Leaky Gut, Leaky Vagina and the microbiome with functional nutritionist emma parks

Recently Kate got together with Emma Park a functional nutritionist to talk all things gut health, gut microbiome, leaky gut and leaky vagina; in particular for the pre and post natal period #first1000days. You can check out their video below #first1000days.

We have also linked Emma's guide to pre and probiotic foods to benefit your gut.

For more information on Emma Park and functional nutrition, visit Emma's website for more resources or to book an appointment to see Emma. If you are particularly interested in pre and post natal gut health and the importance of children's gut health, information on Emma's courses can be found on First 1000 days and you can join Emma's First 1000 days Facebook group for more resources.

Coughs, Colds and COVID-19 - and their impact on your pelvic floor

By now we all know that COVID- 19 isn’t great for our health, our families, our community or our hip pockets … but on the other hand it is great for mother earth, family time and slowing down. 

Not wanting to be a negative Nancy... but has anyone sat down and thought about the impact COVID-19 and the symptoms associated with the virus could have on our pelvic floor? 

What is the pelvic floor?

I’m glad you asked. The pelvic floor is a beautiful collection of muscles and fascia at the base of our pelvis that controls urinary, bowel and sexual function, as well as helping with the stabilisation of our spine. 

I can tell you right now that the pelvic floor will loathe COVID-19.

Why? What does the pelvic floor muscle have to do with COVID-19?

By now most of us are aware of the symptoms associated with COVID-19

• Dry cough

• Fever

• Tiredness 

• Sore throat 

• Runny nose

• Shortness of breath

Did you know that coughing and sneezing place great stress on the pelvic floor? Have you ever tried to keep your eyes open while sneezing? The pressure created during a sneeze, means that it is impossible to keep your eyelids open. I dare you to give this a try. That same force and pressure also heads south, forcing our pelvic organs downwards. We rely on our pelvic floor muscles appropriately engaging to oppose this pressure, and by doing so, keep us dry. Pretty impressive, right?

As for those elegant ladies out there who pinch their noses when they sense a sneeze coming. Know this, lovely ladies... the force we rely on to clear our nasal passage is consequently being contained within, and you guessed it... that contained force has to go somewhere. And it does, it heads south, putting further stress on our pelvic floor muscles. So, I say NO to the pinch! Let that sneeze out! Be loud and proud!

In a perfect world, just prior to coughing or sneezing, we rely on an automatic, well timed, perfectly coordinated, strong contraction of our pelvic floor. If achieved this keeps us safe from leakage by resisting the pressure of our organs being forced down and keeping our sphincters closed. Nice work muscles! 

However, when the timing is off, or our pelvic floor muscles are weak, urine is going to flow, as our pelvic floor muscles will be unable to keep the urinary sphincter closed. It is embarrassing, common and NEVER EVER normal. We call this - Stress Urinary Incontinence (SUI).

A recent study has shown that coughing, one of the most common symptoms of COVID-19, puts more pressure on our pelvic floor muscles than lifting 18.2kg, running or even jumping. Imagine that you have COVID-19 and a persistent cough. You are going to hope your pelvic floor is functioning well.  I know that there are people who are already cringing at the very thought of a persistent cough… they already know the consequences. 

If your pelvic floor is not strong and healthy or if its timing is off, urine may leak out when you cough. A persistent cough places extreme pressure on the pelvic floor, even those who suffer with mild pelvic floor dysfunction can suffer from urinary leakage with a persistent cough. Every Winter at Eastern Osteopathy, we have an influx of patients who complain of SUI when coughing. hear you asking. But what can I do about it?

Now is the time to start with a well timed KNACK. What is this KNACK I speak of? It is an  intentional, strong contraction of your pelvic floor muscles just prior to coughing, sneezing, laughing or lifting. If you are one of the many women/men who suffer with SUI, a KNACK can be an essential part of your pelvic floor retraining by learning about appropriate timing of contractions.

ARRRGH but it only works for the first cough/sneeze then I’m like a leaking tap. This is also common, to work on increasing the strength of the pelvic floor and by doing so improving the effectiveness of the KNACK, you can do short sharp contractions of the pelvic floor holding for 1-2 seconds then relaxing before you contract again. Doing three sets of 10 repetitions should get the best results.

To make the contraction even more effective add a short, high pitched sound like quip or tip when lifting and contracting your pelvic floor muscles. STOP reading now!! Give this a try; start with short sharp contractions of your pelvic floor and then add the high pitched sound (quip/tip). Feel and sense the difference..You can thank me later!

One last thing about training your pelvic floor using a KNACK, it is important that you don’t lift and engage your pelvic floor too early. We want and need your diaphragm to descend fully with a breath in. Contracting too early will prevent your diaphragm from doing its job of fully descending and therefore creating enough force to clear your airway.  

If you still experience leakage after strengthening and actively engaging your pelvic floor using a KNACK, check out your posture. When it is time to cough, stand up straight, correct posture and alignment results in any increases in intra abdominal pressure being distributed to the pelvis rather than adding stress to the pelvic floor. Still not working!!!  It's time to see a pelvic floor trained osteopath (or physio) - as you may need a specific training program and to work out the ‘Why?’. Why is my pelvic floor not functioning correctly? What structures are preventing my pelvic floor from functioning correctly?

The impact of COVID-19 and it’s array of symptoms on our pelvic floor do not stop there. The breathing restrictions associated with respiratory distress can also have a negative impact on your pelvic floor. Breathing restrictions do not allow your pelvic floor muscles to fully lengthen and contract as would normally occur with relaxed breathing. This kind of breathing can cause our pelvic floor muscles to stay in a constant state of tension, which is definitely not ideal.

If your pelvic floor muscles are in a constant state of tension and you cough, this group of muscles tend to have nothing more to give. A KNACK just won't cut it. The impact of a tight pelvic floor is huge; it's not just urinary leakage on the cards, it can also result in a variety of symptoms ranging from painful intercourse, urgency to urinate, as well as lower back and pelvic pain. 

What you may need to do is some relaxed diaphragmatic breathing exercises. By doing this you are allowing your pelvic floor muscles to go through their entire range of motion, optimising their ability to contract and lengthen. This action is essential and allows for maximal strength of contraction, which is uber important when you are suffering from coughs and sniffles. 

Not sure how to do a relaxed diaphragmatic breath? Check out our video.

As we enter the season of coughs, colds and sniffles (and COVID-19), we are washing our hands, practicing social distancing and staying home. It's also time to add a KNACK prior to coughing, sneezing and lifting and 5 minutes of daily relaxed breathing to our daily routine, and by doing so we can strengthen, lengthen and teach our pelvic floor muscles about appropriate timing of contraction. These suggestions can help minimise the impact a cough or sniffle has on this essential group of muscles during this tricky time.

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Relaxed diaphragmatic breath with pelvic floor awareness

Today we present you with a short video of how to practise a relaxed diaphragmatic breath, with pelvic floor awareness. 

Why are relaxed diaphragmatic breaths important? Well … when we take a relaxed breath in, our thoracic diaphragm moves down and our pelvic floor lengthens and drops down slightly.  Then, when we breathe out, our thoracic diaphragm moves up and our pelvic floor shortens, as it contracts and lifts slightly.

This breathing allows our pelvic floor to lengthen and shorten in a natural physiological way, this action is vital for the optimal function of our pelvic floor.

At Eastern Osteopathy, we have noticed that many of our patients breathe using their upper chest, rather than allowing their breath to expand their lower ribs, belly and back. This upper chest breathing does not allow the pelvic floor muscles to lengthen and drop down when they breathe in. Over time, this type of breathing can cause the pelvic floor to shorten and may even cause issues with incontinence, urgency/frequency, or pelvic pain.

So it is definitely worth giving diaphragmatic breathing a go!

Chronic Pelvic Pain Awareness Month 2020

Chronic pelvic pain affects teenage girls, women (1 in 5) and men (1 in 12). It does not discriminate as it affects people of all ages, ethnicities and social backgrounds. Pelvic pain is categorised as any pain below your belly button and above your legs, the pain can also radiate into your lower back, buttocks or thighs. It can be dull or sharp; constant or intermittent; and it may be mild, moderate or severe.

Chronic (or persistant) pelvic pain (CPP) is when pain has been present for longer than 6 months and the pain is occurring either with the complete absence of tissue damage, or after the tissue has healed. 

Everyone’s experience with CPP is different and how it presents for each individual is also very different depending on the systems (genitourinary, gastrointestinal & reproductive) and structures (nerves, fascia, muscles, joints & ligaments) involved:

Common Symptoms in women may include:

• Pain when sitting

• Pain around the anus, vulva 

• Painful penetrative sex, this can be at the opening or with deep penetration

• Pain after sex

• Involuntary pelvic floor spasms  

• Painful urination, urgency and/or frequency

• Abdominal & groin pain

• Constipation

• Pelvic girdle pain

  • Sacroiliac pain,

  • Coccygeal pain and

  • Pubic symphysis pain. 

Common Symptoms in men may include:

• Pain when sitting

• Involuntary pelvic floor spasms  

• Painful urination, urgency and/or frequency

• Abdominal & groin pain

• Constipation

• Pelvic girdle pain

  • Sacroiliac pain,

  • Coccygeal pain and

  • Pubic symphysis pain

Headaches, migraines and TMJ pain (pain & compromised movement of the jaw &  surrounding muscles) are also very common complaints for people who suffer from CPP.  

Some possible causes or contributing factors of CPP include: 

• Overactive or non-relaxing pelvic floor muscles. Tension in these muscles can refer pain throughout your pelvic region and even mimic urgency, symptoms of thrush or bladder pain

• Irritation, injury or compression of a nerve in the pelvic region, eg pudendal nerve causing pudendal neuralgia 

• History of infection of the prostate, bladder or even chronic thrush can cause irritation to the pelvic floor and surrounding nerves and fascia

• Endometriosis, adenomyosis or PCOS. For women who suffer from these conditions, tension in the pelvic floor muscles can be a reaction to years of chronic pain and inflammation in the pelvis. This tension in the pelvic floor can refer pain throughout your pelvic region

• Pelvic inflammatory disease

• Injury or trauma to the area can directly impact ligaments, joints, fascia, muscle and nerves. Pain in the pelvic area can cause guarding and tension in pelvic floor muscles, impacting blood flow which may then cause local and referred pain

• Surgery. Many different surgeries (hysterectomy, hip surgery, pelvic organ prolapse & prostatectomy) can impact the pelvic floor and surrounding nerves and fascia and in turn cause pelvic pain

• Constipation

• Pregnancy & childbirth

• Crohn's disease, SIBO, Irritable bowel syndrome & Ulcerative colitis. For women who suffer from these conditions, tension in the pelvic floor muscles can be a reaction to years of chronic pain and inflammation in the abdomen. This tension can refer pain throughout their pelvic regions

• Emotional factors such as mood or past or current abuse

• Lifestyle considerations, such as high stress, can cause guarding and tension in the pelvic floor muscles and surrounding fascia and nerves

As osteopaths with a passion for helping both men and women with pelvic pain, we recognise the role the central nervous system (the brain and spinal cord) have in the perception of pain. The CNS is always involved to a lesser or greater extent and it is our job to identify how much of a role it plays in our patients' pain picture. Doing this helps us create a management plan to best accommodate the needs of our patients. 

How can osteopathy help me with my chronic pelvic pain?

Everyone’s story is different, and everyone’s experience of pain is also very different. There is no ‘one size fits all’ approach to treating chronic pelvic pain. As osteopaths we are always searching for the WHY? The reality is that for most people with CPP, there isn’t just one incident or event that has caused their pelvic pain. There are generally a number of events or conditions that compound, to collectively contribute to, or help perpetuate their pelvic pain. 

The majority of pelvic pain cases have a neuromuscular component (pelvic floor muscle, nerves, ligaments & fascia) and a nervous system component (brain & spinal cord). It is important to identify any contributing factors or events (fall to your bottom, constant sitting, previous history of infection, endometriosis, surgery to your pelvis etc.) throughout your life that could be impacting not only on your perception of pain but also directly on your pelvic floor and surrounding tissues.

CASE HISTORY

A thorough case history is taken, including the full history of your presenting complaint as well as, past medical history and any relevant traumas, surgery etc. This helps us start to create a picture of your situation and formulate an hypothesis as to why you may be experiencing CPP.

WHOLE BODY ASSESSMENT & TREATMENT.

The emphasis of our treatment is on the whole person. It is important for us to identify whole body strain patterns that may be impacting your alignment and biomechanics. We aim to identify areas that could be either directly causing your pelvic pain or predisposing you to pelvic pain.

Osteopathic treatment will also be aimed at helping remove any stress or strain through the fascia (inc visceral region), muscles, ligaments and joints that may be loading your central nervous system. We use manual therapy techniques to help relax your nervous system, therefore helping create a higher threshold for activity.

INTERNAL ASSESSMENT OF YOU PELVIC FLOOR

An internal assessment of your pelvic floor can also be an extremely useful tool in diagnosing and treating CPP.  CPP more often than not will have a significant pelvic floor component that is either a driver to your pain or is helping to perpetuate your pain picture. We use manual therapy techniques to release your pelvic floor, which may include external and internal myofascial techniques. 

MANAGEMENT 

Chronic pelvic pain is a complex condition. Management is an essential part of your treatment plan.

Some important factors;

• Education regarding how to perform relaxed diaphragmatic breathing; explaining how to use your breath to relax tension (down regulation) of your muscles including your pelvic floor and how your breath can be used to relax your sympathetic nervous system that is heightened by stress - as commonly seen with those suffering with chronic pain.  

• Good toilet habits; education regarding good toilet habits, including the use of the squatty potty, mindfulness and breathing when going to the toilet, can help to relax the pelvic floor, allowing for ease of bowel movement and the reduction of stress on your pelvic floor.

• Mindfulness has been shown to reduce the perception of pain and stress levels

• Restorative yoga can help calm your central nervous system

• Movement practises. Move, move, move. Getting your body moving in a gentle way and getting back in touch with your body, can assist in your ability to trust in your body again. This is vital as it allows your brain to receive stimulus that you are moving, pain free and without fear. 

• Gentle Yin Yoga stretches to help any muscles and fascia that are restricting movement of your pelvic floor, abdominal and pelvic region.

•  Advice on sleep. When sleeping, our body has time to recharge and recover and reduce stress, so sleep patterns and behaviours are of vital importance.

• Nutritional advice. Removing inflammatory ingredients such as gluten, refined sugar and dairy can have a positive impact on pain. Not to mention that good nutrition is essential for good GUT health, which can also be a very important part of your management strategies.

• Chew, chew and chew some more. Mindfully and slowly chewing your food fully, can help get the gastric juices flowing, and by doing so this can help your stomach fully digest your food. This is an important first step in developing a healthy GUT which can in turn help reduce inflammation and pain.

The complex nature of CPP means that sometimes we find a multidisciplinary approach involving a variety of health and wellness practitioners is the most effective way to achieve overall health. When required, we will refer to naturopaths, acupuncturists, GP, pain psychologists as a part of our holistic approach to the management of pelvic pain. 

What is Endometriosis?

Endometriosis is a chronic condition where similar cells/tissue that line the uterus (endometrium) are also found outside the uterus on other parts of the body; including but not limited to, the ovaries, fallopian tubes, peritoneum, and bowels. In rare occurrences, the endo tissue can be found as far away as the lungs and eyes. Regardless of its location, this tissue responds to the female sex hormones released by the ovaries, resulting in monthly bleeding which can lead to inflammation and scarring. Unfortunately, this scarring doesn’t grow as nice linear fibers, it grows in abnormal directions, like tentacles, adhering to adjacent organs, muscles, and fascia. This can result in great pain and discomfort. 

Unfortunately, endometriosis is estimated to affect up to 10% of women of reproductive age. 

For some diagnosed with endometriosis, they experience little or no pain and for others, they experience a variety of pain ranging from

• Chronic pelvic pain

• Heavy menstrual bleeding

• Painful periods

• Painful intercourse

• Lower back, hip & groin pain

• Irritable Bowel Syndrome

• Infertility 

• Lethargy

Studies have shown that there is no correlation between the extent of endometriosis and the amount of pain and discomfort experienced. Those with very little endometriosis can have extreme pain and those with extensive endometriosis involving multiple organs/muscles and fascia may have minimal pain/symptoms. 

Management of Endometriosis

At Eastern Osteopathy, we believe that the most successful management of endometriosis, comes from having a multidisciplinary approach, involving a variety of health and wellness practitioners, including but not limited to;

• Gynecologist

• General Practitioner

• Osteopathic care; both pelvic health trained (or pelvic health physiotherapy) and general osteopathy

• Naturopathic Medicine

• Acupuncturist

• Yoga and Mindfulness

• Pain Management. 

We believe that it is important that your team listens and truly understands the complex nature of your illness, and acknowledges the impact that chronic pain has, on both your body and your emotions. On average it can take 6-10 years for a definitive diagnosis of endometriosis. So take your time finding your endo tribe, your endo team. 

The Role of your Osteopath 

Everyone’s story is different, and everyone’s experience of endometriosis is also very different.  There is no ‘one size fits all’ approach to assisting women suffering from chronic pelvic pain associated with endometriosis. As with all chronic conditions, over time the nervous system can become sensitised and overactive. Basically, your threshold for pain is lowered to a point where only a small amount of painful stimuli can result in relapse and extreme pain. Our aim is to help to turn the volume down on your pain by calming your nervous system. 

CASE HISTORY

A thorough case history is taken, including the full history of your presenting complaint, as well as, past medical history and any relevant traumas. We want to be aware of the different stresses present on your central nervous system. A heavy fall on your bottom twenty years ago could end up being a very important part of your pain picture.

WHOLE BODY ASSESSMENT & TREATMENT

The emphasis of osteopathic treatment is the whole person, not just their symptoms. As osteopaths, we have access to a wide range of techniques, enabling us to accommodate the individual needs of all our patients. 

These techniques include:

• Cranial osteopathy

• Visceral manipulation

• Soft tissue & myofascial techniques

• Gentle joint manipulation

• Stretching

• Dry needling

• Trigger-point therapy

• Articulation

Osteopathic treatment will aim to remove any stress or strain through the fascia (including the visceral region), muscles, ligaments, and joints. This stress/strain may be loading your central nervous system, helping to create a higher threshold for activity. We will use manual therapy techniques to help relax your nervous system, remove stress and strain from ligaments, fascia, and muscles to improve overall movement and function. We will also aim to improve overall balance to encourage your body’s ability to self-heal. 

Endometriosis is estrogen sensitive. What does this mean? It means those suffering with estrogen dominance can have an exacerbation of symptoms. Our osteopaths have a  thorough understanding of stress, gut health and constipation, and the impact they have on the production and removal of estrogen as a waste product. With this in mind, we are able to advise on good gut health practices, as well as, stress management and mindfulness techniques. 

TREATMENT WITH OUR PELVIC FLOOR OSTEOPATH. 

An internal assessment of your pelvic floor can be an extremely useful tool in assisting women suffering from chronic pelvic pain associated with endometriosis. In general, as a response to pain, our muscles tend to tighten up; this includes the pelvic floor muscles. Tension within the pelvic floor muscles can be a major contributing factor to the pain experienced with endometriosis; locally causing pain and discomfort as well as referring pain throughout the pelvic region.

For many women suffering with endometriosis, it is also common to experience pain and discomfort during intercourse due to the tension found within your pelvic floor muscles.

As pelvic health osteopaths, we are able to use manual therapy techniques to help desensitise the pelvic floor muscles, as well as using internal myofascial techniques to release your pelvic floor muscles and fascia.

We believe an internal assessment of the pelvic floor, along with localised treatment, and desensitisation of the pelvic floor muscles is important, but it is by no means compulsory. If you’d like more information on internal assessments, please click here

Our pelvic health osteopaths have extensive training in visceral osteopathy. This is a  technique that can be used to help mobilise the abdominal and pelvic organs and fascia to help break up scarring and adhesions associated with endometriosis. 

MANAGEMENT

Endometriosis is a complex condition. When treating women who suffer from chronic pelvic pain associated with endometriosis, advising on the following is an essential part of our treatment plan:

• Education on how to perform relaxed diaphragmatic breathing; explaining how to use your breath to relax tension (down-regulation) of your muscles including your pelvic floor and how your breathing can be used to relax your sympathetic nervous system that is often heightened by stress - as commonly seen in those suffering chronic pain.  

• Optimal toilet habits; education on good toilet habits including the use of the squatty potty, mindfulness, and breathing when going to the toilet, can help to relax the pelvic floor, allowing for ease of bowel movement and reducing the stress on the pelvic floor.

• Mindfulness - which has been shown to reduce the perception of pain and stress levels.

• Restorative Yoga can help calm your central nervous system.

• Movement practices - Move, move, move. Getting your body moving in a gentle way and getting in touch with your body can help you learn to trust in your body again. This allows your brain to receive stimulus that you are moving, pain-free and without fear. 

• Gentle Yin Yoga - stretches to help any muscles and fascia that are restricting the movement of your pelvic floor, abdominal and pelvic region.

• Advice on sleep - when sleeping, our body has time to recharge and recover and reduces stress.

• Nutritional advice - As with any chronic condition, endometriosis is associated with chronic inflammation. Removing inflammatory food such as gluten, refined sugar and dairy can have a positive impact on pain. 

• Chew, chew and chew more - Mindfully and slowly chewing your food fully can help get the gastric juices flowing and by doing so, can help our stomach fully digest our food. This is an important first step in developing a healthy gut, and by doing so, the reduction of inflammation and pain. 

KATE'S TOP TIPS FOR GUT HEALTH

People all over the country are going cray cray buying toilet paper like it’s going out of fashion, some even with rooms full of the stuff! This is leaving those not invested in the hysteria, starting to run low. Really low.

It got me thinking about our use of toilet paper, and if we all had good quality stool, we could all save loads of toilet paper and a stack of money. 

Are you guilty of wiping, wiping, then more wiping, and then just a bit more wiping just to be sure? … If you are doing this after every bowel movement, you are definitely using lots of this highly sought after material... aka toilet paper. Does this sound familiar? When you have a good quality poop (and your pelvic floor muscles that form the sphincter are strong) you should only need to wipe once. Yes. You heard it here peeps!

Did you know that optimum gut health should always be a priority, it reduces inflammation and stress as well as improving the immune system (and who doesn’t want an optimal immune system right about now?) Studies have also shown that good gut health has been associated with improved mood and lowered anxiety and that is a bonus for everyone! Your gut’s relationship to the pelvic floor muscles is also vital, as constipation and straining can cause weakness in the pelvic floor, which may, in turn, affect many aspects of your life. In the past, all of this may not have been enough incentive to get your gut health on track, but maybe the fear of running out of toilet paper, is the push (get it?) that you need! 

It’s time to get your gut health on point. 

Here are my tips for improving your gut health

1. Mindful eating/ chewing - Food is essential to nourish our body so that it is able to function optimally and survive. Our relationship with food can also affect our digestion, especially if it involves anxiety. If this is the case, mindfulness meditation and seeking professional help is essential. Being mindful when eating is of great importance; this may be hard for those who are usually running out the door with a muffin in one hand and a coffee in the other but it is a simple thing to do for great benefit. It is important to make time to relax and sit down for mealtimes, and did I mention without the phone/TV! And chew, chew and chew some more. If you are using a knife and fork, once food is in your mouth, put your cutlery down. And chew. Chewing breaks the food up and gets our stomach juices flowing, which further helps with the digestion of our food. This process also makes it easier for digested food to pass through the intestines with minimal irritation to the gut lining and then allows for the effective absorption of all the essential goodness we receive from our food. 

2. Use a squatty potty. There is a very good reason why toddlers (pre toilet training) squat when doing a poop. Squatting helps to relax our pelvic floor muscles which takes out a kink in our rectum and straightens the last part of our back passage, which then allows for ease of movement of the waste product. It's that simple people. If you don’t have a squatty potty, a cardboard box will do the job.

3. Move, move and move some more. Apart from releasing endorphins that make us feel good, movement causes peristaltic movement in our large intestine. This is a natural contraction of the wall of the intestines to help move stool through the bowel. I think we have all been a witness to this at some point. Have you ever got up for an early morning run and 2km in you are busting for a poop?

4. Diaphragmatic breathing helps our pelvic floor go through its full range of motion of lengthening and shortening, so when it comes to the action of pooping, you are not fighting against a shortened muscle. The act of relaxed diaphragmatic breathing also dampens the sympathetic nervous system that promotes stress and encourages our parasympathetics which leads to rest and digestion.

5. Remove inflammatory foods from your diet. Foods such as gluten, dairy, and refined sugars have all been shown to promote inflammation of the gut. If the idea of this is stressing you out, try eliminating one at a time. For more information check out this blog.

6. Eat less processed and packaged foods including bread, pasta, biscuits, chips, and cheese. This is a hard one, but a good one when it comes to gut health.  

7. Eat more good fats to support the lubrication of the intestines. Good fats include grass-fed butter, ghee, pumpkin and hemp seeds, avocado, salmon, coconut oil, olive oil, avocado oil, macadamia oil, and omega 3 fatty acids.

8. Eat whole foods. Choose organic foods in their original state when possible, with the aim of 5 servings of vegetables a day. Spinach, honey, pear, prune, peach, apple, apricot, berries, carrot, cauliflower, beet all help to lubricate the intestines. If you need help with movement through your bowels; cabbage, sprouts, peas, coconut, sweet potato, asparagus, papaya, fig, rice bran, oat bran, chia seed, psyllium seed, marshmallow root, licorice root all promote bowel movement. 

9. Fluid intake. We usually lose, through urine and sweat, around 2 liters of water a day and what comes out must be replenished. From eating fruit and vegetables we get approximately one liter of fluid. The remainder should vary depending on the weather, activity levels and how much you sweat, you should generally be aiming for 1.5 litres a day. Remember, if you are thirsty, you are already dehydrated. If your urine is dark yellow you are dehydrated. Ideally, you want your urine to be a pale lemon color. 

10. Mindfulness - having a mindful practice has been known to lower stress which in turn has a positive impact on digestion. 

11. Osteopathy - research has shown that visceral manipulation to the intestines can improve constipation. Woohooo! And the good news is, it’s easy to do on yourself. As Osteopaths we believe structure and function are interrelated and by releasing the fascia and ligaments supporting the organs we can have a positive effect on the symptoms associated with gastrointestinal dysfunction. Chloe, Elizabeth and myself (Kate) have a passion for this area of osteopathy, and we have all done extensive training in this field. 

12. Probiotics - find a high count multi-strain probiotic and take the required amount daily. A high quality probiotic introduces friendly bacteria into the gut, with the aim to increase gut motility, aid digestion and absorption of nutrients. A set of mighty impressive skills right there! Different brands of probiotics have different cultures so it’s a great idea to rotate every couple months to introduce different strains of these friendly little guys. 

The information in this blog is meant as general information and is in no way meant to replace medical advice. If you have any concerns regarding your gastrointestinal system you should consult your general practitioner. 

Pillow Talk: Silly Season Sleeping

Dr Lachlan Cossens

Is there a perfect Pillow for me?

The silly season can encourage late nights, drinking and altered sleeping patterns. The festivities can leave us tired and running on less sleep aka exhausted!

When we’re tired we can fall asleep in some funky positions. If you’re like me you’ve probably woken up in some pretty weird positions with a pretty sore neck! Have you ever wondered if there's a pillow that might best support your sleep through the festive season? As osteopaths we often get asked about what position you should sleep in and what sort of pillow you should use so I thought I’d have a chat with you about it. 

SIDE SLEEPER

Side sleepers generally need a larger pillow to fill in the space between their shoulder and neck. We generally see side sleepers who aren’t getting enough support from their pillow end up putting their arm underneath the pillow to try and support their neck. The firmness of the pillow is completely a preference based thing but side sleepers who prefer a softer pillow will generally need a higher pillow as when you lie down it will compress slightly.

BACK SLEEPER

Back sleepers can get away with a really small pillow as there isn’t much space to fill between your back and your head. Again the firmness is preference based. Just be sure that the pillow isn’t too high otherwise the neck may become too flexed making it difficult to breathe well.

TUMMY SLEEPER

The dreaded tummy sleepers. Having to twist your head and neck around at right angles just to breathe and then spending up to 8hrs in that position! As a general rule we prefer people not to sleep on their tummy due to the position it puts their body into. In saying that, lots of people do sleep on their tummies and have no problems whatsoever. 

If you’re a tummy sleeper and you’re experiencing persistent neck pain, waking up with a sore neck or headaches than it is likely the tummy sleeping may contribute to your complaint. An osteopathic assessment may identify if there is anything else contributing to your symptoms.

Sleeping positions are habitual and like changing any habit, it can take some discipline to make a lasting change. If I’m trying to get someone to change from sleeping on their tummy I’ll get them to sleep on their side with a higher pillow and a pillow between their legs and potentially even one in front of their chest to hug. The idea is that it helps you to stop rolling over onto your tummy.

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To best support your sleep you need to use a pillow that’s right for you and suits how you sleep. There is no point getting a fancy $300 duck down pillow if you sleep on your side and prefer a firm pillow. Between these 3 positions there is no ‘ideal’ or ‘perfect’ position to be in but instead your circumstances or your complaint may dictate what position to sleep in. If you have any questions feel free to have a chat with us during your next appointment.

4 reasons why all women should have a postnatal check up

Dr Kathryn Johns

Giving birth can involve lots of tears, love, fear, gratitude and a little bit of OMG! The transition to parenting is a time of discovery and working out your new life as a mother or father of one (two, three or more)! There is so much emphasis on #selfcare for mothers, but when the new addition arrives mama tends not to come first or second. Selfcare is forgotten or put to the bottom of the ‘things to do’ list.

At Eastern Osteopathy we believe there is no better time than postnatally to embrace the self care message, and look after you. For postnatal mothers, we offer postnatal appointments with our women’s health osteopaths. Aside from self care, here are the four main reasons why we believe you should put mama first, and make an appointment.

1. Change

In the hours to days after giving birth your entire body goes through rapid anatomical changes; in particular the anterior abdominal wall (the front of your stomach/belly region) and the pelvic floor. These two areas make up a major component of your core canister.

Your sleep (if any) will be interrupted. You will be tired (aka exhausted) and spending your time breastfeeding (or bottle feeding, or expressing, or both), carrying, cuddling, settling, all while your body is adjusting to its new posture without the support of a strong core. At Eastern osteopathy we encourage all new mamas to make an appointment in the weeks following the birth of their little one to make sure their bodies are in alignment, and moving correctly. When this is achieved we place less stress and strain on our muscles and joints, creating an environment optimum for healing.

2. Pelvic floor

Pregnancy, and giving birth vaginally places huge stress on your body; in particular your pelvic floor muscles (PFMs). It is estimated that during a vaginal birth the PFMs stretch up to 3.5 times their normal length, (WOW!) allowing your little one to pass through your vaginal canal. For some women, to aid in this process, tearing of the perineum or an episiotomy may be required. It’s no surprise it can take some time for these muscles to recover and heal.

Pelvic floor dysfunction can look different for everyone. We find many of our patients only associate accidental leakage with PFD. For many people, this is not the case. PFD can present with a variety of symptoms ranging from, but not limited to, incontinence of urine or faeces, urgency and frequency of urination to constipation or pelvic girdle pain. Not sure if you have an issue with your pelvic floor? Take our short questionnaire here.

At Eastern Osteopathy, we don’t believe you should wait for pelvic floor symptoms to present before seeking postnatal osteopathic care. Being proactive about your health with osteopathic treatment, and getting an appropriate rehabilitation program, involving movement practices, breathing exercises and pelvic floor strengthening, or relaxation techniques is essential after pregnancy.

Both myself (Dr. Kathryn Johns - osteopath) and Dr. Elizabeth Johns - osteopath have completed further training in the assessment, retraining and rehabilitation of the pelvic floor; using both internal and external techniques.

We have also been trained in the use of a Real Time Ultrasound to diagnose pelvic floor and deep abdominal dysfunction. The RTU machine allows Elizabeth and myself to assess your pelvic floor without the need for an internal assessment.

When assessing your pelvic floor, we don’t just assess its function (i.e. how strong it is, and how many kegals you should do), we also look at your body as a whole to see if there are any biomechanical issues that could be impacting on how well your pelvic floor functions.

For more information check out our blog on What to expect from a women’s pelvic health assessment.

3. Diastasis Recti Abdominal (DRA) abdominal separation

During pregnancy DRA is a normal, natural process which allows your body to stretch and change as your little one grows. Research has estimated that by 35 weeks gestation, 100% of soon to be mamas have DRA and by 12 weeks postpartum just under 40% of new mamas will have a DRA. (1) If at 8 weeks postpartum you have a DRA, studies have shown that without intervention, you will still have a separation 12 months after giving birth. (2)

Assessment of the DRA is not about the size of the gap, what we will be looking for is the ability to create tension across the gap (anatomically known as the linea alba). Creating tension in the Linea alba is achieved by correct contraction of the core muscles. If you are unable to create tension, we will endeavour to work out why. Is it due to whole body alignment impacting on the function of your deep core? Or do you need to learn to reconnect and strengthen your deep core?

During your appointment you will be taught how to assess and monitor your ability to generate tension within the linea alba, as to determine when an exercise is appropriate for you.

For more information see Diastasis Recti on our website

4. Pain 

For many mamas to be, pregnancy pelvic girdle pain (PPGP) is reality and for most of these ladies, giving birth resolves the symptoms of their PPGP! For some women, it’s not that simple. 1 in 10 women with PPGP are still suffering with chronic and severe PGP up to 11 years after giving birth (3).

Giving birth, feeding, carrying and settling your young babe can result in a variety of new complaints including, but not limited to, the following:

• Lower back and pelvis pain

• Pelvic girdle and pubic symphysis pain

• Mid back pain during and after breastfeeding

• Neck pain and headaches 

• Wrist pain

As osteopaths, the emphasis of our treatment is on the whole person and not solely on their symptoms. We use a variety of techniques to gently release any strains present; relieve pain, discomfort and improve mobility to support the body’s ability to heal.

A common question we regularly get asked by our pregnant patients is: How soon after giving birth can I have treatment? If you are in pain, you can receive treatment within hours.

Nine months ago I gave birth to my second daughter. Hours later I could barely sit due to coccyx pain, making breastfeeding near impossible. Lucky for me, I have a twin sister who is an osteopath (and my business partner, aka Liz) Less than 12 hours after giving birth I had an osteopathic treatment. The relief soon followed and shortly after, I was able to breastfeed and care for my daughter in comfort.

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At Eastern Osteopathy we see postnatal women at all stages, from those who have been mamas for only a couple of days to mamas who are now grandmothers, and have been putting up with their symptoms for a couple decades. We believe it’s never too late to start looking after yourself and putting mama first! 

Regardless of your concerns during your postnatal check up; as osteopaths, we look at your body as a whole and create an individualised treatment plan, addressing any areas in your body (joints, ligaments, fascia and muscles), movement patterns, dysfunctional postural or breathing patterns that may be impacting on your overall health. 

The treatment will include a physical treatment, lifestyle advice and a specific rehabilitation program to support your treatment outcomes. Generally these programs will include movement practices, breathing exercises and pelvic floor strengthening or relaxation techniques.

To book your postnatal appointment: book online here or call us on 9042 0407.

Want to know more? Call the clinic on 9042 0407 to speak with us today.

References

1. Moto P G, Pascoal A G, Carita A I, Bo K 2014 - prevalance and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther 2014

2. Coldron Y, Stokes M J, Newham D J, et al 2008 - postpartum characteristics of rectus abdominis on ultrasound imaging. Manual therapy 13: 112

3. Elden, H et al (2016). BMC Musculoskeletal Disorders, 17(1), 276.

What is overactive bladder and why is my pelvic floor important?

Note: This article is designed to be educational and informative and should not be used to make decisions about any health-related issues. An appropriate health professional should always be consulted when seeking to diagnose, treat and make decisions about your health. 

When the bladder fills with urine, the bladder wall (detrusor muscle) remains relaxed; simultaneously the pelvic floor muscles (PFMs) contract, this allows your bladder to fill with urine without leakage. When the bladder is full, a signal is sent to the brain where a decision is made about whether it is an appropriate time to urinate. 

When we are on the toilet, the bladder wall (detrusor muscle) starts to contract and at the same time the PFM will automatically relax to allow for the flow of urination. This system is great when both the bladder and PFMs are working correctly. However, with Overactive Bladder (OAB) the relationship is often dysfunctional. Typically with an overactive bladder, the detrusor muscle contracts inappropriately (ie not when the bladder is full) causing the person to feel a sudden, and sometimes overwhelming urge to urinate. 

What are the symptoms of overactive bladder?

Overactive bladder syndrome consisting of urinary urgency, is usually accompanied by frequency and nocturia, with or without leakage, in absence of urinary tract infection (UTI) or other obvious pathology. (1)

URGENCY - The sudden strong urge to urinate. Urgency is often triggered by events such as putting the key in the lock, running water or seeing a bathroom.  

FREQUENCY - It is normal to pass urine 4 - 8 times in a 24 hour period, including once or perhaps twice at night (depending on your age). If your detrusor muscle is contracting when your bladder isn’t full, you may need to urinate more frequently, usually to pass small amounts of urine.  

URGE INCONTINENCE - Making it to the toilet on time can be difficult for some people as their bladder gives them very little or no warning, resulting in urine leaking. This can range from a few drops to a full bladder. 

NOCTURIA - If your detrusor muscle is contracting more frequently, you may find that you are waking at night to pass urine more than what is considered normal. It is normal to wake to void  up to twice at night (depending on your age)

Lifestyle modifications 

Lifestyle modifications, including a variety of behavioral changes can reduce OAB symptoms.

1. Regulating your fluid intake; Too much fluid can overfill the bladder and too little can concentrate the urine, which irritates the bladder. (2)

2. Limit bladder irritants;  Limit Alcohol, caffeine-based drinks, artificial sweeteners, spicy foods and carbonated drinks which can irritate the bladder, further exacerbating symptoms of overactive bladder. (3) (4) Alcohol also has a diuretic effect, which can cause more frequent urination.

3. Avoid Constipation; constipation can trigger or worsen symptoms of overactive bladder. Straining to open your bowels can weaken the pelvic floor. (2)

4. Keep your weight in the healthy range; evidence suggests that losing weight can decrease the severity and frequency of symptoms. (5)

5. Avoid smoking; ceasing smoking can reduce urinary frequency. (6)

Bladder training 

Step 1. Increasing bladder fill volume. (7)

The aim is to increase your urine volume by visiting the toilet less often. How do I do this? 

When you first feel the need to go to the toilet, try to ignore it. If the ‘need” is a strong urge, use the strategies below to defer the urge. Put off going to the toilet until the next time you feel the urge. Initially this may only be a few minutes. As you improve, you should be able to defer for 30 minutes or longer. 

During the night if you wake with the urge to go, get up and go immediately. 

Step 2. Deferral strategies: 

These strategies aim to dampen or suppress the overwhelming urge associated with OAB. We recommend you experiment with the below strategies and find the one that works best for you. Continue with your most effective strategy until the initial urge has passed. Then you can make a decision, if you need to go to the toilet or perhaps you can now wait. 

1. Pelvic floor muscle contractions: Stop, relax, breath and engage your pelvic floor. 

This is one of the most effective methods, as a pelvic floor contraction can turn your detrusor muscle off. Try taking a relaxed breath in and slowly engaging your pelvic floor for 10 seconds or 5-6 rapids contractions until the urge has subsided. (2)

2. Use perineal or clitoral pressure, (hand pressure over the crotch), while sitting on the edge of a chair or table. 

3. Roll up a bath towel and keep it on a chair. Sit on this roll when you have a strong urge to urinate. Tighten and hold your Pelvic floor muscles until the urge passes. You may even choose to place the chair in a place where triggers happen, i.e. at the front door. 

4. Squeeze the skin under your nose, Toe curling, Walk on toes - These can be a great way to distract you from the urge to urinate.

It is important to celebrate every time you reduce the urge to go to the toilet! Even if you last one minute before you need to head to the toilet. This is a positive step towards changing the relationship you have with your bladder.

 Step 3: Decrease your sensitivity to triggers.

Firstly identify your triggers, the most common are running water, arriving home and putting your key in the lock, or entering the bathroom. 

To help decrease the sensitivity of your triggers, try approaching the trigger with an empty bladder. Then, slowly approach the trigger with increasing periods of time after voiding. For example, if your trigger is ‘the running shower’, try going to the toilet prior to turning the shower on,  then slowly start to increase the time period before turning the shower on.

How can osteopathy help with overactive bladder and urgency?

As osteopaths we look at the person as a whole, we will assess overall alignment, movement patterns, breathing, pelvic floor function and deep core engagement. We will endeavour to work out why your symptoms arose in the first place and create a specific treatment plan that will include an osteopathic treatment.

As a part of our treatment plan we  may give advice on a specific bladder training program, urgency deferment strategies, lifestyle modifications, pelvic floor muscle rehabilitation (strengthening or relaxation), and mindfulness. 

With the use of real time ultrasound, your osteopath can check to see if you are correctly/fully emptying your bladder. 

Some patients with an overactive bladder also have tight pelvic floor muscles. A tight pelvic floor can increase the sensations of urinary urgency. You may be asking your pelvic floor to work extra hard to prevent leakage, which can cause your pelvic floor to become overactive and tight. When in this state, the pelvic floor is no longer able to positively influence the bladder (i.e. turn the detrusor muscle off), which can make the symptoms of OBA worse.  

If this is the case for you, your osteopath will help you to address this before any strength training. 

Referneces

1. ICS terminology report, 2010

2. Evaluation and management of overactive bladder: strategies for optimizing care. Marcella G Willis-Gray, Alexis A Dieter, and Elizabeth J Geller

3. Dietary caffeine intake and the risk for detrusor instability: a case-control study.Arya LA1, Myers DL, Jackson ND.

4. Caffeine and urinary incontinence in US women.Gleason JL1, Richter HE, Redden DT, Goode PS, Burgio KL, Markland AD.

5. The prevalence and risk factors of overactive bladder symptoms and its relation to pelvic organ prolapse symptoms in a general female population. de Boer TA1, Slieker-ten Hove MC, Burger CW, Vierhout ME.

6. EFFECT OF SMOKING CESSATION ON OVERACTIVE BLADDER SYMPTOMS IN ADULTS: A PILOT STUDY. Wyman J1 , Allen A2 , Hertsgaard L2 , Overson E2 , Allen S2 , Hatsukami D2 1. School of Nursing, University of Minnesota, 2. School of Medicine, University of Minnesota 

7. Bladder training for urinary incontinence in adults. Wallace SA1, Roe B, Williams K, Palmer M.

What to expect from a Pelvic Health Assessment

It is common to have some anxiety, mixed with excitement about your first pelvic health appointment. Anxiety about the unknown but excitement about seeking help and starting the journey of recovery. Regardless of the feelings you are experiencing we are here to create a sensitive and supportive environment.

When people enquire about a pelvic health appointment there are many questions ranging from;

What can I expect from my appointment?

Is the internal exam required?

What will the treatment involve?

What kind of questions will i be asked?

What should I wear/bring with me?

First of all, each of these questions are normal and we believe you should be asking these questions, it’s your body and it’s important you are informed and comfortable with all of your health appointments. 

What can I expect from my pelvic health appointment?

The first part of your appointment will involve a series of questions. We will discuss why you’ve seeked help with a pelvic health osteopath and the health goals you wish to achieve. Your osteopath will ask you a series of questions about your medical history, toilet habits, sexual intimacy, diet and exercise routine. It's essential that you be as honest as possible as the answers you provide along with how you have answered these questions allows your osteopath to begin building a picture regarding your health concerns. 

Secondly a musculoskeletal exam will be performed. This involves a postural assessment from head to toe, a functional movement screen along with an external musculoskeletal and breathing examination.

It is at this point your pelvic health osteopath will determine and discuss with you whether an internal assessment or real time ultrasound is required. 

If it’s decided you require the use of real time ultrasound, you will need a full bladder and comfortable clothing. 

If an internal assessment of your pelvic floor is recommended, your pelvic health osteopath will thoroughly explain what to expect. If you choose to participate you will be required to sign a consent form. It’s important to know you have the right to change your mind at anytime and If you have any questions please ask. 

Your pelvic health osteopath is highly trained and sensitive. They are here to answer all of your questions and provide education regarding what's normal and dysfunctional as we progress through the appointment. At Eastern Osteopathy we believe understanding your body, your anatomy, how things are connected, along with why you’re experiencing your symptoms is an important first step towards recovery.

To begin the internal assessment you will be asked to undress waist down, lie on the table in a comfortable position and drape yourself with towels provided. 

No instrument will be used. Just lubricant, a glove and 1 or 2 fingers.

Your pelvic health osteopath will insert one finger (or 2 - this will be decided on a case to case basis) into either the vagina or anal canal. You will be instructed to contract and relax your pelvic floor muscles, cough and or bare down to assess how your pelvic floor functions with an increase in intra abdominal pressure (IAP)

The internal assessment will give your osteopath essential information regarding your pelvic floor and it’s tone, strength, endurance and coordination. This information helps to build a picture about your pelvic floor and whether it is weak, hypertonic and moving appropriately. During this part of the treatment, if a muscle or fascia is tight or dysfunctional gentle inhibition or myofascial release techniques will be used to help restore normal function. 

Is the internal examination required?

The answer is no. Is it the best way to assess and treat the PF? Yes. But you 100% get to choose if you are comfortable with this type of assessment or technique. The RTU is a great back up if you choose to opt out of an internal assessment. 

The real time ultrasound (RTU) is non invasive and is a quick tool allowing us to assess the pelvic floor and it’s relationship with the bladder. It is also a great way to check to see if the deep abdominals and the pelvic floor muscles are co-contracting. The RTU gives us important information about the pelvic floor and its ability to contract but there lies its main limitation. Although we can tell if you are able to engage your pelvic floor, we are unable to assess the quality and strength of the contraction .

What will the treatment involve? 

When assessing your pelvic floor, we don’t just assess its function (ie how strong it is and how many kegals you can you do), we also look at your body as a whole to see if there are any biomechanical issues that could be impacting on how well your pelvic floor and deep core functions. 

We will create a personalised treatment plan, where any restrictions identified will be treated using a variety of techniques. We will also advise on a specific pelvic floor rehabilitation program (which may involve a strengthening program or you may need to learn to relax your pelvic floor before beginning a strengthening program) movement practice, breathwork and recommendations for lifestyle changes to help you achieve your health goals. 

What should I wear/bring with me?

You should wear comfortable clothes and if the situation permits have a full bladder (if the RTU is not required, you will have opportunity to void.) If you have completed a bladder/ bowel diary have x-rays or blood test or any other relevant information please bring this to your initial consultation. 

For more information on women's health consultations, or to make an appointment, contact Kathryn or Elizabeth at Eastern Osteopathy on (03) 9042 0407