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Causes of Bladder Pain Part 1

Posted: Thursday, December 19, 2013 at 8:07:48 AM EST by Alyssa Tait

Bladder pain: what could be behind it?

Pain in the bladder can be downright distressing. Like all ‘’organ’’ pain, it is compounded by the anxiety associated with ‘’something being wrong’’ with an important body system.

There is a range of experience of bladder pain. Some aspects include:

-Pain when passing urine

-Pain that feels like it’s coming from your bladder, which increases as your bladder gets fills up

-An ongoing discomfort with urge; a feeling of constantly needing to go to the toilet, which doesn’t really ease when you go

So what are some of the possibilities when your bladder hurts?

Urinary tract infection.

The good old UTI is probably the most common cause of pain in the bladder, and usually is accompanied by a ‘’triad’’ of symptoms: frequency (going to the toilet more often, often for only small amounts), urgency (a feeling that you can’t put off the urge and have to rush to the toilet) and dysuria (pain with passing urine, usually worse at the end of the stream). Sometimes the body can fight this off, especially if you alkalise the urine with Ural or bicarbonate of soda, but if symptoms persist, it’s important to get to a doctor who can do a dipstick to check for white blood cells and send it off for culture. You will most likely need antibiotics. It is critical that the infection does not reach the kidneys, as this can cause long-term damage. You should always act quickly, particularly if you have a fever.

Stones.

Bladder stones are made up of minerals and proteins in the urine. Sometimes bladder stones can remain in the bladder with no symptoms. However, passing stones is normally (but not always) extraordinarily painful. A dipstick test with the doctor will show up blood in the urine (which may not be visible to the naked eye). An X-ray can show up some types of stones (calcium oxalate, but not uric acid stones), or a cystoscopy (camera in the bladder) may be necessary to diagnose them. They normally occur in older people or people who have become dehydrated.

Vaginal infection.

Sometimes, an infection in the vagina (bacterial or yeast infection) can cause pain in what feels like the bladder; it is also possible to have pain when passing urine, as the urethra (bladder tube) can be inflamed (this is called urethritis). Especially if your symptoms are not the ‘’classic triad’’ and don’t show up as a urinary tract infection on a culture, it is important to have a vaginal swab to rule out vaginal infection. It is important to consider chlamydia, an extremely common sexually transmitted infection, which in some women causes no symptoms at first, but can cause pain with passing urine.

That's just the beginning - watch this space in the next few days for some more causes of bladder pain and arm yourself with information!

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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

Causes of Bladder Pain Part 2

Posted: Thursday, December 19, 2013 at 8:07:30 AM EST by Alyssa Tait

What Else Could Be Behind Your Bladder Pain?

This is Part Two - so make sure you scroll down to the post below to get the full story on possible causes of bladder pain!

Cancer.

Let’s get this one out of the way! While bladder cancer or a bladder tumour, is an uncommon cause of bladder pain, especially in younger people, it is important to be ruled out. It is always important to identify the cause of blood in the urine, either macroscopic (meaning visible to the naked eye) or microscopic (meaning it shows up on a dipstick test).

Obstruction.

If the urethra (bladder tube) gets blocked, the bladder can overfill and become distended like a balloon, and cause pain. Obstruction may occur for many reasons, including prostate enlargement in men, bladder stones, tumours, scar tissue, or bladder prolapse in women. It is uncommon in women, and would occur with the symptom of difficulty emptying the bladder or a change to the urine stream.

Incomplete bladder emptying.

If the bladder does not empty completely it is possible for the bladder to overfill and cause pain, as in obstruction. This could occur with damage to sensory nerves of the bladder, such as with gynaecological surgery or a traumatic childbirth. There is also a rare condition in young women known as Fowler’s Syndrome, where the urethra (bladder tube) does not relax properly when trying to pass urine, leading to urinary retention.

Interstitial cystitis or painful bladder syndrome.

Interstitial cystitis (IC) is also known as painful bladder syndrome (PBS) or bladder pain syndrome (BPS). It is a condition causing pain (or pressure or discomfort) associated with the bladder, usually worse as the bladder is filling, and relieved to some degree with passing urine. It is a chronic condition (present for at least 6 weeks) where a urinary tract infection has been clearly ruled out. A dipstick test may show blood in the urine. A cystoscopy will normally show bleeding wounds in the wall of the bladder called ‘’glomerulations’’ or petechial haemorrhages. However, it is possible to have PBS without this classic sign of IC. Antibiotics will not change the symptoms.

Endometriosis.

Endometriosis is a condition where the endometrium, or uterine lining, grows abnormally in places that it shouldn’t, such as the bowel, the bladder and the pelvic cavity. Endometriosis often causes pelvic pain, usually exacerbated during menstruation. Sometimes the pain can feel specific to the bladder. With bladder endometriosis, a dipstick test may show pyuria (pus or white blood cells) in the urine, but a culture for a urinary tract infection will be negative. Antibiotics will not change the symptoms.

A Final Message About Bladder Pain

Bladder can be acute and self-limiting (meaning that it is related to clear cause and resolves predictably) or it can be chronic, where the cause is more difficult to find. When it persists for a period of weeks or months, it takes on the characteristics common to chronic pain, such as neurogenic inflammation and central sensitisation. Recurrent urinary tract infections are another issue that need expert help to resolve. Here at Equilibria, we have the expertise to help you solve these problems once and for all.

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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

Chronic Pain - Do You Really Get It?

Posted: Saturday, August 16, 2014 at 7:07:16 PM EST by Alyssa Tait

You step on a thumbtack, and yow! – your body pulls your foot back faster than you know what hit you.

You accidentally touch that hot plate, and eeek! – you’ve pulled your hand back off it in the blink of an eye.

‘’Pain is the message your body part sends your brain when your body part is being damaged’’…right?

WRONG. This is a huge misunderstanding of pain, especially the area of chronic pain or persistent pain. It is a big mistake to make. If you misunderstand your pain, it can actually impede your recovery.

So what is pain, then, actually? Pain is what is PRODUCED by your brain and nerves (your central nervous system, or CNS) in response to a THREAT to the body tissues. That’s right, a THREAT. It does not have to be real or true damage. In fact, in chronic pain, it rarely is. Instead, your brain senses the body is in danger, and responds accordingly. It actually puts together an individualised pattern of pain in order to protect you from this potential threat. Believe it or not, this is what modern neuroscience research teaches us!

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Of course if you have persistent pain, it is very important to have all the appropriate investigations done to rule out (or at least tease out) any causes directly related to tissue damage. If nothing can be found – or if pain is out of proportion to what would be expected for the specific tissue damage – then you can be sure that your central nervous system (CNS) is playing a big role in maintaining your pain.

The complex pattern of pain that your CNS puts together can involve a contribution from multiple systems in your body. As well as pain, you might have emotional or psychological changes (anxiety or depression), muscular changes (tense, sore muscles that are bracing you to deal with your pain, or run away from it) circulation changes (heat or cold in the sore area), tissue changes (weak or fragile skin in the painful area) and hormonal changes, which can affect your energy, sleep and the health of your whole body. All of this put together is like a big personalised puzzle of pain! Putting together the different parts of the puzzle is very important in overcoming the persistent pain.

In summary, persistent pain (or chronic pain) is complex but enormously changeable. In order to solve the puzzle of your persistent pain, you need to be able to put the pieces of the puzzle together, and bit by bit, see the picture clearly. Retraining the brain is an important part of resolving chronic pain; retraining the brain in chronic pain in the vulva and pelvis is a particular focus of mine as a clinician.

If you experience persistent pain – regardless of the cause – you need to address the central nervous system. You may benefit from a physiotherapy session dedicated to learning about pain and what causes it to persist – and how you can change this. When you book in for an appointment, mention you are wanting ‘’pain education’’ – and if you can, bring your loved one with you, so they can understand your pain as well. If you are a female and pain is somewhere in the pelvis, you can also start work on retraining your brain by using my e-book Outsmart Your Pain.

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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

Epigenetics and Chronic Pain

Posted: Wednesday, December 18, 2013 at 12:25:00 PM EST by Alyssa Tait

How targeted nutrition can affect your pain experience

Epigenetics: it’s a bit of a buzzword floating around at the moment, but what does it actually mean?

Epigenetics is the study of how environmental factors influence what genes your body ‘’decides to express’’. We all know about our genes – in fact we often resign ourselves to a medical condition or symptom because it’s ‘’in our genes’’. However, it’s also the case that you can have the gene for something but not get the disease. This is because of epigenetics – the way our environmental influences affect our gene expression.

These environmental factors are not just the obvious ones: exposure to radiation from a nuclear disaster, exposure to chemicals in a factory accident, exposure to too many UV rays sunbaking on the beach. Environmental factors start in utero (that is, as a baby in the womb), and don’t stop as long as you are still breathing!

One important chemical processes in our cells that influence epigenetics is DNA methylation. The effects of diet on DNA methylation have been well studied. Your ‘’methylation status’’ greatly affects your likelihood of developing certain conditions that may be ‘’in your genes’’, such as heart disease, cancer and depression. The field of nutrition medicine (practised at Equilibria) focuses on optimising individual health via nutrition, and optimising methylation status is one way we do this.

A 2012 study in the journal Pain Medicine discussed the role of methylation and other epigenetic processes in chronic pain. Specifically, it focussed on how acute pain (which is normal in healing) turns into chronic pain (which is a living nightmare for millions of people).  How does epigenetics affect whether your pain will hang around and turn ugly?

Here are three mechanisms whereby improving your epigenetics (such as via nutrition) can reduce the transition of acute pain to chronic pain:

  • By altering your sensitivity to opioids, your natural pain-relieving chemicals
  • By altering the production of inflammatory chemicals, called ‘’cytokines’’
  • By altering how responsive your cells are to steroids (important hormones, such as vitamin D – so there’s a clear nutritional lead already!)

As a physiotherapist and nutrition medicine practitioner immersed in chronic pain, I treat people every day with chronic pelvic pain using not just physical techniques alone, but targeted nutrition strategies. It seems that research is heading more into this area. In the meantime, has your pain been affected by your nutritional status? I would be interested to hear people’s personal stories.

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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

Coffee - could it be good for you after all?

Posted: Wednesday, December 18, 2013 at 12:23:39 PM EST by Alyssa Tait

You love your coffee. You’ve never wanted to believe that it’s bad for your bladder, bad for your arteries, and a crutch allowing you to work too hard.

So it’s been great to hear the good news stories about coffee being good for you after all...but can we trust them?

I owe the blog post idea to a friend who reported with delight that he’d heard from an expert on the radio that due to its health benefits, coffee should be drunk at a rate of six cups a day. As someone who quit coffee at age 16, and counsels women regularly to give it up for the sake of their overactive bladder, I agreed with him that this was worth some investigation.

A 2008 study of 30 000 people showed that 6 cups of coffee per day is not linked with increased deaths. Still, knowing that statistically, death is no more likely if I indulge in coffee is not quite enough to convince me to take up the habit. You could say the same about nose-picking.

Unexpectedly, some studies have found a link between coffee consumption and reduced stroke risk (but not if you are not already a regular coffee drinker). Others showed a less risk of developing Alzheimer’s and Parkinson’s disease with coffee drinking. And even more startling, drinking more than 6 or 7 cups a day reduced diabetes risk.

So, there’s no denying there seem to be some positive links between coffee and your health. However, the important thing to remember is that these are associations only – and an association is not the same as a cause-effect relationship.

It’s important not to oversimplify these findings. One theory about the effect on diabetes risk was that coffee contains magnesium, which is important for insulin regulation. This is an oversimplification. In reality, coffee is a diuretic, and by producing more urine, it results in increased loss of magnesium from the body. So if coffee does actually cause positive change (and remember, we can’t prove cause, only association), it isn’t because of this.(And by the way, magnesium has positive effects on your bladder).

Over-focusing on these findings also tends to make us ignore the big picture. It makes scenarios like these possible:

  • Despite the fact I have an enormous amount of visceral (abdominal) fat, I believe that drinking coffee will prevent me getting diabetes
  • I reach for that seventh cup of coffee because the scientists are telling me it’ll reduce my diabetes risk, but meanwhile, I increase my risk of bladder cancer and possibly osteoporosis
  • I deny any harm of my coffee habit – despite the fact I never have a coffee without a cigarette

It also focuses on serious diseases at the expense of general well-being and quality-of-life issues. For example, drinking coffee:

  • Increases the excretion or blocks the uptake of numerous essential minerals, such as iron, calcium, zinc and magnesium
  • Can reduce the quality of your sleep
  • Makes you pee more often, and for some, can make it harder to get to the toilet without leaking
  • Stimulates the bowel in some (but not all) people, which could be a good or a bad thing, depending on whether you tend towards diarrhoea or constipation (but is definitely not good if you experience any level of accidental bowel leakage)

Still, a scan of the research literature about coffee proves surprising. There seems to be no link with gout, and no link with bladder pain syndrome/interstitial cystitis. Even when it comes to your bladder control – incontinence and overactive bladder – there is not very convincing research evidence to convict coffee.

What’s the take-home message?

It seems that coffee is not necessarily the demon it is made out to be. It definitely improves your short-term mental performance, and is related in some way to a reduce risk of certain diseases (though we can’t say it directly causes this).

Having said that, research evidence looks at trends in a large population group. It is not the same as discerning an effect for yourself. That’s why I do suggest to all my overactive bladder patients that they have a caffeine-free trial. Many of them notice no difference whatsoever when they cut out coffee. Others notice a startling improvement, which drastically improves their quality of life, and  makes it all worthwhile.

This just shows that reporting of research, while essential, does not account for individual variations. Where there’s no risk involved, it’s always smart to test out the hypothesis on yourself. Feel better after a week off coffee?  Bladder problems disappear when you lose the coffee? Great. Cut it out. The proof is in the pudding.

 If you don’t see the benefits from losing the coffee, then don’t feel guilty about your coffee drinking. But be realistic. You’ll know if you’re using it as a crutch or if it’s linked with other poor health habits like reaching for a cigarette, eating too many biscuits, working too hard or being a couch potato. And please, if you do love your coffee, think about taking magnesium and zinc supplements to make up for your losses.

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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

Chronic Pelvic Pain - some media coverage at last!

Posted: Wednesday, December 18, 2013 at 12:22:26 PM EST by Alyssa Tait

ABC radio’s Health Matters show yesterday covered one of the most overlooked health problems in Australia: chronic pelvic pain.

One of my patients rang and let me know about it, for which I was very grateful. I downloaded the recording after work, and as I listened to it, I recognised in the stories things I am told over and over again in my clinic.

Despite the fact that everyone’s journey is unique, so many themes arise again and again: the physical suffering, the loneliness and social isolation, the despair at being made to feel like you’re crazy, malingering or exaggerating. The tendency to diagnose depression or anxiety when the symptoms don’t perfectly add up. The complete lack of awareness in a large majority of (otherwise capable) health professionals.

The symptoms that people mentioned echoed those of so many women and men I have seen over the years. To take just a handful of examples:

  • The constant burning pain
  • Being unable to sit down or find a comfortable position
  • The feeling of ‘’little cuts all over the vulva’’
  • The ‘’red hot poker up the backside’’ feeling

These symptoms are described to me every day by different patients, most of whom assume they are the only one who has them. But what I hear most commonly from my patients is

‘’Why did it take me so long to find you?’’

My patients have typically seen ten or more health professionals before me who either

  • Didn’t take the problem seriously
  • Didn’t recognise the symptoms
  • Didn’t refer appropriately
  • Wrote the symptoms off as caused by depression, anxiety, or a lack of sex life
  • Did not seem to care, and even seemed skeptical

It is a relief for people to finally find someone who understands chronic pelvic pain. To be frank, health professionals who really ‘’get it’’ are thin on the ground. The good news is that, because there are so few with good expertise in this area, those of us who understand it have good networks – so we know the people you need to see for the essential multi-disciplinary approach.

An important point raised during the broadcast as well as from listeners’ e-mails is that pelvic pain can have important identifiable medical causes, such as fractures and cancer.

However, when appropriate medical investigations have been done, and no clear cause has been found (and keep in mind a laparoscopy is required to definitively rule out endometriosis), then this is a case of chronic pelvic pain.

Chronic pelvic pain has many subtypes, some of which are diagnoses in themselves. There are also concepts that anyone with chronic pelvic pain will want to understand. You may want to investigate the following:

All of these are conditions I have successfully treated here at Equilibria for the past eight years.

I’m not sure how long the broadcast will be available for download, but it is thoroughly recommended listening.

Go to:

http://www.abc.net.au/radionational/programs/lifematters/pelvic-pain/4502250#comments

 If you are suffering from chronic pelvic pain, come in and get some help.

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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

Coeliac Disease: could you spot this in your child?

Posted: Wednesday, December 18, 2013 at 12:15:28 PM EST by Alyssa Tait

Up to one in one hundred people have coeliac disease. The problem is, most of these don’t know it.

What signs would alert you to this in your child, or the children you treat?

A 2013 study suggests the common symptoms of coeliac disease depend on the age of the child.

Kids younger than six with coeliac disease are most likely to have diarrhoea and failure to thrive (that is, be small for age, short and skinny, with poor growth).

Kids older than six with coeliac disease are more likely to have the same symptoms an adult with coeliac disease would: “irritable bowel” symptoms. Abdominal pain and nausea are two of the key symptoms here. This is interesting, as nausea is not often thought of as a symptom of coeliac disease.

Abdominal pain was the most common symptom, being present in more than 50% of the sample of kids who were diagnosed with coeliac disease. It’s interesting to note than only just over a quarter of the kids had the symptom of diarrhoea, which people often mistakenly think of as the key symptom of coeliac disease.  In fact, in the seven-to-thirteen age group, there was actually constipation in over 10%, and in the under-sixes, it was present in almost a quarter. This makes it clear that we should not forget about the possibility of coeliac disease in our paediatric patients with constipation!

Big tummies are also the other thing to look out for, especially in the under-sixes, one-third of whom had abdominal distension.

One final note was that in this group, approximately 13% of them were IgA deficient. Note well: this means that a blood screen for coeliac disease will produce a false negative in these kids. In other words, the (correct) diagnosis of coeliac disease will be missed! This is because the standard blood tests for coeliac disease (transglutaminase antibody and IgA antigliadin) both are IgA-based. They rely on normal amounts of IgA being present in the serum. If there is IgA deficiency, the individual will not test positive to coeliac disease on blood tests even when they have it.

Finally, coeliac disease is hard to diagnose in the under-fours. This is because until four years of age, coeliac serum testing is unreliable. So don’t assume that if your four-year old patient had a negative test for coeliac disease a year ago, she is clear of the disease. If you suspect it’s a possibility, make sure you refer appropriately for testing.

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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

Nutrients in Chronic Pain

Posted: Wednesday, December 18, 2013 at 12:12:00 PM EST by Alyssa Tait

Part 1: Magnesium

Chronic pain is complex; no one can deny that. Anyone who is experiencing chronic pain can think of their pain as a giant puzzle. There are many pieces that make up the picture, and an often-overlooked piece is the nutrition piece. Nutrients, which trigger certain (normal) physiological functions, are one part of this nutrition piece, and magnesium is a single one of these numerous nutrients that play a role in the process of persistent pain.

What is the role of magnesium in the body? Magnesium is a cation that plays numerous roles in various body compartments.

It helps maintain the internal “balance” (homeostasis) within the cell, so is imperative in cellular function. Magnesium has a “calcium channel blocking” action.

It is present in high amounts in the extracellular compartments, influencing excitability of nerves and nerve conduction. It has a role in skeletal, smooth and cardiac muscle function.

It is a cofactor for many enzymes, including those involved in the production of brain and gut neurotransmitters, thus influencing both gut and brain function.

Magnesium seems to be linked to various pain disorders and has some potential to help them:

One study showed a statistically significant link between low serum magnesium levels and myofascial pain syndrome. A 2012 study showed that magnesium supplementation helped to prevent migraine. Magnesium reduced pain in primary dysmenorrhea in a 1992 study. Furthermore, a 2007 systematic review of randomised trials found evidence for decreased postoperative analgesic requirements when magnesium was given.

Is there any evidence for the efficacy of magnesium administration in chronic or persistent pain?

One study showed that giving magnesium before surgery could help reduce both muscle fasciculations (twitching or spasms) and myalgia (muscle pain) experienced post-operatively.

Central sensitisation is a key process underlying chronic or persistent pain. An experiment was done with rats, whereby a drug called fentanyl was administered to produce delayed hyperalgesia (a sort of “exaggerated pain”). This was to try to create an animal model of central sensitisation.  Administering magnesium to the rats partially offset this process, resulting in less pain.

In chronic pain, we know there is abnormal processing of sensation. This is part of the “syndrome”, if you like, that is chronic pain (regardless of where in the body you feel it). Certain receptors called the NMDA (N-methyl-D-aspartate) are involved as “gates” that help process this sensation. Activation of the NMDA receptor leads to abnormal processing of sensation – therefore increased pain. This effect – part of what is known as “central sensitisation” – has effects in the spinal cord, in an area called the dorsal horn, as well as in the brain itself. Magnesium is involved in blocking the NMDA receptor, so that process cannot take place.  This was shown in an experiment with rats with in whom neuropathic pain was induced. The rats developed something called “allodynia” (where a stimulus that is not usually painful becomes painful) and mechanical hypersensitivity (where touch or pressure feels oversensitive). Giving magnesium to the rats “fixed” the allodynia (i.e. made them not feel this abnormal pain to normal stimulus) and delayed the onset of mechanical hypersensitivity, and stopped the change that takes place at the dorsal horn of the spinal cord. Hyperalgesia and allodynia are two aspects of the pain experience that we test in women who have vulvodynia and similar pelvic pain conditions. This makes these findings especially interesting to anyone experiencing these conditions.

Another group of rats was subjected to treatment that creates hyperalgesia. In this experiment, opioid agonists were used to try to resolve the pain (drugs like morphine). The morphine didn’t work – except when the group of rats were given magnesium first, which enhanced the analgesic effect of the morphine. Morphine works in the brain – so it seems that magnesium helps the “brain side” of chronic pain.

Finally, a 2013 study gives us some nice findings on magnesium in neuropathic pain. A 2-week intravenous magnesium infusion followed by 4 weeks of oral magnesium supplementation can reduce pain intensity and improve lumbar spine mobility during a 6-month period in patients with refractory chronic low back pain with a neuropathic component.

Ultimately, magnesium is cheap and fairly harmless as long as you don’t have a kidney disorder.  It’s certainly worth using if you experience persistent pain – and judge for yourself whether it helps. Clinicians working with people with pain should also consider giving magnesium early – before the pain becomes chronic. This might save a whole lot of grief. Not all magnesium supplements are the same, however; absorption (and therefore effectiveness) varies markedly across the different forms. For help in choosing an appropriate magnesium supplement, contact us at Equilibria.

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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

Small Intestinal Bacterial Overgrowth: Could This Be Behind Your IBS?

Posted: Tuesday, March 25, 2014 at 1:45:19 PM EST by Alyssa Tait

Ever felt that everything you eat makes you bloat?

Have your symptoms been dismissed as irritable bowel syndrome? You could have SIBO.

SIBO  - that is, small intestinal bacterial overgrowth. Research is slowly growing on this common cause of abdominal bloating and pain. However, as with all early research, it won’t necessarily have found its way into the mindset of your local GP or gastroenterologist yet.

Research shows that SIBO is common to develop in people who have been put on proton pump inhibitors (for example, Nexium, Losec and Pariet). SIBO may also be present after bowel surgery, which may lead to changes in motility (i.e. the movement through the gut). (On the former topic, there are a number of unwanted side effects of reflux medications, or proton pump inhibitors).

Some research shows SIBO is present in around 40% of people with IBS, but it may be even higher. Common symptoms are diarrhoea (more common than constipation), abdominal pain and bloating. Longer term symptoms can be nutrient deficiencies, leading to low iron (for example) or even iron-deficiency anaemia,

So what is SIBO – how can you find out if you have it – and what can you do about it?

To understand SIBO, you need to know a little about the normal gut. It is normal to have large numbers of normal bacteria in the colon, or the large intestine. However, numbers of normal bacteria in the upper gut, or small intestine, should be much lower. In SIBO, there is an increase in the numbers of normal bacteria in the small intestine. These bacteria are not the “bad guys” – so it’s not the same as having an infection – rather, there are simply too many of them in the wrong place. In this situation, using probiotics (“good bacteria”) is a bad idea. It won’t help, and can possibly make the problem worse.

This increased number of bacteria in the upper gut causing increased fermentation when you eat, leading to the common symptoms of irritable bowel syndrome, especially bloating and pain.

Interestingly, though, SIBO may contribute to symptoms in a whole range of other conditions as well, from fibromyalgia to interstitial cystitis.

Here’s what you need to know about diagnosing SIBO.

SIBO cannot be diagnosed via a blood test or stool test. It can’t be diagnosed via an endoscopy. This also means it cannot be ruled out by an endoscopy. So if you have had a normal endoscopy, and your gastroenterologist says “you’re fine, it’s just a little bit of irritable bowel syndrome”, SIBO is a possibility.

It’s always important to get the main medical things ruled out first. Other conditions with overlapping symptoms include inflammatory bowel disease, coeliac disease, non-coeliac gluten sensitivity and FODMAPS malabsorption. As I have said in another blog post, it's ideal to aim for an accurate diagnosis before excluding gluten from the diet. Symptoms of coeliac disease vary, and there are essentials you should know if suspecting coeliac disease in your child. It may also help to understand the effects of stress on irritable bowel syndrome in more detail.

But if you have had these things ruled out, you may wish to investigate SIBO.

If SIBO is confirmed, there is a very effective herbal antimicrobial and specific dietary regime available for treatment. We are trained in the this at Equilibria.

If you would like more information on whether you could have SIBO, contact 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

Chronic Pain in the Vulva and Pelvis: Retrain Your Brain

Posted: Saturday, August 16, 2014 at 6:54:38 PM EST by Alyssa Tait

Have you ever wished there was a manual to help you outsmart your pain?

Good news – there is. In fact, it is called “Outsmart Your Pain: Twelve Key Insights for Conquering Vulvodynia and Persistent Pelvic Pain”. I wrote this as an e-book to make it accessible to the largest number of people in the shortest possible time frame.

Recent research shows that persistent pain has a lot to do with the brain. The brain begins to process sensation inaccurately, and needs to be retrained in order to resolve the chronic pain.

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But firstly – why would we need a book specifically on pelvic pain anyway?

Persistent pain at the vulva has a lot in common with persistent pain anywhere else in the body, like the back or the knee for example.

However, it is at the same time quite different.

The female genitals are a region of intense privacy and emotional vulnerability. The vulva and vagina are important symbols of femininity, womanhood and sexual identity for many women.

Therefore, pain in this region may be of a different quality and have a particular psychological and emotional impact.

The difficulty in talking about and coming to terms with pain in this area can hamper recovery.

On the flip side, these identity issues can be addressed through education, therapy and self-help methods that are referred to throughout the e-book. These include methods for retraining your brain.

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The e-book also contains a Recovery Workbook designed for you to use over twelve weeks. This section summarises each section and its Practical Tips, and gives you a structured system for following the concrete tips I give you. This is not a complete manual on any type of pelvic pain or vulvar or vaginal pain, but rather a summary of the neuroscience aspect of persistent pain, structured as an educational tool and workbook to help you in your recovery.

Get the e-book here.

If you need the specific help that only a health professional experienced in this area can provide, contact me to make an appointment and get started on your recovery.

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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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