One in four Australians (more than 6 million people) are affected by constipation (1). As dietitians, we know that food and nutrition is central to solving the problem and so ask many questions about bowel movements and fibre intake – but there is another consideration to make. Patients with digestive concerns often present with concurrent increase in pelvic floor muscle tension, which results in chronic constipation, bloating, trapped wind and discomfort. In this podcast, we sit down with dietitian Elissa Robins and physiotherapist Brooke Dobo to talk about the considerations for patients with constipation, experiences and the case studies from their practice.
Elissa Robins is an Accredited Practising Dietitian with 18 years experience across both clinical inpatient and outpatient settings. Elissa specialises in Gastroenterology, Digestive Health and Eating Disorders from a weight neutral approach. Elissa has spent the last 3 years in her own private practice, Inner Health Nutrition, supporting hundreds of people suffering with constipation arising from varying etiologies. Elissa does not claim to be an expert, but continues to learn with each new client and is always willing to share her insights on current best practice and how she applies it in the patient setting.
Brooke Dobo is a women’s, men’s and pelvic health physiotherapist working at The Wesley Hospital, Brisbane. She has completed a Bachelor of Biomedical Science with first class honours, followed by a Master of Physiotherapy Studies and further post-graduate studies in pelvic floor rehabilitation at The University of Melbourne. Brooke is currently completing her Master in pelvic floor physiotherapy and shares her time between treating patients on the acute wards and in the outpatient clinic. Brooke is incredibly passionate about delivering best care for her patients and enjoys treating antenatal/postnatal issues, bladder and bowel dysfunction and pelvic pain, with a special interest in sexual dysfunction.
In this episode, we discuss:
- The definition, causes and diagnosis of constipation
- The process and tools to diagnose pelvic floor dysfunction (PFD)
- What a typical consult looks like with a patient diagnosed with constipation or PFD
- The link between constipation and PFD
- How dietitians can increase their knowledge in the area of PFD
Private dietitian supervision sessions. Group sessions to come: Inner Health Nutrition
1. Werth, B. L., Williams, K. A., Fisher, M. J., & Pont, L. G. (2019). Defining constipation to estimate its prevalence in the community: results from a national survey. BMC gastroenterology, 19(1), 75. https://doi.org/10.1186/s12876-019-0994-0
2. Svedlund, J., Sjödin, I. & Dotevall, G. GSRS—A clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Digest Dis Sci 33, 129–134 (1988). https://doi.org/10.1007/BF01535722
Bijkerk, C. J., Muris, J. W., Knottnerus, J. A., Hoes, A. W., & de Wit, N. J. (2004). Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Alimentary pharmacology & therapeutics, 19(3), 245–251. https://doi.org/10.1111/j.0269-2813.2004.01862.x
Bove, A., Pucciani, F., Bellini, M., Battaglia, E., Bocchini, R., Altomare, D. F., Dodi, G., Sciaudone, G., Falletto, E., Piloni, V., Gambaccini, D., & Bove, V. (2012). Consensus statement AIGO/SICCR: diagnosis and treatment of chronic constipation and obstructed defecation (part I: diagnosis). World journal of gastroenterology, 18(14), 1555–1564. https://doi.org/10.3748/wjg.v18.i14.1555
Drossman D. A. (2016). Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology, S0016-5085(16)00223-7. Advance online publication. https://doi.org/10.1053/j.gastro.2016.02.032
Ho, K. S., Tan, C. Y., Mohd Daud, M. A., & Seow-Choen, F. (2012). Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World journal of gastroenterology, 18(33), 4593–4596. https://doi.org/10.3748/wjg.v18.i33.4593
Lesbros-Pantoflickova, D., Michetti, P., Fried, M., Beglinger, C., & Blum, A. L. (2004). Meta-analysis: The treatment of irritable bowel syndrome. Alimentary pharmacology & therapeutics, 20(11-12), 1253–1269. https://doi.org/10.1111/j.1365-2036.2004.02267.x
Rees, G., Davies, J., Thompson, R., Parker, M., & Liepins, P. (2005). Randomised-controlled trial of a fibre supplement on the symptoms of irritable bowel syndrome. The journal of the Royal Society for the Promotion of Health, 125(1), 30–34. https://doi.org/10.1177/146642400512500112
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