"

• You void 6 - 8 times in 24 hours.
• During the day, you void every 3 - 4 hours.
• If you're over 60, that may include once at night.
• If you're over 80, that may include twice at night.
• You always have enough time to get there, never needing to rush.
• When your bladder calls, you get a cue to void, but can put it off for 15 - 30 minutes if you need to.
• When you sit down, you release immediately and easily.
• It takes 12 - 20 seconds from start to finish.
• In your mind's eye, it looks like a bell curve, starting slowly, building into a waterfall, ending slowly.
• Once you're done, you're done….no double voiding or leaking afterward (even when you stand up).
• You can enter your home, walk by the loo or wash your hands without suddenly needing to void.
• You don't need to wear pads, even when you're going for a long walk or jumping.
• If you've had a baby recently, you have full bladder control at 6 - 8 weeks.
• If you've had surgery lately (women), you have full bladder control within 2 weeks.
• If you've had prostate surgery (men), you have full bladder control at 2 - 6 weeks post removal of your catheter.
• You NEVER leak.
• Even if you cough, sneeze, laugh, snort, sing, run, jump on a trampoline, have sex, you NEVER leak.
• Even if you walk on a cold tile floor in bare feet, get chilled or come inside from the cold, you NEVER leak.
• Even if you delay peeing for 30 - 60 minutes, you NEVER leak.
• Even if you drink a lot of water, you NEVER leak.
• Even if you drink coffee, tea, beer or wine, you NEVER leak.
• Yup, you never leak.

 
Now…..when you arrive at the toilet, there are some tricks to keep in mind.

• Make time for this important task….no phone, no multitasking, no busy mind.  You're here to pee.
• Sit comfortably, your thighs level or your knees slightly higher than your hips, seated well, knees open.  Use support under your feet (don't make pointy ballet feet) if you need to (a low step or yoga blocks).
• Breathe into your belly with a long, relaxing, deep breath, feeling your vagina and anus open and widen or your scrotum and anus descend.
• If you start to void, enjoy the feeling and notice the bell curve.  How talented are you!
• If you have a "shy bladder" or "hesitancy", just stay calm, breathe into your belly, massage your tummy and don't let anxiety or a sense of "gotta go!" take over.  You're here for one reason, so enjoy the quietude and trust that you're learning to let go with ease.  Each time you take time helps!
• If you feel totally empty, wipe front to back or pat gently until dry and off you go. 
• If you're a fellow, you're typically a shaker or stripper or may be a talented bilingual guy.  If you feel fully emptied, do your thing, then off you go.
• If you're not sure that you're empty you have a few options:
• Rock and roll - As you breathe into your belly, rock your pelvis forward, letting your belly bulge and hips open up, then let your pelvis rock backward as you breathe out.  Notice if there's a little "whoosh" part way.  This might mean that you have a prolapsed bladder that had kinked at the bladder neck during voiding.  It needed to tip it up again to fully release all the urine.  Repeat 3x.
• Breathe in deeply, fully, tension-free in your belly, buttocks, hips, with big puffy cheeks then let the air out slowly (keeping big puffy cheeks).  This helps keep your sphincters and pelvic floor open sufficiently to stop early closure, like during a urinary tract infection when you have those pesky urethral spasms.  Repeat 3x.
• Do a few gentle (25 - 50%) pelvic floor contractions (only your pelvic floor, not your hips and buttocks), holding for 3 seconds, releasing for 5 seconds and repeating 3x.  This can "milk" the urethra, helping that sneaky little bubble of urine hiding out in your urethra.  It will drop down when you come to standing if you don't empty fully, so help it go now!
• Enjoy practicing any or all of these until you're sure you're empty, then wipe and/or shake/strip and off you go.
• Don’t Bear Down or "push out" the urine.  You can be instrumental in creating your very own prolapsed bladder if you make this a habit.  And STOP yourself from using this technique to start the flow to begin with.  It's just not helpful.

Other Rules:

• No "just in case" voiding (check your excuses with the "normal, healthy" list).
• If you know where ALL the publicly accessible toilets in the town of Creston and neighbouring communities, you're busted.  3 - 4 hours between voids with no leaking is usually substantial enough.
• Pads are costly and your tender vulvar skin doesn't like them.  Learn to control your bladder and its function rather than relying on pads.  If you use pads, find the ones for urine, not for period flow.
• Medication can help, but learning to retrain your amazing brain to your skilled voiding reflex is way more effective in the long run, less costly and less likely to need upgrading/changing over time.
• Prolapses can mask urinary incontinence.  Learn full urinary control while learning to lift your prolapse (pelvic physio + hypopressive training is a well researched and effective blend).  If you're going to have a hysterectomy and/or prolapse lifting surgery, learn urinary control first.  It will ease your post-op recovery and you'll impress yourself.
• If you've had a perineal tear of Grades 3 - 4 in order to deliver your baby, relearning bladder control is a more difficult job.  Seek help.
• If you've had a surgical delivery of your baby (caesarian section), you may have scar tissue that's impacting your bladder function.  Seek help.
• If you have pain when your bladder fills in the area of your lower pelvis, urgency to pee and pee too often, all of which are relieved immediately upon voiding, you may have Painful Bladder Syndrome.  Seek help.
• If you're heading down the road of prostate hypertrophy (enlargement, stiffening of the prostate) and/or prostate cancer treatment (surgery/radiation) find a pelvic physio trained in men's pelvic function. You will learn to use your pelvic floor muscles and external urethral sphincter so that, when they become the gatekeepers of your urine flow (now that your internal urethral sphincter and prostate are reduced in function or removed surgically), they know what to do and how to do it!  This reduces the number of days that you're wearing pads and brings you dry days/nights/sport/fun sooner.  Research has shown us that learning prior to surgery/radiation brings much quicker and better results.

 
**Not to be copied without permission; property of Full Circle Physio Creston**
                                  Joanne Gailius, BSR, PT/OT   Women's Health, Pelvic and Oncology Physiotherapist      
Full Circle Physiotherapy
C2 - 1204 NW Blvd.     Creston, BC     Ph  250-254-3494   Fax  1-855-655-5281   [email protected]  Mar 2020

What is IBS?

Hint:****It's not all in your bowel, but it's the brain to bowel, bowel to brain, round and round interaction.....so think about IBS in a holistic way and read on......many of us who have "had" IBS all of our lives have no pain any longer, no bloat/distension, no suffering once applying all these principles and practices.  It's SO worthwhile!  And it's bespoke - sleuthing out your particular triggers and factors is a job and often takes 6 - 12 months.  Hang in there and enjoy the journey!
 
Irritable Bowel Syndrome is a collection of symptoms that add up to a diagnosis of IBS.  It’s not a disease and there are no tests that can confirm or deny this name being attached to you!  It’s mostly women (twice as many women as men), can be affected by hormones (worse at times of the monthly cycle and often worsens during postmenopause, when you’re one year past your last cycle). 
The Rome IV criterion for IBS are:

1.  Recurrent abdominal pain at least 1 day/week for the last 3 months.
2. Pain and other symptoms originating for at least 6 months prior to diagnosis.
3. Change in stool frequency (more or less often) that began when the pain did.
4. Change in stool form (see the Bristol Stool Scale) that began when the pain did.

IBS also has 3 subclassifications:

1. IBS with constipation – slowed transit of stool through your digestive system +/- a tight pelvic floor.
2. IBS with diarrhea – loose or liquid stool that is difficult to anticipate/control.
3. IBS with mixed or alternating constipation and diarrhea.

Additional symptoms may or may not include:

1.  Increased sensitivity of your viscera (organs and supporting structures), often more sensitive just prior to and during your period flow and postmenopausally.
2. Pain and symptoms responding to stress, anxiety and/or depression indicative of the enteric nervous system (the gut’s own wiring, the “gut feeling” or gut-brain axis).
3. Disrupted intestinal flora or microbiome, including SIBO (small intestine bacterial overgrowth) and altered intestinal secretions (the microbiomes change in the gut at rest or while actively digesting in the stomach and small intestine or moving stool) through the large intestine.
4. Bloating (feeling gassy or puffy) and/or distension (measurable increased belly girth.
5. Bowel urge increasing or appearing, the sudden onset of noticing that you need to find a toilet soon.  Normally, you have 10ish minutes to go to the loo for your bowel movement after your first cue.  With urge, you feel the need to rush.
6. Sensitivity to some foods that you used to enjoy.  Dairy, beans/peas/lentils, brassica family (kale, brussel sprouts, cauliflower, broccoli, chard etc.), onions/garlic and wheats are commons (in that order).
7. Other pelvic concerns may include slowed, incomplete bladder emptying and/or pain with intimacy as your pelvic floor can become hypervigilant due to anorectal pain and/or bowel urge/loose stools.
8. Proctalgia Fugax – This is a condition in which you have infrequent intermittent sharp pains in your anus/vagina with stress and/or some activities (like walking, running or specific bespoke postures).  Again this is attached to a hypervigilant pelvic system and is treatable with finding those triggers and pelvic downtraining.  You can learn this with your pelvic physio then do it on your own at home.

 
What to do?  What to do?
IBS is often a diagnosis given to folks when all tests of the digestive system come out “normal” and you’re still experiencing pain or discomfort, bloating and sensitivity to foods.  There are medications, but long term and large studies since 2020 have shown that there are much more effective systemic (whole body) ways to address IBS.  The interesting and surprising part of the studies is that medications are NOT the most effective treatment.  They’re a great place to start, to help you desensitize your digestive system, but long term benefit is gained from a committed multi-pronged approach in which you discover what triggers your gut and what reduces your gut sensitivity.  Everyone is different, so you are the sleuth that treats yourself best.

1.  Understanding pain neuroscience – The gut’s own nervous sytem, the enteric nervous system, is also called the gut-brain axis.  The gut chats with the brain and the brain with the gut.  It helps organize and populate the microbiome and supports the immune and lymphatic system of the digestive system.  Some of the gut microbes make neuroactive compounds including neurotransmitters (little conversational starters and wirings) and metabolites that talk to the brain.  This is where we learn how the gut sends “threat messages” (not pain messages) to the brain and the brain decides what is actually pain and what isn’t.  This doesn’t (for one second) say that this is “in your head”.  Your brain is there, for sure, but is does give you agency to reduce the threat-to-pain response and explains why stress, anxiety and depression heighten our pain response!  It’s good news.
2. The Vagus Nerve – This long nerve is the pathway for the gut-brain-gut-brain….chat.  We can support vagal tone in many ways including breathing practices (for improved diaphragmatic excursion which uses pressure/movement to calm the organs and for stress reduction), meditation/prayer and specific gentle yoga practices along with a daily calm walk.
3. Pelvic Physiotherapy – Pelvic physios train in bowel health and support, so can help your with stool consistency, bowel transit, rectal complicance and sensitivity, intact neurological function and muscular activity/support of the pelvic floor and anal sphincters and sphincteral integrity/timing/synergy and strength.  As well, if you have scar tissue from labour/birth and/or pelvic/abdominal surgery, this may need external/internal mobilization.
4. Sleep disorder – Sleep can be illusive if you’re in pain and/or suffering from perimenopausal sleep disorder and/or not feeling emotionally well.  Sleep support with brilliant sleep hygiene, investing in the importance of daily, consistent, boring, sleep (cool and dark room, warm and cozy bed, no blue lights 2 hours prior to bedtime, no caffeine or alcohol after noon, light protein snack at bedtime and never wavering until your sleep is restored).
5. Specific yoga practices – Pelvic yoga therapy came out top of all the approaches to IBS as it provides a multipronged approach with calming, gentle, stress reducing, mid body rotation, breathing….all the factors that we know contribute to a reduction in belly pain, bloating and untoward symptoms. It you go to Vimeo and ask for Shelly Prosko, her Pelvic Yoga Part A provides you with an online option.  You can also attend Gentle Pelvic Yoga classes here at The Yoga Room with Barb Minichiello on Friday mornings or livestream it into your home if you’d prefer or are far away.
6. Dietary changes – A simple way to check on your own sensitivities is to remove a potential trigger food category for 3 weeks completely (and don’t sneak some in) then add it in for 3 days.  You’ll know right away if it causes symptoms or not.  Try in this order: dairy, lentils/dried beans and peas, brassica family, onions/garlic (the bulb part) and/or wheats.  Do one category at a time so you’ll know for sure!
7. Reduce or quit alcohol – Drinking alcohol is hard on our gut microbiome and yours may need support. 
8. Add microbiome support – The research on probiotic “pills” is wavering these days, so I encourage adding in sauerkraut (2 T. once or twice daily), olives, kombucha or other fermented foods instead.
9. FODMaP – The FODMaP dietary programme is from Monash University in Australia and is a short term food restriction and addition plan specifically for IBS that you do on yourself.  Google Kate Scarlata in the US for a clear description of how to take away all FODM and Ps, then slowly add them back in, deducing your own trigger foods.
   
10. Counselling – Specifically cognitive based therapy counselling was studied to help someone with IBS learn to restructure their awareness then noticing then response to IBS symptoms and found to be helpful.  In addition, as stress, anxiety and depression are often a factor in IBS, this may be a time and place to address those concerns.  Only you know.
11. Email me at [email protected] if you’d like to find a pelvic physio or counsellor near you. 

 
Property of Full Circle Physiotherapy – not to be copied without permission with thanks.
 
Joanne Gailius, BSR, PT+OT, Physiotherapist
(Pelvic, Women's Health and Oncology)     
C Lower - 1204 NW Blvd.     Creston, BC     Ph  250-254-3494   Fax  1-855-655-5281   [email protected]

 Strategies for Menstrual Health or Taming Your Periods
 
You'll have about 400 periods in your lifetime, so track them, learn about your experience and how to thrive before, during and after each cycle.

1. Eat a primarily plant based diet.  Pork, ham and processed meats can irritate your periods.  Real food + mostly plants + not too much (with kudos to Michael Pollan) = healthier periods.  Research it and think Mediterranean Diet.  At least 3 pieces of fruit (not processed, not juice) + olive oil daily were important factors in research in Spain.
2. Optimize your bowel health.  Your bowel removes extra hormones.  If you're constipated at the same time each month (think luteal phase when progesterone is higher), you'll hold back icky hormones.  If you're loose (right before your period begins when estrogen/progesterone drop and prostaglandins spike), eat less fruit, more vegies.  Think full, painfree, complete and satisfying daily morning BMs with enough fibre (be boringly consistent), adequate hydration and relaxed pelvic floor muscles for toileting.  Your GI tract and healthy microbiome are important in estrogen metabolism (i.e. how your periods work). These are hormonally determined in women.  Track your cycle.  Become an expert on yourself.
3. Spices that may help  are Cinnamon, Fennel and Ginger.  Use ginger (tea, in food, topical cream/oil, capsules) in the week prior to your period as it's anti-inflammatory and pain killing.  Fennel is helpful for bloating and GI issues….use in cooking, as tea, essential oils in massage.  Cinnamon is warming, pain reducing (duration + intensity) and anti-inflammatory on morning oats, and in tea/coffee.
4. Sleep.  Disrupted sleep with cramps/bloating/anxiety/Gi issues causes increased pain perception.  Turn off blue lights 1 - 2 hours prior to bed.  Go to bed and wake up at the same time every day.  Have a cool room + warm feet.  Use a journal prior to bed (write everything down) and leave it, with your cellphone, outside your bedroom.  Empty your bladder prior to bed when you brush your teeth and, if you're constipated, have a glass of tap hot water.  Reduce light in your bedroom and make sleep time a priority.  No compromise on making sleep your job!
5. Stress management.  Notice if you're down (depressed) or anxious at the same time each month.  PMS and painful periods are higher in people who are anxious/stressed and vice versa.  Finding ways to reduce your stress will reduce the challenges with your periods.  Exercise is the best studied option, so good on you for exercising.  Sleep and a healthy diet support exercise.  If you think it would be helpful to talk with someone, find a counselor (professional or someone safe with whom you can be vulnerable).  Practice a gratitude journal - write down 3 things each day that you're grateful for.  Learn self-compassion, being as kind to yourself as you are to your bestie.  Start the minute you look in the mirror in the morning, saying "Hello bestie!".
6. Caffeine and Alcohol?  Caffeine helps your bowel move but interrupts your sleep…..which are you and which time of the month is that true?  Alcohol is different……daily use of alcohol raises your levels of estrodoil (pro-estrogen), so your liver is on guard to remove the alcohol toxin and ignores the extra estrogen, leaving it circulating when it should have been removed.  It is linked with Alzheimers and breast cancer, so is best done without if either are in your family story.  If you do have a drink, enjoy it on a special occasion (best at 1 - 2/month).  If/when you do drink, for women the "dose" is one beer, on 5 oz. glass of wine or 1 oz. of hard liquor at a time…..then stop!  Be informed and make your best decision.                                                                                                        
   
7. Heat?  A hot water bottle or warmed wheat bag are helpful, not too hot, wrapped in a towel and snuggle down with it tucked into your low tummy!  It reduces your pain perception and simply feels wonderful.  Every woman knows.
   
8. T.E.N.S.  Transcutaneous Electrical Nerve Stimulation for painful periods to endometriosis pain is well researched.  Talk to your pelvic physio about learning how to use one, borrowing a machine and trying it, then buying one/applying it yourself at home.
9. Manual Therapy.  Compared to Ibuprofen by itself, manual therapy had better pain relief in low back pain + headaches + diarrhea + fatigue + PMS.  Think massage therapy and physiotherapy (for therapists:  QL, Obturator Internus, Psoas, Iliacus, Adductors, Diaphragm, Pelvic Floor, MFR and post manual therapy relaxation techniques for hip rotation, abduction, flexion, extension).  Why did it work?  We think it's because it decreased threat, created safety, re-established healthy/free movement and the body's ability to be at ease.
10. Vibration.  You can use a vibrator over the low belly/uterus (from the outside) after heat for 15 minutes for 3 - 5 minutes with an empty bladder to reduce period pain.  The same effect was found with exercising on a power plate (whole body vibration) 3x/week.
11. Orgasm.  Orgasm reduced period pain….either with a partner or yourself.
12. Water.  1600 mls/day of water during your period can reduce your period pain.  Drink more.
13. Movement.  During your period, yoga and a gentle walk can be best options.  Think half cat/cows with your tummy released/hanging freely on a big out breath/deep sigh.  Think sphinx/baby cobra to child's pose, back and forth with your breath.  Think windshield washers of your hips/knees in sphinx (TV watching pose on your belly).  Think deep, low belly breaths throughout your day.  When we want to curl up in a ball with a hot water bottle, it can increase pain output in the end, so we're trying to go gently outside of that.  Breathing deeply and well, increasing your out-breath and being able to stretch your belly again may be surprisingly enjoyable (open up the front line of your body).

 
Try one idea at a time to learn what works best for you.  You are unique as are your cycles.
 
What looks like a good idea for me?  Practical?  Applicable? 
During, before or after my period begins?

1. My Choice:_________________________________________________ Date:___________________

      Outcome: __________________________________________________Change:_________________

1. My Choice:_________________________________________________ Date:___________________

      Outcome: __________________________________________________Change:_________________

1. My Choice:_________________________________________________ Date:___________________

            Outcome: __________________________________________________Change:_________________

1. ­­­­­­­­My Choice:_________________________________________________Date:___________________

            Outcome: __________________________________________________Change:_________________

1. My Choice:__________________________________________________Date:___________________

            Outcome: __________________________________________________Change:_________________
 
 
 
Property of Full Circle Physiotherapy, updated July 2022, not to be copied without permission.  JG

Whatsa Prolapse and What Can I Do About It?
 
Long time, no blog.  My apologies!  It's time to get back in the proverbial saddle (no horses on the farm anymore) and blog a bit…… it's all in the effort to help women and their healthcare professionals, their partners, friends, sisters, coaches and more understand women's amazing bodies.
 
So……whatsa prolapse?  Most women experience a pelvic organ prolapse or dropping of their pelvic organs at some time in their lives….it's in the neighbourhood of 70% of us, depending on which study your read.  Dropping or descending of your bladder/urthrea, rectum/lower bowel, cervix/uterus (and rarely your small intestine and other higher-up organs) is common; it feels like pressure, weightiness, a dragging sensation that is often relieved by lying down (overnight), antigravity positions (legs up the wall) and penetrative sex with a man (the penis helps nudge things back in place).  As we work through our day and especially when we're doing a lot of heavy leaning forward and effortful work, we notice the pressure in our pelvic floor, the vagina (the inside) and the vulva (the outside) more and more.
 
Why does this happen?  Life and all its experiences and joys and challenges can bring prolapse into our lives.  Think pregnancy, labour, delivery and postpartum times…..pregnant heaviness on your pelvic system, pushing hard in delivery for more than one hour, a tear or episiotomy at your perineal body (the thick and strong spot between your anus and the base of your vulva) and lots of leaning forward work of new parenthood (breastfeeding, diapering, bathing, snuggling on a tired and hormonally released body).  Having multiples (yay fellow Moms of twins and more!), babies who arrive at more than 8 pounds, forceps and vacuum deliveries, more than 3 deliveries also add to the mix.  Then, you might add in being overweight (belly fat adds downward pressure), having a persistent cough (asthma, COPD, smoking, allergies….), doing heavy physical work,  doing leaning forward work (sitting, gardening, lifting +++…), chronic constipation/bearing down on the toilet and impact sports (basketball, running, power lifting….).  How we sit (cross your legs/feet and slouch), how we breathe, how we move, how we live in and above our pelvic system adds some more prolapse factors.  Now……think about lovely postmenopause.  Remember that menopause is that moment when you are one year past your last cycle.  You shift from perimenopause to postmenopause in an instant.  The loss of spunky estrogen, the hormone that supports your muscles to be active, thick, juicy and responsive, means you lose some of the natural hormonal support of your organs.  After reading this list, you see why most women prolapse at some time in our life.
 
How do we test for prolapse?  We pelvic physios follow a testing protocol that is well researched and supported.  During your pelvic exam, we figure out where your organs are at rest, then we ask you to take in a deep breath and bear down.  We measure, with our finger or a POP stick, the descent of the organs down your vaginal vault.  The "gold standard" of testing involves you doing 6 repetitions of 6 seconds of bearing down with a wee break in between.  But, that's not all!  We also measure the quality and speed along with the amount of natural retraction of your organs between each bearing down.  We might ask you to lift your pelvic floor, to try a different position, to breathe out with an anal squeeze or a hypopressive manoeuver so we can sleuth out how you can help lift your organs yourself.  It's all about finding out what works specifically for you once we see that you're prolapsed.  We "stage" the prolapses out of 4.  If you have a stage 1 prolapse, it's pretty minimal and possibly inconsequential……this means that your organs are descending to less than ½ way down your vaginal vault on bearing down, it doesn't worsen as you repeat it and they mostly return to their starting position in between.  If you're at a stage 2, your organs are descending to the "introitus" or the opening of the vaginal vault at the vulva.  At stage 3, the organs go beyond that and poke out past the opening and stage 4 means they're mostly living there.  Women at stage 3 and 4 might describe a constant pressure that worsens with toileting and a scraping or bulging on wiping after BMs and voids.
 
 
 
 
Why do prolapses happen?  Big friendly letters - It's Not Because You Have a Weak Pelvic Floor!  Repeat after me!!!!  Prolapses happen because your pelvic organ support system, the core cylinder of your central body, has some pressure management fault.  There is a natural support system on every breath and every movement that moves your thorax to abdomen to pelvis that involves your pelvic organ support.  It's supposed to keep supporting your organs as you go through life!  But there are times in a woman's life when we ask more of the system than the support system can manage, so we develop coping strategies that create prolapse and/or we don't find pelvic organ lifting as we need in a day.
 
What can you do about it?  Brace yourself - SO MUCH!  Simply change how you breathe, sit, move, eat and toilet and you're all set!  If you have an intractable stage 3 or full stage 4 prolapse, you'll be referred to a gynie surgeon who might offer to tack up your organs onto your pelvic ligaments/fascia.  But, please see a pelvic physio in the meantime so that the habits and situations that caused your prolapse are sleuthed out and you don't return to said surgeon for round #2.  At stage 1, you're probably post partum or early perimenopause and might be just fine.  I'd still recommend that you check it out with a pelvic physio so that your prolapse doesn't progress.  Stage 2 and early stage 3 brings you the opportunity to meet in the clinic - you can learn to lift your organs with some lifestyle changes, some adaptations to what and how you do what you do, some strengthening and postural exercises and perhaps referral to other options like hypopressive training, postural work, yoga therapy and  more!  Don't stop doing what you love to do but learn to do it with joy and employ clever lifting of your organs.  As a previously prolapsed postmenopausal woman, I run, work hard on our farm, lift haybales (repeatedly and often) and am no longer prolapsed.  It takes attention, training and time, but it's so worthwhile.
 
What else do you need to know?  You may have postmenopausal urogenital syndrome (vaginal atrophy) that's contributing to your prolapse.  Address that.  You might have interrupted or double voiding or persistent urinary tract infections.  Address that.  You might need to splint your anorectal system to poop effectively or be constipated all the time.  Address that.  You might have other spinal issues that are contributing.  Address that.  If you're carrying extra weight on your tummy, it's pushing on your prolapse.  Address that.  And your cough, COPD, smoking, allergies, posture, heavy lifting……what things can you begin to address that will already help your organs lift and be perky again?
 
The important bit = Prolapses happen to most of us and are common, but they're not normal nor acceptable.  Ask at your next PAP smear or seek a pelvic physio to help you learn to have happily supported pelvic organs, a strong deep core, brilliant voiding and pooping and a happy pelvic life throughout your seasons!

Bloating Bellies
 
Many people suffer from bloat - that inflated, super sensitive belly that happens when you eat something that doesn't agree with you, you get stressed, you go out for dinner (and eat something new + are socially stressed), you _______......there is usually a story that you recognize.  And it's both possible and plausible to prevent a painful, gassy bloated belly as well as manage it yourself with a few nudges, learnings and cues.
 
Let's sleuth out bloating bellies.
 
Bloat is that pesky experience when your belly feels tight, puffy, gassy and can be somewhere between uncomfortable and really painful!  As with many conditions that pelvic physios address, this may or may not be a medical (see your doctor) issue.  Bloating may be more of a functional issue, a challenge that interferes with you enjoying life's adventures or traveling, a colourful and yummy variety of food (Cue #1:  Remember to go for 30 different plants per week…..grains, seeds, nuts, vegies, fruits, legumes), dinners at restaurants or friends' homes and socializing in general.  That makes bloat a human issue!
 
What causes bloating?
One common cause of bloating is constipation (Cue #2).  You can be constipated and not realize it, since having fewer bowel movements, smaller BMs or BMs less often than you normally do are just a few symptoms of constipation. You may still be constipated even if you have regular bowel movements. The longer your stool stays in your colon, the more time the bacteria have to ferment what's there, resulting in more gas and bloating.  We think about constipation in a variety of ways, including how you have a BM (positioning, starting, stopping, texture, stickiness, effort needed etc.) and how it might change under different circumstances.  Remember that your bowel thrives on boring, consistent, regular……and it deplores change of any kind!

1. Straining to start or finish a bowel movement, a habit that works for the moment but is likely to create more problems down the road, like pelvic organ prolapse!
2. Stool that looks like rocks and pebbles, think deer or elk droppings.
3. Not feeling empty after a bowel movement or what we call "incomplete evacuation", that feeling that there is still something lingering in your rectum.  You might notice more smelly gas or a heaviness in your anorectal area (back passage).

Aside from constipation, other causes of bloating include:

1. Irritable Bowel Syndrome (IBS) - This is an interesting syndrome (or collection of symptoms) in which you notice a sensitive digestive system that may cause pain, gas, cramping and varied BMs (constipation to loose stool).  The cause (or etiology) is poorly understood and there's lots of research going on in this area!  Some people find the FODMaP exclusion to inclusion (you don't stay excluded forever) really helpful.  Refer to the Monash University website in Australia and Kate Scarlata in the US.  But we know that IBS isn't all about what you eat, but how….how you think about food, eating, movement, stress, life in general (Cue #3).
2. Small Intestinal Bacteria Overgrowth (SIBO) - SIBO is another mysterious condition in which the small intestine (duodenum, jejunum and ileum) has a higher bacteria count than is expected in a normal small intestine (where most of the digestions + nutrient capturing happens).  This often happens after intestinal surgery, with those with IBS already and during/after a stressful period in life (Cue #4).  There is some research into the importance of the appendix in supporting our microbiome.  Stay tuned on that!
3. Gastroparesis - This condition causes delayed stomach emptying, which can cause bloating, nausea and even bowel blockage and is a reason to check in with your doc (Cue #5).
   
4. Gynie issues - Occasionally, the first sign of ovarian or uterine pathologies/disease is a change in your digestive function, like bloating/constipation.  This is a BIG nudge to NOT skip your pelvic exams with your doc and to report into your GP if there are changes in how you're digesting and/or if you have spotting or any bleeding after menopause (one year since your final period) (note Important Cue #6).
5. During your Cycles (Periods) - Hormones, gotta love them!  Progesterone family of hormones are integral to our monthly cycles and they are responsible for slowing us down, calming us, making us move, breathe, think, act more slowly (Cue #7).  They also do this to our digestive system….so pay attention to when, in your own particular monthly cycles, you need to slow yourself down (usually during ovulation or just pre-period-onset) both physically (you're more prone to sport injury in these days) and digestively (eating gentle foods that your tummy loves to digest with ease).
6. Habits - Do you chew 3x and swallow while standing at your counter and checking your cellphone?  At varying times in the day and on the run?  In your car while commuting to/from work or taking kids to lessons/events?  Eating your regular, predictable, nutritious and colourful meals made of real foods takes time, planning, preparation and (eventual) enjoyment is a thing (Cue #8).  Eating calmly, chewing well, slowly, with no sense of rush or stress, with a warm drink and the good plates, eating real food + mostly plants + not too much (credit to Michael Pollan for those words), taking and making time for sourcing out and bringing home what you need, then time to plan/chop/prepare and cook those yummies and taking time to enjoy the fruits of your labour is a thing.

Then, there's Abdominal Phrenic Dyssynergia (oooo, don't we love confusing nomenclature in the medical world!).  This has proven to be more common that we'd thought in time gone by.  APD is when the abdominal muscles relax (when they should be active or contracting) and the respiratory diaphragm contracts (when it should be relaxing) during digestion or in response to pressure changes within the colon (Cue #9).  Over time, our respiratory diaphragm can unlearn its mobility as it gets too busy, working when it should relax and rise up. What we enjoy (in a healthy, responsive system) is called our visceral somatic reflex.  The diaphragm raises up and relaxes while the front tummy muscles increase their tone and contract (shorten) to contain any distension during/after our meal.
What can we do about APD?

1. Calm our system.  Downtrain our stressors, then our stress responses (in our minds) and in our body's response to stress.  Notice.  Gently nudge.  Change.  Keep the new habit.  Repeat.
2. Change the dance between the abdominal muscles (there are a gang of them) and the respiratory diaphragm…..at the brain to nerve to muscle level (it's kind of a domino effect) and back up to the brain level and then change the awareness of the whole system level.  Think of it like stepping stones.
3. Calm/downtrain the overactive respiratory diaphragm and the obliques (diagonal tummy muscles), then help then learn how to work when they're needed in the right way followed by releasing and relaxing again.  It's not about strong, but about variable skill and capacity and responsiveness.
4. Learn to fully and completely relax and release their tummy muscles.  Let Your Belly Go!  Belly breathing, in this case, is probably what these folks are relying on, but it's not serving them.
5. Learn to rotate, side bend, forward bend and extend their whole rib system and thoracic spine (middle spine) in all positions…..sitting, standing, hands and knees, squatting, forward leaning, reaching up.  Often these folks are "shoulder holders" and/or "butt grippers", so they're clenching in an unhelpful way throughout their day (and sometimes while sleeping).
6. Relearning the dance between the front tummy muscles and the diaphragm……it's helping these folks find that their tummy muscles naturally lift/retract as they breathe out.  The pelvic diaphragm is sometimes a great cue/teacher on relearning this skill.  All our diaphragms love to work together.
7. Reminding ourselves that our brains and bodies were born with these natural abilities and that, with all that life brings us, we sometimes forget how they are brilliantly capable to do just what they're meant to do.  You're relearning what your body wants to do, so take a breath and enjoy.

What is PF?
Proctalgia means pain around the back passage area (anus/rectum) and/or, for some women, into the vagina.  It's most often a central spasm + pain and less often appears on one side more than the other.
Fugax is a Latin word meaning fugitive or fleeting, so it's a pain in your anus/vagina that's like a spasm and is short lived……a squeeze and gone or a deeply unpleasant clench that can hold on for a 2 - 20 minutes.
Pain can appear frequently over a few weeks, each time lasting only seconds or minutes or appear rarely and only during specific actions/activities. It is a sudden, cramping, severe pain that may make you feel nauseous and quite awful. It may wake you up in the night.  If the spasm builds and becomes difficult to release (feeling "locked in"), you may have aching for up to a day afterward leaving you with a tired + tender anus/vagina that makes lengthy sitting uncomfortable and release for toileting and intimacy unpleasant. About 1 in 5 people have PF, so this is worth attending to! 
 
A specialist once told me "you just have to live with it".   If you've been told that, read on.
This isn't because doctors don't know about PF, but reflects that they can't test it or see/palpate it, because you're not usually in their office when it clamps on.  Then it passes, so it's not really a huge or impactful medical issue, but it IS a functional issue that has had very little attention…..until now.  Your doctor can rule out other problems that may cause similar symptoms, so please mention these anal/vaginal spasms to them! 
Then find a pelvic physio to assess your pelvic floor.  You can begin by reading onward and seeing if this story and these suggestions help you to reduce the frequency and intensity of your PF, then help you bid PF goodbye!
 
It is treatable, manageable and you can stop it from coming on. 
This requires attention - when you have PF, take stock of your life, activities, rest, stress, food etc. at the time.
Ask yourself what was going on just before or within the last ½ day?  Jot it down on the calendar or in your in notes on your phone.  Next time you experience PF, write it down again.  Pay attention to your triggers.
Shared problems may include:  IBS or an IBD?  Bloat?  Abdomino-phrenic Dyssynergia?  Overactive pelvic floor? Urge/urge incontinence for your bladder?  Overactive bladder (pee too often)?  Pain with sex?  Sluggish/painful bowel release)?  Hemorrhoids?  This pesky list reflects pelvic diagnoses that also occur with an overactive, hypertonic or hyperrecruited pelvic muscle system. 
 
Find your Triggers.
There are numerous triggers for PF including sexual activity, stress (+++) of all varieties and blends, grief, constipation, bowel movements, during/right before periods, sport activity like speed walking/running/interval work/hill work, gymnastics, basketball, sudden start/stop sports like softball or baseball …….although the PF can occur without a trigger. 
Increased stress (physical, emotional, relationship or a blend thereof) is most commonly implicated due to our very human tendency to protect ourselves by "holding on" when stressed.  We do this by butt gripping, pelvic floor clenching and tensing our lower abdominals (especially the Transversus Abdominus muscle just above your pubic bones).  Some of these muscles share attachments with your anus (external anal sphincter) and your vaginal walls (too many amazing muscles to list) and they all share the same electrical circuits (neuromotor or nerve to muscle communication).  Nerves (and muscles) that wire together, fire together.
 
Notice onset (like an aura with a migraine).
Some people describe a sensation of lifting or tightening of their pelvic floor or a very mild ache in their deep buttock or anus prior to the onset of PF…..notice it and begin emergency measures immediately.  You can learn to stop PF from coming on to a full clamp.
 
Immediately apply emergency management measures!
You need to release a spasm, so think of PF like a foot or calf cramp….it takes work + calm + time + skill.  Begin by taking deep, pelvic-diaphragmatic breaths, inhaling fully for a slow count of 4, then releasing it with big (Dizzy Gillespie playing the trumpet) cheeks or a deep bear growl or a long, slow, groany groan.  If you're near a toilet, sitting on the toilet seat (not the lid) with your feet planted on the floor and your elbows on you knees ("reading the newspaper on the floor position") can be helpful for 2 reasons:  you're used to releasing your pelvic floor on the toilet (habit) and the toilet seat is built to open up your pelvis (that sinking down in the middle).  It's a good tool!  Imagining release (motor imaging) of your pelvis, anus, vagina, buttocks, low belly and hips helps, so picture it while releasing with your mind.  Go to your Savasana or meditation or beach or post-run feeling in your mind.  Positions that might help:  squat (on your own or with your sacrum on the wall for support or at the wall or with a yoga block or low stool under your buttocks), hinging at the hips with your palms or elbows on your thighs, wide kneed child's pose or happy baby.  In all these positions, release your anus and vagina, especially on a deep and low in-breath with back pressure outbreath (big cheeks or bear or deep groan) so that you find ways that you (when you're not in spasm or pain) can release, release, release.

Do some prevention movement, breath practices and stress management daily.
Ask your pelvic physio to help you learn to turn OFF your pelvic floor and lower abdominals; we call this downtraining or quieting.  Do this practice every day for 2 weeks, then continue on most days, reminding your lower muscles, the centre of your deep core, that activation is OK but release is brilliant too!  Learn to do pelvic diaphragmatic, 4 part, back pressured out breath (big cheeks, bear or groan) or Dirga breaths as part of your "release your body and mind" practices each day.  You don't always breathe this way but it helps you to know when to use this technique for the right moment (toileting, sex, birthing, PF).  Never grip your buttocks nor hold your tummy in - these are really unhelpful habits.  You're beautiful as you are and gripping/holding doesn't help.  Learn where "your body keeps the score" - find those spots in your own body where you "hold on" and notice when you're feeling the urge to protect, get stressed out or overwhelmed and learn to release them.  Responding fully with a calm body to stress without being stressed out is a wonderful thing.  Make squatting and/or happy baby and/or child's pose or leaning forward with your hands/elbows on your thighs a stretch that you include in your day, especially before/after situations that often trigger you.  And breathe deeply and fully into the stretch, feeling the release and enjoying the moment.
 
Joanne Gailius, BSR, PT+OT, Physiotherapist
(Pelvic, Women's Health and Oncology)
C Lower - 1204 NW Blvd.     Creston, BC     Ph  250-254-3494   Fax  1-855-655-5281   [email protected]

Toileting Tricks
Position
Sitting with your feet solidly supported on a stool/yoga blocks, knees slightly higher than your hips, completely calm and relaxed, leaning forward slightly ("reading the newspaper on the floor") position is often helpful, but not always. 
You're looking for release of your pelvic floor (especially your puborectalis muscle) and a straight anorectal angle so that the rectum is a direct highway. 
You can try this by going to the bathroom when your bowel isn't cueing you for a BM, closing the toilet lid, sitting down on it, feeling your tailbone and/or anus  and trying which position, breath pattern, knee height releases your very own system.
                                            
Pressure Management
This happens at your glottis (throat/larynx) and involves you finding which noise/action opens your glottis to that Goldilocks perfection of releasing your pelvic floor and anus.  Try these by sitting on your toilet lid (as above) and noticing….When does my anus open for a free and calm release? 
 Look at the photos above for cues.......
Grrrrr………………..Shhh…………….Mooooo……….Sssss…………….Straw blow………….Dizzy Gillespie cheeks……
 
Sometimes You Need External Support (with rectal prolapse and/or deer pellet poops)
With your finger just ahead of your anus on the Perineal Body, inside and onto the back wall of the vagina or using a Femmeze to push that "R" pocket back towards your buttocks and make the passageway straight.
 
Best Stool Shape, Consistency + Size
You're seeking a smooth, long, snake-like, Bristol Stool Score #4 stool…..what eating + drinking + fibre + stress management + movement + sleep support do you find that works consistently for you to create that?   Find it and repeat. 
 
Try for a BM 20 - 30 mins After Arising/Drinking, Before Leaving Home
Try to teach your colon and whole system that a morning, post-arising (moving), post warm drink, pre leaving the house BM sets you up for a good day.  Effortless, releasing, calming, restoring, empty-bowel-for-the-day kind of routine.
 
Breath Patterns that Help You
Play around, feeling your tailbone/anus…..what breath actions help you release.  Is it low, slow, deep, pelvic breaths?  Big cheek puffy breaths in and out?  Saggy body, open hip breaths?  Find your best breath pattern and repeat, repeat.
 
Make Toilet Time a Priority
No tech, no cellphone, no ipad, no lists…..don't take toileting for granted.  Make time (get up a little earlier) to toilet well, fully and completely, without effort and with calm, soft release.  See if you can be in the bathroom alone and teach your family that this is you-time…..that you're a happier and healthier you if you have solo toilet time.
 
Pooping Away from Home may need sound support (turn on the fan) +
Confidence of Privacy (lock the door) +
Reducing Odours (make + use the Poop Spray)
 
If you don't have a BM prior to leaving home in the morning and it just doesn't become your habit despite attempting to teach your digestive system to do so, you may need to have your bowel release during your outside/work day.  Use all the best tricks (sound, privacy, poop spray) to make it happen regularly, confidently, calmly and with consistency.
                                  Poop Spray
Essential oils (orange, grapefruit, lavender, peppermint), 15 drops
2 T. vodka
1 drop dish soap
water to fill bottle
Pre-pooping, shake the bottle well and put 4 squirts into the bowl prior.  The spray will catch the odours and it will all flush away.


 
 
 
                                                          Joanne Gailius, BSR, PT+OT, Physiotherapist                              Jan 2023
(Pelvic, Women's Health and Oncology)
C Lower - 1204 NW Blvd.     Creston, BC     Ph  250-254-3494   Fa

Hello friends of Full Circle. 
It's a time of year when stress may nip our heels.  Have a read through this list....ponder on what you can begin, with a sense of playfulness, even delight.....what would be fun to try, to repeat for a week or two and see how you feel.  Calmer?  A little more ease?  Less frantic?  Tummy less cranky?  Reduced pelvic pain? 
You are the expert about yourself and your own body. 
What would make today more colourful, more vibrant for you?
 
Daily Gratitude List
Write down 3 things for which you're grateful today.  Keep going if you'd like to, but create a habit of finding 3 things or people or daily activity or interaction or weather or ______ that you noticed gratitude about.
 
Move Your Body
Go for a 10 minute walk or jog or toodle down a quiet road or through the forest…..no phone, on your own, no distractions, noticing the temperature, the humidity, the clouds, the trees.  Just be present in the moment of moving in the world.  Go every day, growing your movement to 30 minutes each day.  Even the stormy, snowy, windy or rainy days can be brilliant!
 
Breathing Ideas
Pick one of these breathing ideas and do any of these 10x in a row, notice if you feel calmer.  Then repeat daily (or whenever you feel your shoulders rising, jaw tightening or butt/toe gripping).  Or try another and play!
So Hum
As you breathe in say (or think) "Sooooooo…." Then as you breathe out slowly, say (or think) "Hummmmmm."
Alternate Nostril Breathing
Place your fingertips #2 and 3 on your forehead.  Use your thumb tip to close your R nostril.  Breathe in your L nostril.  When you're full of air, use fingertip #4 to close off your L nostril and breathe out your R nostril.  Don't move your fingers when you're empty of air.  Breathe in your R nostril.  Full of air = switch fingertips on nostril closure so you breathe out your L nostril.  Breathe in your L nostril and repeat.  Slowly.
Deep Pelvic Breath
Ly or sit in a comfy chair.  Place one palm on your chest bone and one on your low belly, releasing your belly, buttocks, hips and pelvic floor.  Breathe in your nose, slow and deep with only your lower hand lifting with your filling belly, feeling your hips release, your pelvic floor (vagina/scrotum/anus) open and widen and your back arch gently.  Breathe out your pursed lips, slowly and simply letting your body release and let go….no action, just settling back to the starting position.
 
Distance from External Expectations
Reduce the power and proximity of societal, familial, friend (other) expectations in your mind, body and self-talk.  Step back from Facebook, Twitter, Instagram, You Tube, your cellphone.  Take at least one day unconnected to it all.  Notice what matters to you (not others).
 
Greet the Woman in the Mirror
As you wash your face and brush your teeth in the morning, greet the woman in the mirror and thank her for coming into the day, taking care of herself, being her/you.  Notice how you look, take time to appreciate your eyes, your smile, your presence.  All that you bring into the day is improved if you're thankful to be you.
 
Sleep Well
Invest some commitment, time and energy into sleeping well.  Stop all scrolling/watching/phoning 2 hours prior to a consistent, calm, warm bedtime.  Make bed time routine and sleep a really important part of your daily commitment to a healthier, calmer, more vibrant you.
 
Connection
Where, when, how and with whom do you fill your cup?  Is there a weekly visit with someone that you'd find energy-giving?  A weekly walk with someone, a teatime, volunteering, checking in with _______?
 
Creativity
Everyone is an artist and has a creative urge that support each of us being ourself……Cooking? Baking? Drawing? Knitting?  Painting?  Journaling?  Photography?  Hands on, expressing you being you.
 
Unitask
Once your estrogen is depleting/depleted (peri to post menopause), your cortisol (stress hormone) will rise if you continue to multitask.  Estrogen helped you multitask; you don't have it any more.  You'll ask your stress system to respond if you keep multitasking, so stop it!  One task, one activity, one skill, one thing at a time.  Prioritize and do one thing.  Then stop and appreciate that you've done "it" and go onto the next one.  Way less stress.
 
Compassion
Self Compassion (Self-compassion entails being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or flagellating ourselves with self-criticism) and Fierce Self Compassion (Fierce self-compassion involves “acting in the world” to alleviate suffering. It tends to involve protecting, providing for, and motivating ourselves. Sometimes we need to stand tall and say no, draw boundaries, or fight injustice. Or we may need to say yes to ourselves, to do what’s needed to be happy rather than subordinating our needs to those of others. And if we’re stuck in a bad situation or habits that are harmful, it means doing something different. Not because we’re unacceptable as we are, but because we care.)  Definitions by Kristen Neff with gratitude for her two books.
 
Noticing
All of us have stress in our lives.  In fact, we need a modicum of stress in order to be alive!  In addition, some of our stressors aren't changeable ….. our family, our health concerns, our aging parents, our jobs, our financial position. 
But…..we can notice our "body keeping the score".  Are you A jaw clencher?  A shoulder holder?  A butt gripper?  A toe grabber?  If your body continues to "keep the score" of all of life's stresses/stressors, do you respond further by Not sleeping?  Developing a headache?  Catching the latest virus passing by? 
You can change up your stress response by first noticing how you in your "only you" way respond to stress.  AHA!  Paying attention is surprising and enlightening.  Then release your jaw, soften your shoulders,you’re your tummy go, rock back and forth on your toes while you release your buttocks and wiggle your feet.  Just breathe.  Repeat with your inbreath, "I am safe", and with our outbreath, "It's OK to let go".
 
These small ideas can change your sense of calm, your response to life's challenges and your vibrancy.
 
What works for you?
 
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C2 - 1204 NW Blvd.     Creston, BC     Ph  250-254-3494   Fax  1-855-655-5281

 
         Fertility Facts
 
Fertility Difficulties are complex and are important to sleuth out with the help of specialists (OBGYNs, both general and specialized), Urogynecologists (particularly for those with persistent pelvic pain), Other specialists (eg. if you have UC or CD, your Gastroenterologist or if you have RA or Lupus, your Rheumatologist) and your GP/NP.
 
Fertility challenges are 40% due to the female partner + 40% due to the male partner + 20% of unknown/interactive (i.e. woman's allergic response to the man's sperm) issues.
 
1 in 6 couples in the UK sought fertility help in 2019.
 
Over 80% of UK couples will conceive within 1 year of trying and a further 50% of the remaining will conceive within the second year.
 
When we struggle with fertility, it's an often overlooked, challenging, difficult journey (ref: youtube channel of Lauren Mancell (https://celebratemuliebrity.com/2018/09/trauma-awareness-in-womens-health/).
 
30% of all pregnancies end up in miscarriage.
 
 
         A Woman's "Normal" Cycle
 

• 28 - 42 days
• relatively predictable, regular, trackable (get tracking!)
• 3 stages          - flow stage = period appears (call this day 1)

                              - follicular stage = building, growing, high estrogen (preparing for implantation)
                              - luteal stage = holding, implanting, high progesterone (maintaining implantation)
 
 
    Know When You Ovulate and Track it Yourself
                             
                              Duration of cycle                 Ovulation day
                              22 day cycle                          day 6 - 10
                              24 day cycle                          day 8 - 12
                              26 day cycle                          day 10 - 14
                              28 day cycle                          day 12 - 16
                              36 day cycle                          day 20 - 24
                              32 day cycle                          day 26 - 30
 
     Ovulation Information
 
Mittelschmertz - a stabby kind of pain on one side of your lower pelvis when the egg is released.
 
Your mucous is like egg white (stretchy, springy) and is more receptive to sperm, drying out a little after ovulation passes; the neck of your cervix is more open and welcoming.
 
Your basal body temperature (taken first thing in the morning, prior to arising/warm drink) dips slightly at ovulation and rises slightly in the luteal stage.
 
Keep a pen, paper (or phone tracker) and thermometer right beside your bed.  Test and record your temperature daily and learn about how your body navigates the monthly-ish cycle.  This is to create self-knowledge and to provide helpful information, not for complete focus.  It's a "know thyself" moment.
 
A BMI of >19 and <30 is the "golden window" for conception.
 
Habits that help: no alcohol, no smoking, active lifestyle, manage diseases (Hep B/C/HIV), avoid occupational (chemical) exposures, wear loose-ish undies (especially the men), manage/address Endometriosis/PCOS/PID before/during fertility times, wait 3 - 13 mos. after coming off OCPs (the pill) while your body re-establishes its own natural hormonal cycles, avoid use of Ibuprofen (Advil, Motrin).
 
Specific Dietary Recommendations:  Mediterranean Diet, plant focused (at least 5 plants/day with a variety of up to 30 different plants per week), nutrient dense, organic/healthy protein sources that aren't processed, add Omega 3's that are algae based, look at your micronutrients (Folic Acid, B12, Zinc, Iodine, Vit D, Selenium, Iron with Vitamin C and without caffiene), Dairy should be high fat, Eliminate transfats, meat < 3x/week with fish > 1x/week, pass on alcohol + caffiene for both women and men, All the Dietary Recommendations equally affect both partners!
 
Sleeping well/restoratively/consistently + Stress management/reduction are hugely important in themselves and need their own special focus!
 
Daily exercise - some cardio, some strength, some flexibility, some restorative….."moderate physical activity" boosts conception success (including IVF) so think Goldilocks (not too little, not too much, just right).
 
Get your hormonal profile checked if you're over 35 or not successfully pregnant within 1 year of trying and/or if you've had miscarriages (2+) to track/check your ovulation and/or have had 3 miscarriages.
 
 
    Egg Meets Sperm Facts
 
Your egg is ready/fertile at 24 - 28 hours after you ovulate.
 
Your sperm can be lively/ready to fertilize an egg for 5 days after being released in a hospitable environment.
 
      Find a Pelvic Physio trained in Fertility Support
 
Manual  Physiotherapy doubles IVF success rate (specifically myofascial + lymphatic + visceral) by improving the mobility/health of the implantation neighbourhood.  Ongoing studies suggest the same result of these therapies for natural pregnancies.
 
Addressing depression + anxiety is helpful.  Studies recommend calming yoga (gentle hatha, restorative and/or yin) + Cognitive Behaviour Therapy + mindfulness practices + lifestyle changes to improve sense of self-efficacy and confidence.  Consistency is the key, trying one new practice at a time for 4 - 6 weeks, 4 - 7 days/week before adding a second change.  Remember small, consistent baby steps (1% change per week) is the best and most helpful, long-term approach.
 
Weight management is vital for both partners so that BMI is stable between 19 and 30.
 
Managing and stabilizing all chronic diseases including coeliac, endometriosis, adenomyosis and PCOS particularly.
 
Cease smoking asap for both partners (refer to Alan Carr's "Easy Way to Stop Smoking" book).
 
Addressing sleep disorders is vitally important as sleep is restorative and a key health factor.  This means consistency with bed times, awakening times, cool room, warm feet, darkened windows, quiet or white noise, no blue light 1 - 2 hours prior to bedtime, no cell phone/ipad/laptop in the bedroom, warm bath/shower prior to bed, no snacks after 7 pm….make restorative sleep a priority.
 
Identify and address all physical + emotional + relational stressors in your life.  Craft a life that is calm, enjoyable, consistent and with comfort, predictability and joy.
 
If you've had a miscarriage (or 2,3), you may feel loss and grief.  It may help to speak with someone with whom you can be vulnerable and open.  If you're able to be open and find support, it may help lift the veil of grief for you.
 
IVF adds a whole new adventure/challenge.   You may experience heightened anxiety when patience and care, sensitivity and support are what you need.  Practicing daily/consistent mindfulness, breathing practices, progressive muscle relaxation and pelvic relaxation/release may be helpful.  You may find that psychotherapy (particularly CBT) is an additional self care strategy.  Biofeedback (self-taught or mindful training) to reduce stress hormones + improve sleep are recommended.  Big self care, self compassion and calm are the bywords to repeat.
 
Your individualized plan:
 

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Property of Joanne Gailius, Full Circle Physiotherapy, Not to be copied without permission.

 
Inflammatory Bowel Disease
(Ulcerative Colitis (UC) and Crohn's Disease (CD))
 
What does a pelvic physio have to offer someone who has IBD?
 
Top Down (stress management + sleep challenges + microbiome support + exercise prescription + lifestyle factors + individualized concerns re: work/play/restoration/meaningful activities)
 
Bottom Up (anal incontinence and/or constipation + bowel functional support/education) treatment, bladder + sexual + pelvic organ support + systemic challenges (skin, joint, eyes…)
 
Focus:  What's happening now?  What is getting in the way of you enjoying your best, most meaningful life? Write your very unique list.  All recent research says that lifestyle (more than medication or        surgery) is the #1 most effective way to treat UC and CD or the combo.
 
Facts About IBDs from 2015 - present research:
 
Genetics?:  Presence of IBDs has a genetic link, but there is no genetic link to the severity of the disease.  Severity of both diseases is clearly linked to lifestyle/diet/smoking/stress management.          These are modifiable factors and put you in the driver's seat.
 
Stop smoking immediately (including second hand smoke) - Refer to Alan Carr's book on smoking        cessation.  Smoking is pro-inflammatory and your job is to reduce inflammation or "put out the fire".
 
Reduce or stop alcohol consumption - 1 - 3x weekly of one beer, one x 5 oz. glass wine or 1 oz. alcohol.  No stacking (never more than one at a time).  Alcohol impedes a healthy gut microbiome and is pro- inflammatory as well!
 
The Story of IBDs and Fibre?  There is no evidence to support a low fibre diet for someone with IBD (most of the time).  Fibre is protective for those with IBDs with a minimum of 27 gm fibre/day and preferably 35 - 50 gm fibre/day.  It's very old, outdated advice to eat a low fibre diet.
 
            Why?  - Fibre feeds your microbiome, helps control blood sugar, stabilizes body weight, helps immune regulation in your gut's T Regulator cells, maintains healthy gut barrier to reduce leaky gut, increases the mucous production to keep pathogenic bacteria off gut wall, helps excretion of excess hormones and supports your gut-brain axis (you think more clearly!).
 
            Proviso** - If you have a stricture or scar tissue limitations, you may need to eat low fibre until that is released surgically and/or with pelvic physio.
 
           
 
 
 
 
 
 
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How do you increase your fibre intake? - Low and slow is the motto.  Choose one thing from the list below, see how your body responds over 2 - 3 weeks, then try the next.  Keep what serves you.
 

1. Begin by adding cooked vegies then low glycemic fruit then healthy, whole food, primarily plant based, Mediterranean diet. 
2. Stop all dairy x 3 weeks, then add back for 3 days and see what your belly says.  Avoid "healthy" junk food (eg. Almond Milk) that has industrial oils, sweeteners, emulsifiers and stabilizers.
3. Stop all processed meats, especially pork and beef (no sausage, bacon, ham, sliced meats).
4. Reduce all meats including chicken and turkey, then fish.
5. Cut out all false sugars - if using sweeteners, choose maple syrup or honey or organic cane sugar.
6. Vegan diet (unprocessed, whole food, plant based) had similar maintenance of remission rates as medications (Levine 2018, Letellier 2016, Chiba 2019, Yanai 2022, Lo 2020).
7. Fibre supplements/additives are much less effective than changes in what + how you eat and think and move.  It takes time/commitment and daily, boring consistency, but research bears out that eating a Mediterranean, whole food, plant based diet with stress, sleep and lifestyle changes helps you live your best life.

 
Fatigue - Fatigue is a functional concern for most people with IBDs, but especially women + younger + early stage + if you have pre-existing depression and/or anxiety.  Research shows that the experience of IBD related fatigue is very similar to the fatigue people experience while having chemotherapy.
 
            Why? - IBD creates an inflammatory state in your body which is anxiety provoking, your gut-brain axis is wobbly (need microbiome support…..see all dietary suggestions above), treatments/surgery are   taxing, depression/anxiety/loose stool may interrupt sleep.
 
            What can I do about it? - Calm your system/put out the IBD fire, develop a brilliant and varied              microbiome, help your system to reduce medical/pharmaceutical/surgical needs by caring for yourself with healthy choices and consistency, then…Practice unwavering, consistent sleep hygiene (daily consistent bedtime and awaken times, safe/comfortable housing, cool room/warm feet, quiet/calm evening routine, no blue lights 1 - 2 hours prior to bedtime, covered windows, no evening snacks, cellphone not in bedroom (no texts/emails/calls during dedicated sleep time), write list for tomorrow on paper/phone and leave it in kitchen)….find what works for you and stick to it every single day/night!
 
 
Personalized Exercise Programme
 
Daily to 3x/week aerobic + resistance (weights or body resistance) boosts your immune system's response (but studies show that it didn't change bowel function).
 
Aerobic exercise for 30 mins. x 5/week helps support your heart health, gives you a sense of calm (endorphin release) but can activate the bowel.  Keep timing and fatigue in mind.  Most folks with IBD choose early morning for their run/bike/swim.
 
Calming exercise, like yin yoga and/or a regular gentle stretching routine can help reduce stress, anxiety and promote sleep.  No surprise that this can be a lovely part of an evening time to promote sleep and calm the mind.
 
 
 
 
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Mental Health Considerations

1. Again, we go to some big studies…..showing that people with IBDs often experience life interruptions, more frequent health interventions and secondary autoimmune disorders…..all leading to a more stressful path in life.  A combination of cognitive behavioural therapy (weekly as needed) and meditation (daily) gave the best mental health outcomes, reduced anxiety, managed depression and helped people have the skills to manage their health challenges with more ease.
2. Three more interventions were noted:  exercise in the morning, keep life's priorities clearly in focus and learn to decatastrophize your thinking/responses. 
3. Decatastrophizing when you have a chronic disease is a learned skill.  Here are some keys: Acknowledging that unpleasant things happen: Life is full of challenges as well as good and bad days. Recognize a difficult day and know that later/tomorrow will likely be better.  Recognizing when thoughts are irrational: Catastrophizing often follows a distinct pattern. A person will start with a thought, such as “I am hurting today.” They will then expand on the thought with worry and anxiety, such as, “The pain is only going to get worse,” or “This hurting means I’ll never get better.” When a person learns to recognize these thoughts, they are better equipped to handle them.  Saying “stop!”: To cease the repetitive, catastrophic thoughts, a person may have to say out loud or in their head “stop!” or “no more!” These words can keep the stream of thoughts from continuing and help a person change the course of their thinking.  Thinking about another outcome: Instead of thinking about a negative outcome, consider a positive one or even a less-negative option.  Offering positive affirmations: When it comes to catastrophic thinking, a person can learn to believe in themself and that they can overcome their tendency to fear the worst. They may wish to repeat a positive affirmation to themselves on a daily basis.  Practicing excellent self-care: Catastrophic thoughts are more likely to take over when a person is tired, unwell and/or stressed. Getting enough rest and engaging in stress-relieving techniques, such as exercise, meditation, and journaling, can all help a person feel better.

Pelvic Physiotherapy
Pelvic physios are trained in incontinence of bowel and/or bladder, bowel management (constipation et al.), sexual function/dysfunction, pelvic organ support, persistent pelvic pain and more.  Any of these challenges may be within the experience of those who have IBDs.  Prehab and rehabilitation from abdominal/pelvic surgeries, including ostomy surgeries, is part of our work as well (scar tissue release, tendomyofascial release, posture, abdominal/pelvic recruitment + strengthening + function and more).  As a very specific example, the puborectalis muscle (a sling shaped muscle that wraps around and supports the anorectal canal) can become over-recruited and tight in some people with frequency/loose stool and functionally impedes the movement of the stool as it exits.  It then looks like constipation, but is actually the opposite!  A pelvic physio can help with manual therapy (releasing the muscle) and teaching you to accomplish this yourself with breath, positioning, your own hands/therawand…..even how/when you toilet.  Assessment and treatment are yours to choose/guide.  If you contact a pelvic physio, ask if they are trained in anorectal dysfunction prior to your appointment.  And if you have any questions or concerns, please feel free to email me at [email protected] and/or peruse my website: fullcirclephysiotherapy.ca.
 
 
 
 
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