Ulcerative Colitis, Crohn's Disease and Pelvic Physio

 
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  It's very old, outdated advice to eat a low fibre diet.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.
 
           
 
 
 
 
 
 
Full Circle Physiotherapy and IBDs                                                                                                                Page 2
 
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.
 
 
 
 
Full Circle Physiotherapy and IBDs                                                                                                                Page 3
 
 
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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