You never paid much attention to your bowel habits…until now. In the last few weeks, your day has flipped flopped between dashing to the bathroom with diarrhea or spending quite a bit of time struggling to have a bowel movement and all the while experiencing bloating and abdominal discomfort. You meet with your MD and finally get a diagnosis: irritable bowel syndrome.
April is irritable bowel syndrome (IBS) awareness month. IBS is a sudden alteration in bowel habits. For some that can mean predominate diarrhea or constipation, or a combination of both. Bloating, gas, and discomfort accompany these changes.
Approximately 10-15% of individuals in North America experience IBS. It is the second leading cause for days of missed work, and 25-50% of referrals to gastroenterologists are attributed to IBS. Women and individuals under age fifty are more likely to experience IBS (Wald, 2017). Living with IBS can feel pretty crummy and aren’t a whole lot of answers out there.
Why does this happen?
Unfortunately, there is no clear cut reason why someone develops IBS, but there are a few theories out there (Mayo Clinic, 2018; Herman and Wallace, 2019).
- The nerves supplying the colon get disrupted
- The gut is full of all types of healthy bacteria that aide in the digestive process. These healthy bacteria become altered
- Poor diet
- Intestinal inflammation
- IBS also likes to accompany many autoimmune conditions and endometriosis
How is IBS diagnosed?
An official diagnosis of IBS uses something called the Rome IV criteria.
For an individual to have IBS, they must have:
Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
1. Related to defecation
2. Associated with a change in the frequency of stool
3. Associated with a change in the form (appearance) of stool
These criteria should be fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.
How can a pelvic PT help?
It’s no secret that certain foods may trigger IBS symptoms. Pelvic health PTs often times assign bowel diaries. A bowel diary is essentially exactly what it sounds like. A patient tracks their fluid intake, food intake, and information about bowel movements for several days. The patient then will bring the diary to the next visit and review it with their therapist. Your PT will assist you in recognizing patterns and potential triggers and suggest modifications that can make your life quite a bit easier.
The squatty potty has become a hit for a reason; it optimizes body mechanics while going #2. Long before the squatty potty went mainstream, pelvic PTs were teaching their patients better ways to poop.
Excessive pushing and straining while having a bowel movement or incomplete emptying are signs of pelvic floor dysfunction. When it comes time to empty your bowels, the pelvic floor muscles should relax and allow stool to pass. Poor posture on the toilet can make it more difficult to allow the pelvic floor to relax.
Learn to use your reflexes to your advantage
Did you know that there is an optimal time of day to have a bowel movement? Every time you eat a meal, a reflex called the gastrocolic reflex becomes stimulated. This reflex initiates the chain of events that help things move through the system and should give you the urge to go following a meal.
You can suppress the urge to go if you need to run out the door to work after breakfast. Routinely suppressing the urge can make it harder to have a bowel movements. Conversely, if you experience diarrhea dominant IBS, you may run out the door but experience a very strong urge to go while on the way to work. Your pelvic PT can help you stay on top of constipation or diarrhea with a good bowel routine.
Check out our December blog post for more tips to stay “regular” and manage constipation here: http://hudsonvalleypt.com/2018/12/03/5-tips-to-stay-regular-this-holiday-season/
Introduce safe exercise back into your life
Regular physical activity seems to better help individuals living with IBS manage their symptoms. In a recent study, regular aerobic training was shown to improve quality of life in women living with IBS (Fani et .al, 2019).
A systematic review found a trend toward improved quality of life and reduction in symptoms for those individuals who practiced yoga (Schumann et. al, 2016). As both a yoga teacher and pelvic health physical therapist, I am biased toward using yoga as a tool for pelvic rehabilitation. You can read more about that here: http://hudsonvalleypt.com/2018/08/30/when-pelvic-floor-meets-yoga/.
Pelvic health physical therapists are movement specialists with a deeper understanding of the GI system. This combination makes your pelvic PT the perfect person to guide you through an appropriate home exercise program.
Stress worsens IBS symptoms (Irritable Bowel Syndrome). The Mayo clinic recommends stress reduction as one strategy for IBS management.
Stress reduction is much easier said than done. Using guided relaxation training, tools like biofeedback, and even postural retraining (to avoid clenching throughout the day), pelvic PTs can help you cultivate better body awareness and come up with strategies to reduce stress.
Get things moving
Fascia is an amazing thing. For those unfamiliar with the term, fascia is the connective tissue that surrounds your muscles and organs. It literally connects everything head to toe. Fascial tightness around the organs and muscles (which is not at all uncommon in IBS) can cause significant discomfort. Pelvic PTs have the training to evaluate fascial tension and get things moving again.
Irritable bowel syndrome can feel quite overwhelming. Explore and find the strategies that work for you. Between physicians, nutritionists, pelvic health PTs, and other healthcare practitioners, assemble your team to point you in the right direction.
-Megan Fosko PT, DPT
Fani, M., Mostamand, J., Fani, M., Chitsaz, N., & Feizi, A. (2019). The effect of aerobic exercises among women with mild and moderate irritable bowel syndrome: A pilot study. Journal of Bodywork and Movement Therapies,23(1), 161-165. doi:10.1016/j.jbmt.2018.02.003
Herman and Wallace. Pelvic Floor Level 2A Manual. Herman and Wallace Pelvic Rehabilitation Institute.
Irritable bowel syndrome. (2018, March 17). Retrieved from https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016
Lacy, B. E., & Patel, N. K. (2017). Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. Journal of clinical medicine, 6(11), 99. doi:10.3390/jcm6110099
Schumann, D., Anheyer, D., Lauche, R., Dobos, G., Langhorst, J., & Cramer, H. (2016). Effect of Yoga in the Therapy of Irritable Bowel Syndrome: A Systematic Review. Clinical Gastroenterology and Hepatology,14(12), 1720-1731. doi:10.1016/j.cgh.2016.04.026
Wald, A. (n.d.). Clinical manifestations and diagnosis of irritable bowel syndrome in adults (N. Tally & S. Grover, Eds.). Retrieved April 23, 2019, from https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-irritable-bowel-syndrome-in-adults