You & Your Gut: it's complicated
When I first started specializing in Pelvic Health Physical Therapy, I thought to myself, “the pelvis has muscles and bones just like the other body parts I’ve treated. Shouldn’t be such a big jump from orthopedics.” Well, I was definitely wrong. As I saw more patients with pelvic dysfunction, the commonality was that they reported digestive issues, such as bloating, constipation, and symptoms of irritable bowel syndrome. If you’re wondering what the pelvic floor has to do with the gastrointestinal (GI) system, the answer is it has a lot to do with it.
The GI system has become a hot topic in the past few years and that’s because it is so complex and its impact goes way beyond digestion! With more research, we now know our gut plays a much larger role between all systems of our body and can very well explain medical phenomenon beyond our standard Western viewpoint. So, hold onto your hats, this post is going to take you for a ride <3
The Gut-Brain Connection
For starters, our gut behaves like a second brain. It contains between 50-100 million nerve cells, called the enteric nervous system, that communicate with our central nervous system. Many neuroimaging studies have revealed a correlation between chronic pelvic pain and structural/ functional changes of the central nervous system.
Up to one-third of patients with chronic pelvic pain do not receive a physical explanation for symptoms !! yet annual costs for diagnostic testing and treatment are estimated to be $2.8 billion.
So, what could explain this connection between pelvic pain and the GI tract? In times of high emotion, physical, or environmental stress, our central nervous system sends a complex cascade of messages to both our pelvic floor and digestive systems, which can result in increased pelvic tension and the slowing or expedition of peristalsis (contractions and relaxation of the intestines). These effects on the gut can present as bloating and irregular bowel movements. Also, the increased tension of our pelvic floor may lead to compression of nerves that our brain can perceive as pain.
The Gut-Immune System Connection
The intestines are lined with vastly more immune cells than any other place in our body. They contain a unique composition of bacteria, viruses, parasites, and fungi that we call microbiota.These immune cells form a tight barrier that prevents toxins, undigested food, and other harmful substances from invading our bloodstream. However, when our gut lining is inflamed due to imbalance of our microbiota, this can lead to “leaky gut,” or more permeability in the intestinal wall.
So, what does that have to do with pelvic health? Well, when working with women with GI distress, we have to consider the possibility of hormone related conditions that can increase gut inflammation such as endometriosis or polycystic ovarian syndrome.
Endometriosis is when endometrial-like tissue grows in other areas of the body, usually limited to the abdominal cavity, causing an inflammatory response in the body. Coincidently, up to 90% of patients with endometriosis report GI distress, including bloating, nausea, constipation, diarrhea, and vomiting.
We also see similar GI symptoms in women with Polycystic OvarianSyndrome (PCOS) and pelvic pain. In a study of 987 female patients with chronic pelvic pain, 35% reported criteria specific to irritable bowel syndrome. Whatever the original cause of inflammation, whether it was the reproductive orGI system, we know one can directly affect the other.
The Gut-Hormone Connection
We also know that hormones largely influence your GI system, too. Yep, the same hormones that influence your reproductive system. Hormone imbalance can throw both systems into disarray.
Let’s introduce estrobolome-- microbes naturally found in our gut whose primary job is to regulate the metabolism of estrogen. Excess estrogen is broken down in our liver via bile and eventually excreted. If there is a disturbance in this process (not fully eliminating or constipation) this can lead to estrogen dominance. This imbalance can especially aggravate conditions such as endometriosis, polycystic ovarian syndrome, and menopause.
The Gut-YOU connection
What does all this information mean to you? The reproductive and digestive systems work in sync with each other, when one system is off, this can result in a disturbance of the other. These two systems must work together effectively for our bodies to optimally function. Pelvic floor physical therapy can help harmonize and balance these systems so you can feel better in your body.
How can Pelvic Floor Physical Therapy help you?
· Release tight pelvic floor muscles that affect positioning and function of the rectum to alleviate constipation
· Stimulate vagal nerve activation to down-regulate central nervous system activity and increase peristalsis and normalize digestive processes
· Correct posture and body mechanics to optimize organ and pelvic floor alignment
· Perform manual interventions to increase peristalsis and instruct self-manual techniques
· Education on the connection between pelvic floor and maintaining gut health
Resources:
The estrobolome - a bridge between gut
Role of the gut microbiota in nutrition and health
Leaky gut: What is it, and what does it mean for you?
Central Nervous System Changes in Pelvic Inflammation/Pain Patients
