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If I'm Not Supposed to Do My Pelvic Floors at Traffic Lights, When Am I Supposed to Do Them?

Posted: Wednesday, December 10, 2014 at 3:34:16 PM EST by Alyssa Tait

If you’re like my patients you’re a woman with a million things on her plate…how on earth are you supposed to remember to do your pelvic floors?

I recently blogged about how I don’t like the common advice to do your pelvic floor exercises at traffic lights.

This came at some disappointment to one of my patients!

Quite reasonably, she asked “when am I supposed to do them then?”

I understand the need for something to link your exercises to.

A mental association, a trigger.

A way to actually guarantee they get done.

A way to form the habit.

While we pelvic floor physios wish our patients would have the pelvic floor on the brain all day (as most of us do!), we do realise this can be a big ask!

So yes, I do agree it is a good idea to have a mental trigger that it’s Pelvic Floor Time.

My favourite activity triggers are those in which it is normal and helpful to be activating the pelvic floor.

Favourite Trigger #1: Every time you turn on the tap.

This is because a drop in pressure inside the urethra is normal in everyone when they hear running water. In some people, though, the pressure can drop too low, leading to a feeling of urgency like you need to pee.

Tightening the pelvic floor muscles increases the pressure inside the urethra and can prevent this from happening. Turning on the pelvic floor muscles is a natural action when you hear the sound of running water. So it makes sense to…

 “Turn it on when you turn it on!”

Favourite Trigger #2: Every time you stand up.

The pelvic floor muscles should be working every time you move. They work as a team with your other muscles of posture that stabilise your spine. In fact, these muscles should be so smart, they actually start to tighten even before you stand! That’s why my second tip is to…

“Pull up when you stand up!”

When’s your Pelvic Floor Time? Have you got any nifty triggers to share with the rest of us?

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

The Yummiest Way to Get Folate

Posted: Tuesday, December 9, 2014 at 10:55:23 AM EST by Alyssa Tait

For best fertility and a healthy pregnancy we know we need to be getting enough folate, and for at least 3 months before conception.

But how many women are doing this? Only 20% are taking a preconception supplement containing folic acid at the time of falling pregnant.

Coeliac disease? You’re even more at risk.

At least 10% of women diagnosed with coeliac disease have a folate deficiency, even if they had been on a watertight gluten-free diet for two years.

On the Pill?

The Pill depletes folate in the body and may increase risk of birth defects if you fall pregnant while on it (which occurs in around 1 woman for every 100 who take it in a year).

Bad genes?

Up to 18% of women have both copies of the MTHFR mutation, which confers specific requirements for folate (and even more have one copy, which may also change your folate needs). (Read my blog post about MTHFR here).

Folate, the natural form of the vitamin (as opposed to synthetic folic acid) is available in raw vegetables and some fruit, but levels are variable. Unless you are regularly eating unusual foods like amaranth leaves and acerola cherries …

Your best sources of folate are likely to be these:

Highest folate fruit and vegetables (raw) Micrograms per cup
Avocado 122
Mango 71
Orange 70
Kiwifruit 45-63
Papaya 54
Beetroot 148
Turnip greens 107
Red capsicum 69
Lettuce (cos/romaine) 64
Sprouts (e.g. mung bean) 63
Sprouts (e.g. mung bean) 61
Chinese cabbage (e.g. pak choy) 46-60
Broccoli 58
Oyster mushroom 57
Celery 56
Kale 36

 


Some weird folate facts for you:

Broccoli stalks are higher than the florets.

Some tinned or frozen foods are higher than raw – such as asparagus and frozen blackberries (this may be because they are snap-frozen, and folate starts declining rapidly after harvesting – so ideally pick it straight from the garden and eat it.)

Cos lettuce is much higher than iceberg or leaf lettuces.

Silverbeet has only a measly 5 ug per cup (I must say I was relieved to discover this).

My best tip for a delicious dose of folate, especially for summer in Australia?

A spinach-mango smoothie.

Truly, this is delicious and ridiculously easy, with only two ingredients. Simply blend a mango (remove the skin and seed first!) with 1 to 2 cups of spinach leaves, eat with a spoon and share with a folate-needing friend – i.e. any human being!

What’s your tip for a yummy way to get your folate?

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

The Essential Fertility and Preconception Test Your Doctor Will Not Send You For

Posted: Tuesday, December 9, 2014 at 10:57:16 AM EST by Alyssa Tait

Epigenetics: it’s more than a buzzword.

It’s the way you can influence your genes.

It’s the element of control you have over whether you inherit your mum’s endometriosis or your dad’s bipolar disorder.

And when you are planning for a baby, the idea of being able to influence the genes for the health of your baby takes on a whole new significance.

Conventional preconception care is pretty basic at best. Sexually transmitted infections and general blood screens are sometimes the limit, maybe with minimal thyroid function screen and iron studies. You are told to take a preconception supplement containing folic acid, and to just let nature take its course.

But what if you have the MTHFR gene polymorphism?

(The what?)

In a nutshell, MTHFR is an enzyme used in a process in your body called methylation, and is critical for folate metabolism. As with other genes, you can have one or more copies of a mutation. In this situation, a mutation or polymorphism results in diminished activity of this important enzyme. The end result is an increased risk of just about any disease you care to name (but more accurately, cardiovascular disease, cancers, neurological diseases, diabetes, autoimmune disease and CIN – or a bad result on a Pap Smear, and a precursor to cervical cancer). Elevated homocysteine in the blood (or homocysteine at the upper end of the range) can be a marker for this.

Specifically relevant to conception is the issue that the MTHFR polymorphism increases risk for:

  • Male infertility
  • Recurrent miscarriage
  • Hypertension in pregnancy
  • Pre-eclampsia
  • Pre-term labour
  • Health issues in the infant, such as neural tube defects (e.g. spina bifida) or Down syndrome

But there are two pieces of good news:

Finding out your MTHFR status is easy, and cheap.

I frequently send patients for this test as a cheek swab (what a bonus, no blood test needed!) and is around $50. A small price to pay for a critical piece of information about your own and your future baby’s health.

Even better, there’s something you can do about your risks if you do have the polymorphism.

It involves judicious supplementation with certain B-vitamins to offset your risk.

And what about the recommendation to take folic acid supplements from 4 weeks before a pregnancy? A 2014 study pointed out this is not long enough to normalise homocysteine, optimise red blood cell folate and reduce risk in the majority of women, and that only 20% of women are doing this. It is critical to get good folate intake in the diet.

So there’s no way out of it girls – eat your greens! And see my blog post for a delicious way of getting folate in your diet.

So why not just take megadoses or folic acid, like those available over the counter at the pharmacy?

As in many cases, something that sounds like a bad idea IS a bad idea! Taking too much folic acid can mask a vitamin B12 deficiency, which is very bad news for a pregnancy. Folic acid is also not the optimal form of folate for use by the body. Folic acid is a synthetic form, which must be metabolised to tetrahydrofolate by the body in order to be of use. And you guessed it, there are multiple factors that influence this – so taking folic acid is by no means a complete solution.

Ideally, all women should ascertain their MTHFR gene status before falling pregnant and work with their functional medicine practitioner or integrative doctor to support their health.

Genetics can be slightly scary or overwhelming – but hooray for epigenetics, which means we can do something about it!

Do you know your MTHFR status?

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

My Favourite Secret Exercise to Do At Traffic Lights (Hint: Not Pelvic Floor Exercises)

Posted: Thursday, December 4, 2014 at 3:49:28 PM EST by Alyssa Tait

“Squeeze that pelvic floor every time you’re at a red light”: have you ever heard that one?

I am not a big fan of this, and here’s why.

It’s not functional (meaning, it’s not practical and a true-to-life way of using these muscles).

It’s too easy to do it wrong this way, due to both the position of the pelvis sitting in a car, and the obvious distractions around you.

And I see too many people that hold tension in their pelvis as they are rushing around all day feeling stressed about the next thing they need to get to.

Isolated muscle training requires focus – mindfulness - and this strikes me as a fairly mindless way of using the pelvic floor muscles.

But there is another exercise I like to encourage at red traffic lights.

And it fits quite nicely with the fact that most people are tense, rushed and stressed when driving.

It’s diaphragmatic breathing, otherwise known as belly breathing.

This is the natural form of breathing that your body engages in when you are relaxed. It follows that by consciously employing this method of breathing, you can help your system be more relaxed.

Now, by relaxed, I don’t mean sleepy, zoned out or slowed down – if so, I obviously wouldn’t be encouraging it while you are driving a car.

No, by relaxed, I mean:

Alert but calm.

Ready to respond but not tense.

Able to invest the right amount of energy for the task at hand.

The best, most effective version of yourself, in fact.

If this sounds a bit like what you are trying to achieve with meditation, then that’s no accident.

Belly breathing, when performed at 3-5 breaths per minute, is very similar to the breathing pattern used in meditators, according to a study way back in the 1980s.

A more recent study on yoga mantras and the rosary is one of my favourite atudies on breathing.

It showed that specifically breathing at a rate of six breaths per minute, either by a method of saying the Hail Mary or yoga mantras, resulted in an increase in parasympathetic nervous system activity (that is, the “rest and digest” arm of your unconscious nervous system).

Learn belly breathing with your physiotherapist, and consider using it whenever you need to…well…breathe. (And make sure you talk to your pelvic floor physiotherapist about when you really SHOULD be activating your pelvic floor).

So rest easy at the red traffic lights, and enjoy the relaxation that comes from belly breathing!

Driving is my favourite time to do belly breathing. What's yours?

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Do Probiotics Work?

Posted: Tuesday, December 2, 2014 at 10:22:50 AM EST by Alyssa Tait

A (Greatly Truncated) Response to the Question of Whether Probiotics are Overrated

Probiotics: myth or miracle?

It’s the kind of grab-your-attention, oversimplified, dichotomized headline we are used to in the media. But, I was grateful to be asked for my opinion on an article of this name:

http://www.theguardian.com/lifeandstyle/2014/nov/30/probiotics-myth-or-miracle-prebiotics

So here is the quick 10-minute version of my opinion on this, straight from my Facebook response.

This article is better than I expected from the headline - at least they correctly cited some conditions there is evidence for treating with probiotics, such as IBD and traveller's diarrhoea. Until the concluding line! Just focus on consuming good quality yoghurts, my foot! Do they exist?! Aside from the ones you make yourself, that is. There are two problems with this statement.

Problem number one: numbers in yoghurt are too low.

For therapeutic effect - that is, not just to "stay healthy" (never mind that most people trying to "stay healthy" have symptoms or conditions they could be treating nutritionally) but to treat a condition, you simply need higher numbers than are in yoghurt - especially standard store-bought yoghurt. Problem number two: strain specificity. While a healthy gut has hundreds of different species and strains (and by extension we can assume we need to be consuming these, unless of course we have a perfect gut microbiome handed down from a mother with a perfect microbiome, have never had antibiotics etc) to actually treat a health condition (such as ulcerative colitis) the specific strains used in the research are necessary. Assuming that taking Inner Health is going to correct all our microbiomial shortcomings is analagous to taking a multivitamin and expecting it to correct the health problems arising from the epigenetic problems from the MTHFR polymorphism (i.e. doesn't work).

probiotics

This article has picked and chosen a couple of conditions there is evidence for. Actually, there is evidence for probiotic treatment of urinary tract infections, thrush, bacterial vaginosis, (for more information on these, subscribe to our newsletter and tick "vaginal health, thrush and BV") allergic rhinitis, eczema, diarrhoea from chemotherapy, cow's milk protein allergy, irritable bowel syndrome, lactose intolerance, diarrhoea from radiation, viral gastroenteritis. The bottom line is strain specificity.

Asking "do probiotics work?" is like asking "does physiotherapy work, or is it overrated?" Work? For what? What kind of physiotherapy approach/technique? We don't give staged basal expansions (i.e. breathing exercise) for patellar maltracking (i.e. a biomechanical problem at the knee). Choose the intervention according to clinical reasoning, basic science, clinical experience and, ideally and where available, the evidence base. We need to remember that a lack of available evidence to show effect is not the same as availability of evidence showing no effect.

And make no mistake: with the very real problem of antibiotic resistance, the price we pay for being too skeptical about probiotic therapy is prohibitively high.

Sure, there's a lot more research to be done. But there is research available, and not making ourselves aware of it (and thus failing to educate our patients) is a mistake. I am so glad to see physios interested in the concept of the microbiome and probiotic therapy. What I find discouraging is the idea that people will read an article like this on probiotics and fail to change their habits (overusing antibiotics, failing to incorporate fermented foods into the diet, not considering probiotics and adjuncts to therapy for their particular health condition) due to a misinterpretation that the probiotic thing is overrated and a fad.

And by the way, as the article points out, prebiotic foods ARE incredibly important...but they can only feed what is there. If you lack bifidobacteria - as I see frequently on stool analyses of my patients - then eating artichokes and onions is not going to make them magically materialise. Take home message: don't just lucky dip and hope for the best. See a functional medicine practitioner! Or at least read their blogs :)

Perhaps start with this one on the role of the microflora in a healthy and balanced vagina.

http://www.equilibriahealth.com.au/Blog/equilibria-blog/Post/the-healthy-and-balanced-vagina

And please…tell me about your experience with probiotics by commenting below!

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

I'm in pain...do I need a physiotherapist, or an integrative nutritionist?

Posted: Tuesday, November 11, 2014 at 12:49:11 PM EST by Alyssa Tait

(Or: An Open Letter to My Dear Patients)

The majority of people I see are referred to me by a health professional (usually a GP, specialist, physio or osteopath) for my expertise as a physiotherapist.

This is the field in which my training started.

It is also the field in which I specialised (in pelvic floor dysfunction) and then sub-specialised (in pelvic floor pain syndromes).

The expectation of patients, therefore, is often that I will be treating them using physical or manual means.

Most of you know I am dually trained in physiotherapy and integrative nutrition, but this can be hard to get your head around, especially when you are expecting a certain type of treatment when you come.

The longer I am in practice, though, the better I get at pinpointing which approach is going to work best for you. This is usually obvious to me within the first session.

The surprising thing is, sometimes this may not match your expectations. Your condition (or symptoms) may seem to fit entirely within the realm of the physical – the biomechanical – the anatomical – the structural – or whatever you would like to call it.

But particularly with conditions involving pain, the lines start to get blurry.

For example, despite its obvious nutritional nature  -

I can treat irritable bowel syndrome from a physical or manual therapy standpoint, using techniques like visceral manipulation and connective tissue mobilisation.

And conversely, despite the obvious role of physiotherapy  -

I can treat vulvodynia from a nutritional or biochemical standpoint.

Most commonly, I like to take a joint approach (as well as recommending any other types of input you may benefit from).

I will always take into account your preferences. Occasionally I see a strong need for nutritional intervention, but the patient lets me know they do not want to go this direction…sometimes just with the non-verbals!

I was recently interviewed for the magazine of the Australian Physiotherapy Association about this combination approach I take. I was quoted as saying:

The vast majority of patients are really excited when they know there is another angle that their health can be looked at from. If we broaden the vision a little bit, then it gives us more scope for treatment.

My hope for you as my patient is that you will keep an open mind. I have seen many people be surprised by the success of an approach they didn’t initially expect when they walk through the door.  I hope you will let my dual training work as an advantage for you.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Sing Your Way to Pelvic Floor Recovery

Posted: Wednesday, November 5, 2014 at 5:32:05 PM EST by Alyssa Tait

Or, Pelvic Floor Rehab Doesn't Need to Be Boring!

So your pelvic floor seems to be failing you. Maybe you are leaking urine when you run (stress incontinence), maybe you are now having to run to make it to the toilet (urge incontinence), or maybe things feel heavy and bulgy down there (could be a prolapse).

You’ve been told by well-meaning health professionals you shouldn’t be running, lifting, straining, doing sit-ups, bending, or even daring to move without making sure you have your pelvic floor zipped up and locked on.

In fact, you are even in danger of losing urine with laughing now. Talk about sucking the joy out of life!

Yikes! Life has never felt so dangerous. There seem to be so many activities that seem to put pressure on the pelvic floor!

Well, I have more bad news for you. (But don’t worry, I will then follow it up with some delightful news.)

The bad news is that other seemingly benign activities also put pressure on your pelvic floor – activities like walking, getting out of the chair, and prolonged standing. (And, as I mentioned, laughing!)

I talk to women every day who feel like anything physical is now off the agenda. But at least you can sing without any qualms, right?

Wrong. Singing, like any forced exhalation, also potentially places pressure on your pelvic floor.

The good news is that singing is also a wonderful method for rehabilitating the pelvic floor.

Good singing technique involves coordinated activity of the diaphragm, deep abdominal muscles and – yes, you guessed it – the pelvic floor muscles.

So doing some vocal exercises commonly used in singing training can be a fabulous way to rehabilitate pelvic floor and abdominal function with all forced exhalation activities, including coughing, laughing, sneezing, nose blowing and raising your voice.

And more good news – you don’t have to be singing in tune to do it – just with correct technique!

A good singing teacher can teach correct vocal technique - but only a qualified pelvic floor physiotherapist can accurately integrate pelvic floor function into this.

Come and see me at Equilibria for a fun and practical progressive program to rehabilitate your pelvic floor.

appointment_button

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Dairy Dilemma: What's the Link Between Constipation and Cow's Milk Protein Intolerance?

Posted: Friday, October 31, 2014 at 4:35:33 PM EST by Alyssa Tait

As a naturopath, you can’t help but see some patterns that come up over and over again. When it comes to cow’s milk protein (CMP) intolerance, we see links to kids’ health problems like recurrent ear infections, tonsillitis, eczema and late bedwetting.

Another clear link is between cow's milk protein (CMP) intolerance and constipation.

To the kids who love milk and their long-suffering parents, telling them that dairy could be causing their child’s suffering is hardly music to their ears (though it may be music to their rears, if you’ll pardon the pun).

I realise how difficult it can be to take kids off dairy. So I usually try other things first: probiotics, prebiotics, toilet habits, fibre, fluid, behavioural things, laxative manipulation and so on.

But often, it comes back to an overwhelming suspicion that the child is not tolerating something in their diet…

And dairy tops the list of usual suspects.

At this point, I usually suggest we do food sensitivity testing.

This is not the same as food allergy testing, so it (like all tests) is not a perfect test to rule out a problem with cow’s milk protein (CMP). But it’s amazing how often dairy comes up as a positive on this test, and how removing dairy from the diet makes a difference to the patient.

My experiences may or may not convince you, so…

Wwhat does the research say about this?


A 2014 review of ten studies found that a CMP-free diet had a 28-78% success rate in childhood constipation.

The authors recommend a 2-4 week exclusion period to test the theory.

A Russian study from 2013 on infants with constipation and dermatitis found that if probiotics were added to a CMP-free diet, the effect was more pronounced.

Adding probiotics is always a must.

Another 2013 study showed that patients with food intolerance had higher anal sphincter pressures. What is fascinating here is that the patients had anal fissures (a painful condition associated with constipation), and that healing of these anal fissures was higher in the group who were put on an elimination diet. What’s more, the fissures came back when CMP and wheat were (separately) re-introduced! The patients who reacted to these challenges had higher amounts of eosinophils in the anus, suggesting an allergic response.

So anal fissures, a notoriously difficult to treat condition, could be related to CMP intolerance as well.

A group of children placed on a soy formula instead of CMP achieved resolution of chronic constipation in another 2013 study. This study also compared the effects of A1 and A2 milk protein, and while there were better effects on the A2, this was not statistically significant.

Reflux in infants commonly overlaps with CMP allergy, and where this is the case, a 2-4 week CMP free diet can resolve the reflux symptoms, according to a 2013 review.

So how common is CMP allergy?

One study found that in a group of children with chronic constipation, 77% were CMP allergic!

And how long does the child need to remain CMP-free for?

One study looked at the “development of tolerance” – that is, the ability to reintroduce the food without causing the same reaction. It found that if CMP was reintroduced in six months, only 22% of children had developed tolerance. On the other hand, of reintroduction was at twelve months, a full 88% had achieved tolerance!

It’s sad news for the constipated kids who love their milk – like my 2-year-old patient from this week, who drinks over a litre a day. But the stats are there, and if your child suffers from chronic constipation, the time and effort taken to see if they are reacting to CMP could be well and truly worth it.

 

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Getting Off The Pill Step 2

Posted: Thursday, January 8, 2015 at 4:07:31 PM EST by Alyssa Tait

Understand the problems – both the hypothetical and the real

In deciding whether to continue with (or change to ) the Pill, or the Mirena, or Implanon, you need to weigh up the pros and cons for you. My last blog post talked about the pros: the possible reasons people use these medications. This post focuses on being aware of some of the potential issues with the Pill, technically known as the combined oral contraceptive Pill. The next two posts will look separately at the Mirena and the injection (Implanon).

How does it work?

The Pill contains a synthetic type of oestrogen and progestogen that gives messages to a part of your brain to stop you producing your own oestrogen and progesterone, by making your brain think you are pregnant. It aims to stop you ovulating, but does not always do this (ovulation occurs 2% of the time on the regular oestrogen Pill and 1% of the time on the lower oestrogen Pill). This means you are not having normal cycles, and you are not producing your own progesterone (which occurs with ovulation). The progestogens you are receiving in the Pill do not have identical physiological effects to your own body’s progesterone. So in summary, the Pill makes your body behave in a “high-oestrogen” way, which may explain some of the side effects and risks.

thepill

What are the less serious side effects? (note, if these are more than mild, they could be considered serious!)

  • Nausea
  • Breast tenderness
  • Mood changes
  • Breakthrough bleeding
  • Headaches

What are the more serious side effects?

  • Loss of sexual arousal and pleasure, orgasm and lubrication
  • Folate and other nutrient deficiency, which can lead to neural tube defects if a pregnancy occurs
  • Insulin resistance, a precursor of diabetes
  • Increased risk of thrombosis (a blood clot that can lead to death even in young women)
  • Increased risk of cervical cancer and breast cancer

There are other reasons you may not feel comfortable with using the Pill.

Masking the underlying cause of the problem

Many women first go on the Pill due to acne or painful, heavy periods. While the Pill can improve these symptoms, this benefit is actually a double-edged sword. Two common underlying causes here are polycystic ovarian syndrome (the most common hormonal disorder in young women) and endometriosis (a serious inflammatory disorder leading to scarring and possible infertility). The Pill actually only acts to mask these problems, not fix them. Being on the Pill can have the negative effect of delaying diagnosis and proper treatment.

Fertility problems: it’s worth thinking about.

Even if you are not thinking about children just yet, it is important to consider the risks of staying on the Pill long-term and only coming off when you’re in your thirties and planning to have children. If you have underlying endometriosis or polycystic ovarian syndrome, these are masked by the Pill, and you may find that you have fertility problems when you come off the Pill. It is better for these to be identified and treated as early as possible, rather than finding out it’s too late.

Especially if you haven’t been 100% happy on the Pill, the side effects and risks may not be worth it. It’s important to remember that in practice, 8 out of 100 women will fall pregnant in one year. For some, these statistics for contraceptive effectiveness are not convincing enough.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Herbal Medicine for Period Pain

Posted: Thursday, August 28, 2014 at 4:46:02 PM EST by Alyssa Tait

Period pain is a destructive force in many women’s lives.

Time off work, pressure on relationships, stopping participation in sport and hobbies are just some of the effects…not to mention the untold suffering from the pain itself.

What can you do?

Many of my female clients report pain during their periods (also called dysmenorrhea) or an exacerbation of their chronic pelvic pain or vulvar pain. But what can you do about it, aside from the all-too-common “solution” of going on the Pill, or over-relying on non-steroidal anti-inflammatory drugs, and risking their significant side effects?

In a word: herbs.

I’m sorry to sound simplistic, but I’ve seen herbs work so often for painful periods that I’m pretty black and white about this. Try herbs for period pain. Especially before you resort to the Pill – or if you want to get off the Pill, but are worried about your period pain returning.

But don’t take it from me. Let’s look at what the studies say.

Yes, there is research supporting it to silence the naysayers.

Promising results for herbal medicine in dysmenorrhea were found by a 2008 Cochrane systematic review (considered one of the highest levels of evidence in medicine).

A 2011 study showed effectiveness of the herb Valerian for dysmenorrhea, probably due to anti-spasmodic effects.

corydalis

The herb Corydalis is the most common herb used in Taiwan for dysmenorrhea – used in one-third of prescriptions for period pain for women aged 13-25. Analgesic effects were confirmed in a 2010 study. Corydalis is one of the most common herbs I use as well – not just for dysmenorrhea, but other forms of visceral pain or neuropathic pain.

A 2012 study showed that ginger for dysmenorrhea was more effective than placebo in reducing severity and duration of period pain. It was most effective when started 2 days before the onset of bleeding.

ginger

And you don't have to take it all month long.

The great thing about herbs for dysmenorrhea is that they can be used “lazily” – that is, just reserved for use during your periods. Unlike herbal formulas for many other conditions, which I usually get people to take twice per day on an ongoing basis, herbs for painful periods work even when just used at the time of the pain.

A recent example is a client of 17, who I had been seeing for persistent vulvar and urethral pain and dyspareunia (painful sex), and a diagnosis of vulvodynia and vaginismus. This is one of my many patients where physiotherapy has formed only a small component of the treatment, largely being nutritional therapy. This young lady experienced period pain that she described as “like someone shooting knives up me” , and a “constant burn in the back passage” . She would get extreme cramps in the abdomen, anus (like proctalgia fugax) and down her legs. This would start within one hour of her bleeding. She described herself as feeling “borderline suicidal” from the pain.

The next month she used a herbal combination of corydalis, ginger and some other herbs. The difference was startling. She had no pain at all during her period. No pain, period. (Pardon the pun.)

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Is An Alkaline Diet Good For Chronic Pelvic Pain, Vulvodynia and Interstitial Cystitis??

Posted: Wednesday, August 20, 2014 at 4:00:26 PM EST by Alyssa Tait

The state of the body's acidity vs alkalinity both reflects and affects health.

This is a topic I summarised in my last post. But what about the specific scenarios of chronic pelvic pain, vulvodynia and interstitial cystitis?

Does acidity or alkalinity have anything to do with chronic pain?

The short answer here is yes. We all know that after heavy exertion with exercise, we wake up with sore muscles; one explanation for this has been lactic acid in the tissues. There is also an interesting 2001 study that tested an “alkalising supplement” on people with chronic lower back pain. There was an improvement in pain scores; in fact they dropped by 50%, showing that acidity may be associated with pain, especially muscle or joint pain. The conclusion of the researchers was that "a disturbed acid-base balance may contribute to the symptoms of low back pain".

Does acidity or alkalinity have anything to do with specific types of pelvic pain, like vulvodynia or interstitial cystitis?

Vulvodynia

I often consider at the concept of tissue acidity in patients with chronic pain conditions such as vulvodynia. Acidity is often present in these patients. At times, tissue acidity can be assumed from a combination of symptoms and blood test measures that give information about pH. It is difficult to be certain whether the acidity is one of the causes of the symptoms of vulvodynia, caused by one of the underlying processes in vulvodynia, or completely unrelated. However, if there are enough clinical clues pointing towards acidity being a problem, I often guide treatment to influence it. This may encompass addressing a cause of the acidity (such as tissue inflammation or mineral deficiency) and experimenting with a change in diet.

stingingontoilet

Interstitial cystitis or painful bladder syndrome

Interstitial cystitis is a special case here. Tissue acidity may well be present, but a common trigger reported by people with IC is acidic foods – drinking coffee, carbonated beverages (fizzy drinks), oranges and tomatoes. A theory here is that the lining of the bladder, which can be “worn away” in parts in IC, may be directly vulnerable to the acid in these foods. Many of my patients with IC have been firmly committed to cutting these out – even foods like lemon, which are acidic in nature, but don’t affect overall tissue acidity. However, “IC diets” on the internet are often an over-simplistic solution. Individual food sensitivities can cause inflammation of the tissue, which may exacerbate symptoms of IC in some people. Identifying individual food sensitivities is, in my experience, a more reliable approach to the food question in IC.

So in summary, I do not use a "one-size-fits-all-alkaline-diet" for patients with chronic pelvic pain, vulvodynia or interstitial cystitis. While the acidity-alkalinity issue is relevant and worth addressing, this is best done via individualised assessment and evaluation of factors promoting acidity, such as presence of inflammation, mineral deficiency and digestive dysfunction. For more about these individual factors, see my last post.

 

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter
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