Constipation and Vulvar Pain
I always thought that if I could learn more and more information about VVS, things would become easier and more simple to understand. It has turned out, however, that it's quite the opposite. The more I know about VVS, the more I understand just how complex this whole pelvic pain situation is. Rather than that being a source of frustration though, it strikes me that the ability to approach the same problem from many different directions gives me a much greater sense of hope to really get it figured out.
In a series of emails, I'd like to try to cover some of the different factors that can lead to vulvar pain; for the first topic, I've chosen to cover constipation as it seems to be a rarely talked about yet important subject.
(Note: a "chicken and the egg" argument can often be made for which of the factors came first. I'd like to side step that discussion as I don't feel that it adds to my ability to deal with the problem at hand.)
Chronic constipation. The standard "normal" bowel movement frequency is at least once per day. A healthy digestive tract should, in theory, balance how much goes in to how much goes out. (As in, if you eat 3x a day, you should, theoretically, be going 3x a day. But that's the "perfect" digestive tract; once per day is still considered normal.)
To most of us, this is relatively unheard of and many women (with or without VVS) really struggle with staying regular.
Why Dealing With This Is Important:
While staying regular is important for everyone (think of it as a back up sewage system...that almost always gets me in a mind frame to tackle the problem!), it is especially important for women with VVS.
Why? Constipation puts an enormous amount of pressure on the pelvic floor. What's worse, straining to have a bowel movement can cause pain for up to two weeks later, IF treated. So you can imagine what happens if you do nothing about it at all.
What does pelvic floor pressure do? Pressure means that your pelvic floor muscles tighten, shorten, and spasm which in turn sends the signal to the nerves to react. And that, of course, leads directly to what you feel as pain.
Constipation also leads to the tightening and shortening of the muscles of the rectum. End result: rectal pain that is similar to vaginal pain. While many women don't realize that they have rectal pain due to the fact that they don't pursue anal penetration, it is still a very important problem to address as the pain between the vagina and rectum can be referred back and forth, creating a vicious cycle of tension and overly active nerves.
(Note: this topic is so important, in fact, that it calls for its own email...more on this later.)
With the facts above, I hope it is apparent why I think constipation must be controlled. Luckily for us, there are many things to try when it comes to staying regular. So as always, a list!
8 Ways to Beat Constipation
These treatments for constipation can be used in certain combinations but I definitely don't recommend that you try them all at once (you most likely will get the opposite effect). What I have done is tried one at a time and then added/removed supplements by gauging my body's reaction. The best thing to do, of course, is to go to your doctor or naturopath for direction on this matter which is what I eventually did.
Magensium is a girls best friend in fighting constipation because it acts as a muscle relaxer. Unfortunately, many women are deficient in it which is why taking magnesium supplements is so important for digestive health. It comes in many different forms (you might have seen this at the store); this is why a little trial-and-error is called for with this one.
To add to the confusion, it is also sometimes necessary to take several magnesium-rich supplements simultaneously to achieve the effect that you are looking for. For example, I take 3 different supplements with magnesium in it on top of some the other remedies. Again, it's a good idea to be kind to your body and don't overwhelm it with too much at once.
a) According to my physical therapist (and reiterated in several pelvic pain books; Secret Suffering is just one such example), the best form of magnesium to take for constipation is Magnesium Oxide; these can be bought at pretty much any any drugstore. The dosage varies from person to person but most health care professionals recommend starting at 500 mg and moving up to 800 mg. b) Magnelevures--this is magnesium in powdered form. I have taken anywhere between one packet and a packet and a half each night. (My naturopath recommended that I start with one packet for a couple days to see the effect and then gradually upping the dosage until I began to experience regular bowel movements.) c) Ca/Mg supplements--taking these alone didn't help me much with constipation (probably due to the Ca in them) but taking them along with other remedies seems to be helping quite a bit. (I take one in the morning and 2 right before I go to bed.)
Now, the following supplements were recommended to me by a medical professional; they are made by a company called Nature Sunshine which is what she prefers to use. Unfortunately, these are proprietary blends so that I can't say much about alternatives to these. If you would like to use these products exactly, I believe you can buy them at most health stores. If you don't want to buy the Nature Sunshine products, I recommend sitting down with a doctor or naturopath and looking at the labels online so that you can find supplements that have similar ingredients.
c) Skeletal Strength--essentially, this is a blend of different forms of magnesium which will help with constipation (so don't let the name fool you!). It works for me to take 2 tablets, 2x a day. d) Fibralgia--this supplement is designed to help the communication between muscles and nerves. The reason this can help is apparent when you think about what may be happening in your body (PS: this is obviously highly simplified so all you science/medical folks please bear with me here): when your colon gets full of waste material, it presses on the surrounding muscles. When these muscles get the message, they signal other nerves to continue the message on up to the brain. Once the brain gets the message, it sends another one down the nerves to fire other muscles which are responsible for the actual process of going to the bathroom. When one or more of these messages gets "lost", constipation can occur. This supplement helps feed both the muscles and nerves so that the muscles can relax/function properly and the nerves can relay the signals. I take 2 capsules a day (once in the morning and once with dinner).
This green stuff is a powerful tool when it comes to constipation because it is an intestinal detoxifier. It helps to maintain proper function of the intestinal tract so that waste does not remain in the intestines for longer than it should (making it easier to eliminate).
I take 3 capsules a day, 1 with each meal; dosage, however, can be tricky with chlorophyll (because too much can cause diarrhea and too little won't have enough power to do anything) so this is something to ask your doctor/naturopath about.
PS: It will most probably turn your bowel movements a rather bright green. Don't be alarmed! I did something of a quadruple-take when I first saw this and immediately called my PT. She has assured me that this is perfectly normal.
PS again: I mean it when I say both "powerful" and "detoxifier". I know that each person reacts differently but I, as a fellow woman, do feel the need to give you a heads up about this. :)
3) Fiber Intake
This one is often talked about so I will assume that you know the importance of proper fiber intake.
I will, however, share a recipe that was left on the VVR website (which was originally found on the ic-network.com) that can help you increase your fiber intake without eating, say, 10 bowls of salad. (PS: Strangely enough, 2 days after I saw this recipe on the website, my PT also gave me this exact same one.)
Here's the recipe as I found it on the website:
"1 cup of unsweetened apple sauce 1 cup UNPROCESSED Wheat bran (sometimes called Miller's bran) 1/4 cup prune juice
Mix all ingredients together. Take 2 tablespoons a day for one week and drink with a full glass of water. If bowel movements are not greatly improved increase to 4 tablespoons a day for one week and continue to increase as needed. The maxium dose is 8 tablespoons a day. Each time you take the recipe you need to drink an 8 oz glass of water with it. The mixture will keep for aobut a week in a plastic container in the refrigerator. I make it up weekly and am only having to take one tablespoon a day. It works so well. Better than anything I have ever tried, even metamusil or citicel."
One drawback of this one is that it is more involved than the other remedies but I have to agree with the person who left this one the website, it does work well.
I use this one the least out of the treatments I have listed here because, in my personal opinion, it seems to be more useful as a short-term solution rather than a long-term and holistic one. I used it as I was finding more long-term solutions with quite a bit of success and I still use it occasionally when my fiber intake is low; but I have discontinued using it every single day. That all being said, it is very good at what it does: alleviating constipation and adding more fiber. Some women have used it each day for long periods of time and have really enjoyed the benefits.
The idea behind probiotic supplements is to encourage a healthy environment in the intestines so that food can be efficiently and readily broken down. This alone probably won't get rid of your constipation problem but I really believe that probiotics have helped me get on the right track to digestive health.
6) Relaxation Exercises/Massage
When I know that I've skipped a day of having a BM, I immediately use the tennis ball massage that I refer to in the article "Deconstructing Physical Therapy" (http://vulvarvestibulitisrelief.com/articles/21). I find that if I can release some of those muscles, elimination usually follows.
On top of that, my PT has me do rectal dilators for 7 minutes during my appointments (a very small one that is kept in the fridge until we're ready to use it). While this does not constitute as a "massage", it does put pressure on the surrounding muscles which forces them to relax. And while this is not the most pleasant activity to do for 7 minutes, I have to admit that it has made a big difference.
I also have really taken to doing breathing exercises throughout the day. Between sitting at work, running around to get errands done, and experiencing general every day stress, I know that my intestines and surrounding muscles tend to tighten up; deep, abdominal breaths help to not only alleviate the mental pressure behind stress but also help relax the muscles of the pelvic floor. That being said, this is not a quick fix but something that helps over time.
For anyone who is interested in more relaxation and massaging techniques, I highly recommend reading the book Heal Pelvic Pain by Amy Stein. The book is designed to move you through a program to decrease pain levels at home (as in, she assumes that you may or may not be going to an actual physical therapist) but she discusses constipation quite a bit. As a result, there are many suggestions for ways to encourage regularity.
I find it hard to argue with something that has been used for about 5,000 years; the whole idea behind using yoga for constipation is to use your body in such a way as to promote the proper functioning of muscles, often through bending and twisting. Here's are a couple routines to try:
a) <a href="http://yogaindailylife.blogspot.com/2007/01/yoga-for-constipation.html"> Yoga for Constipation</a> b) <a href="http://www.yogacards.com/constipation_indigestion/constipation.html">Constipation and Indigestion</a>
8) Food sensitivities
If you suffer from chronic constipation and nothing seems to be working for you, it may be worth getting tested for food allergies and food sensitivities. (Note: Many doctors do not test for food sensitivities so you may need to go to a naturopath for this one.)
You may also determine if you have food allergies/sensitivities by following a "food elimination" diet; this can, however, be quite a time consuming (and even sometimes expensive) process so be prepared if you choose to go this route. That being said, here's a website that discusses how to do the elimination diet: http://www.kitchentablemedicine.com/allergy-elimination-diet/elimination-diet/
Notes on Constipation:
1) Straining is a bad idea. This one is really important for keeping pain levels low; see above for reasoning.
2) Ignoring the need to go is also a not so great idea. The longer waste sits in the colon, the more water will get reabsorbed by the body. This hardens the waste and makes it difficult to eliminate later. (Refer back to Note 1 for further reasoning.)
3) While this one is not as direct of a note as the other ones: it is a good idea to chew your food properly. It goes without saying that bigger particles are more difficult and time consuming to break down for the body. Be kind to it and do more of the work.
4) I have found that it helps to check your medications for constipation as a side effect. I was really struggling with alternating constipation and loose stools until I looked up the side effects of the Singulaire that I was taking only to find that many people were having the same problems. I've been off the medication for 2 days (still waiting to hear how I should adjust the dosage) and the symptoms disappeared!
While this list may not be the more comprehensive, it can definitely be a place to start; that being said, I'd love to expand on this topic so please leave suggestions in the comments section of this article if you are aware of other remedies that work. Thanks in advance :)