How Pelvic Floor Physical Therapy Supports IBS Relief: Expert Insights from Dr. Molly Bachmann

Jessie Wong 00:00:00 Welcome to the IBS Nutrition Podcast, your go to source for navigating the complex diagnosis of irritable bowel syndrome. Here, we dive deep into IBS and discover the power of diet and lifestyle to find freedom from your IBS symptoms. I’m your host, Jesse Wong, Fodmap dietitian and a gut expert. For years, I suffered from debilitating gut symptoms that kept me out of work, feeling constant discomfort in my body and anxious around food. Today, I’m in control of my IBS. Able to eat the food I love again, travel whenever I want and spend quality time with loved ones. It is my mission to help you do the same and transform the way you live with IBS. Let’s get started. Hi everybody! Welcome to another episode of IBS Nutrition Podcast. Today I have Molly Backman with me, who is a doctor of physical therapy who specializes in pelvic health at pelvic Health and Rehabilitation Center. She attended the University of Oklahoma, graduating with a Bachelor of Arts in ballet performance and global health. After studying public health in India, China and South Africa.

Jessie Wong 00:01:10 She worked as a Peace Corps volunteer in Sierra Sierra Leone during the Ebola crisis. Molly graduated with her Doctor of Physical Therapy degree from the University of Pittsburgh, and has worked in orthopedics and pelvic health. Since graduating, she is also certified Birth Doula, a research associate at USC, adjunct faculty at University of Pittsburgh, and mentor to other pelvic floor therapist. Welcome, Molly. Thank you so much.

Molly Bachmann 00:01:44 Thank you so much for having me and giving me a platform to spread the word about pelvic health.

Jessie Wong 00:01:49 Yes, we have so much to cover today. And here are some of the topics we’re going to talk about IBS and the pelvic floor. So that’s the first topic. How does the mu mu so musculoskeletal.

Molly Bachmann 00:02:03 Yeah it’s a tricky word. Word.

Jessie Wong 00:02:05 Musculoskeletal system contribute to bowel function. A top down approach. So that’s the first topic. The second topic is the central nervous system the pelvic floor and bowel function. What are the effects of the central nervous system on the pelvic floor and bowel function. And topic number three is commonly missed.

Jessie Wong 00:02:24 Pathology contributing to or causing bowel dysfunction, endometriosis, menopause, Sibo and what is the role of pelvic floor therapy in these cases? Oh my God, these are all amazing things that we need to learn more about and really help IBS patients, because that’s of course what we see a lot of as well. All right, let’s kick off with our first topic. IBS and pelvic floor. How does the musculoskeletal system contribute to malfunction?

Molly Bachmann 00:02:55 Yeah. So I really enjoy talking about this, this particular topic, because I want people to fundamentally walk away knowing that there are so many contributing factors to making our bowel system function well, which also means that there are many things that can contribute to making it not go well, and oftentimes sometimes it isn’t as simple as eating more apples in a day. Right. There’s a lot that goes into it. So one of the systems that we always have to consider when it comes to bowel function is the musculoskeletal system. And by that I mean the system that controls your muscles, your tendons, your ligaments, your bones.

Molly Bachmann 00:03:39 Those systems have a very crucial role in making our poop move through our body. Well, and it all starts with our jaw. I usually describe it as opposite ends of the same tube as it relates to the pelvic floor. So we have our jaw and our mouth up top and our pelvic floor like a bowl below. And because they work in opposition to each other and with some degree of symmetry, there is a strong relationship between how the mouth moves and how the pelvic floor moves. So what I consider a part of a good robust pelvic physical therapy assessment includes watching somebody speak, watching them move their jaw, and specific motions and addressing any biomechanical issues of the jaw that we’re seeing. Sometimes we see people who have jaw pain. Sometimes we see people who maybe are only chewing food on one side of their mouth. sometimes their jaw is moving well, but their tongue is not moving well. This is the first place that food enters the body. It’s a vital part of how we ultimately absorb nutrients and create stool in our colon.

Molly Bachmann 00:04:59 So if we’re not chewing food sufficiently, then our stomach and our intestines end up having to do the job of the mouth, which is not fair. We’re not setting everything up for success. We have a lot of chemicals that are released in our saliva to help break down our food, and if we’re not chewing well, we will not digest well. So that’s step number one. And what we mean by top down, we have to look at the whole system.

Jessie Wong 00:05:29 This is something we hear all the time. Because of course in nutrition we talk about eating mindfully. Right. And most of us really don’t do that. And we scarf a food down as quickly as we can in that ten minutes lunch break or even in school. In elementary school, kids only or in all schools in the US, right? They only have 20 minutes to eat food, which for a little child, that means they’re not going to be chewing thoroughly, and they will be learning to really eat things very quickly. And now we know that actually affects the rest of the digestive track.

Molly Bachmann 00:05:59 Exactly. Yeah. And this is where I’m very thankful for my background in more of a public health setting, because I understand fundamentally the importance of eating in community and how important that is to health. So, for example, thinking of our modern day society, that is on the whole very fast paced, we are having to attend to 100 tasks at one time because we have unreasonable expectations of productivity we’re standing to eat instead of sitting to eat. We’re on our phone while we’re eating. all of these things contribute to our digestion. The way that we are biologically designed through evolution to consume food is in the company of others, in a calm setting where we are seated either in a chair, on the ground, in a squat position, and slowly consuming food together. We’re not meant to be in isolation on our phones, scrolling through social media, getting overstimulated. It has a very strong effect on digestion, not just the jaw and the rate with which you’re eating, but also on the central nervous system and how those chemicals are interacting with your colon and intestines, which we’ll talk about a little bit later, too.

Molly Bachmann 00:07:21 The second piece of the musculoskeletal part is the abdomen. so when I talk about the abdomen, I don’t just mean the six pack muscles, I mean the obliques, which are the muscles that come around from the sides into the front. I mean, some of the deeper abdominal muscles, like the transverse abdominis, I mean, the top of the abdomen being the diaphragm, the bottom being the pelvic floor, and even some of the muscles in the back. All of these muscles inherently work together. They turn on together, they turn off together. And that’s what keeps us from falling over all the time. So it’s good that they do that. One of their other roles is in digestion, and the role that it plays is on a very basic level, is kind of like wringing out a towel so that rotational movement of the trunk helps to literally squeeze poop along. When you think about physical therapists in a hospital setting. When I was working there doing some rotations in graduate school, there was a running joke that if somebody couldn’t poop or hadn’t pooped for several days, oh, just call physical therapy.

Molly Bachmann 00:08:34 They’ll get them up and moving and they’ll have a bowel movement. And sure enough, we would get them off the bed, they would start walking and they would have a bowel movement, sometimes even in the hallway. They couldn’t control it. Right. But it’s such a great example of movement. Dynamic movement. Rotational movement is very key to incorporate into your daily movement routine, so that you’re getting that mechanical squeezing of the colon to move that poop along in an appropriate timeline. And then the third kind of most musculoskeletal component of this whole system is the pelvic floor itself. And the pelvic floor is three layers of muscle that sit at the base of the pelvis like a bowl. And their main job is to hold up our organs all day long. But they also keep us from peeing and pooping our pants, which is very good. We like that they do that. The problem is, is that just like any other muscle in the body, they can become really, really tight and restricted and not function well.

Molly Bachmann 00:09:38 They become really, really lax and overstretched and not function well. They can have perfectly normal amount of tension, but they’re not strong enough, or they’re too strong and have too much power. And we need to figure out how to train differently when those muscles are dysfunctional. It affects how your poop is stored in the rectum, and also how it is eliminated at the external anal sphincter. Those muscles act like a gate to open up and let the poop descend and go into the toilet, and they pinch off and close when that poop has been evacuated. So a high quality pelvic floor physical therapy exam is looking at each one of those components and saying, is there a contributing musculoskeletal factor at one of these three places or in multiple places.

Jessie Wong 00:10:31 Right. Oh my goodness. Thank you for sharing that. It’s quite eye opening because oftentimes we think about pelvic floor therapy. We are only thinking about that bottom bowl when the whole thing is really connected. Right. And digestion always starts from no, maybe not even the mouth from looking at the food.

Jessie Wong 00:10:47 That’s when everything starts. but we don’t think about that in terms of pelvic floor muscle. And then another thing I think we all do. maybe not in a good way nowadays, is sitting on the toilet for too long, and that can make our pelvic floor muscle. I don’t know what it does, but I know it can cause dysfunction, right?

Molly Bachmann 00:11:06 Yeah, so certainly doing it one time may not cause an issue. But if you’re somebody who is repeatedly sitting on the toilet for more than ten minutes for a month, a year, multiple years even, I’ve seen over time those muscles get overworked and over strained. And what we see is a phenomenon similar to an overuse injury, where the muscle either cannot accommodate that pressure and just kind of gives way, in effect, kind of being overstretched or as a result of that constant straining or sitting there, they have a reaction to that pain or discomfort and become too tight. which is also a dysfunctional state. And so a pelvic floor PT will be able to tell you, you know, kind of which category you fit into and therefore what the best line of treatment is for you.

Molly Bachmann 00:12:10 but not only is that going to affect kind of the the baseline tension of the muscles, it can also affect your coordination. So you may have great strength, but you may not know how to relax your pelvic floor sufficiently or let go. Or maybe because you’ve had, let’s just say for the sake of example, constipation for so long and your stools are are over and large. Now the sensation to perceive fullness is altered. And so in physical therapy, in those cases, we’re working on more of what we would call biofeedback techniques to change your brain’s perception of what true physiologic fullness is in the rectum.

Jessie Wong 00:12:58 That’s great to know. All right. Well, before we move on from this topic, and we did this on the IG live, can you walk us through really quickly what an assessment looks like so that we can get everybody prepared when they go into a pelvic floor? PT what to expect?

Molly Bachmann 00:13:14 Yeah, of course there’s going to be some variation in this depending on the individual symptoms, the skill set of the physical therapist that you’re working with, just a lot of factors, the amount of time they have with you.

Molly Bachmann 00:13:27 But generally speaking, you walk into the room, you’re going to sit down or stand if that’s more comfortable. And we’re going to talk for at least 15 minutes, if not more. Taking in a thorough history, when did your symptoms start? What have you noticed about your symptoms? Who have you seen to try to help you with this problem, what medications you are on, etc. etc. etc.. then typically we spend some time educating the patient on the musculoskeletal system. All of the factors that can be involved in pelvic floor muscle dysfunction. and then the way that I work is, I will say, well, based on what you had to share with me and what I know about the musculoskeletal system, here are the things that I think are most important to evaluate. And here’s how we do them. Sometimes I’m watching people move. So I may be watching them do some squats, or I’m checking their hip range of motion, their lumbar range of motion. Or maybe I’m watching how they’re breathing and then typically what we’ll do is we’ll move to a more specific pelvic assessment where I’m assessing the skin of the pelvic area.

Molly Bachmann 00:14:41 Sometimes that may include the genitals. If somebody’s also having genital issues as well as their bowel issues. I am externally with a gloved hand touching the different superficial muscles, looking for any kind of trigger points or tension, anything that might reproduce somebody’s symptom. And then with permission, sometimes we will do an internal exam. If somebody is coming in for about a bowel issue, that usually means a rectal exam where I gloved finger is being inserted into the anus and rectum so that I can palpate every single one of the deeper pelvic floor muscles. Again asking myself, are these muscles tense? Are they really lax when I touch here? Does it reproduce your symptom versus over here? I ask people to contract so I can understand how strong their muscles are. We do some endurance holds some fast twitch activation. I’ll ask them to bear down and show me how they’re pooping, so I can understand the mechanics of that. And then we’ll remove my finger and talk about all of the objective findings that I think are contributing to somebody’s symptoms, and come up with a treatment plan from there.

Jessie Wong 00:15:56 Well thank you. That’s very detailed. And I’m I’m assuming everybody has a different treatment plan, right?

Molly Bachmann 00:16:02 Correct. Yeah. I really am of the belief that, you know, if you’re a therapist who’s giving out the same exact thing to every single patient, you’re probably not doing the best that you can. every single person is different, even if they have the same diagnosis. And that means that every treatment plan should be different and very individualized to the specific patient.

Jessie Wong 00:16:28 Okay. Well, thank you for that. And I think that’s a really good overview for everything we need to know about the pelvic floor muscle. And of course, what is the top down approach and how the assessment is done. And that sounds like a very thorough assessment really from the top to the bottom. And that’s amazing. You can do that. And for listeners, you know that’s how you can prepare for it. Don’t worry. We are all health care providers. Even if somebody is looking at your private areas, you don’t have to be nervous and you have a private room for all of this, right?

Molly Bachmann 00:16:59 Yep.

Molly Bachmann 00:16:59 And, you know, oftentimes people may feel more comfortable with their loved one or a trusted friend, somebody in the room that is always an option. it is your session. You have a right to make it feel as comfortable and as safe as possible. And we try to accommodate all of those things to make sure that you feel safe.

Jessie Wong 00:17:22 That’s really good to know. Okay. Well, this let’s move on to our next topic, the central nervous system in pelvic floor and bowel function. What are the effects of the central nervous system on the pelvic floor and bowel function.

Molly Bachmann 00:17:36 Yeah. So the central nervous system is complex. And what we mean by the central nervous system we mean the brain and the spinal cord. One of the main functions of our central nervous system is this background functioning that we don’t have to consciously think of, which is very important because if we had to think about our bladder all the time, we wouldn’t be able to, you know, forage and hunt for food, for example.

Molly Bachmann 00:18:06 we would just constantly be thinking about the bladder and the filling and what this means, right? There’s a reason why, you know, when you have to pee and you don’t necessarily have to think about interpreting that information from your body. The same is true for the bowels. And a lot of this is wired through two different kinds of nervous system functions. One is the sympathetic nervous system and the other is the parasympathetic nervous system. The sympathetic nervous system is the one that we call fight or flight. That’s the nervous system that gets activated when we see a bear, where we see a potential threat to our life. That nervous system is what allows us to run away from the bear, or to fight the bear, to protect our life. The other nervous system. The parasympathetic nervous system, is what we call rest and digest. This is the nervous system that gets activated or should get activated when we’re digesting food. When we’re relaxing, we’re reading a nice book or listening to some nice music in the company of good friends.

Molly Bachmann 00:19:15 That’s the nervous system that is being activated in those moments. All of those nervous systems have very, very strong input into our organs. And this is very necessary because let’s say, for example, you’re sitting around a fire outside camping and all of a sudden out of nowhere, a bear shows up. So when you’re sitting around the fire, you’re relaxed, you’re enjoying company. All of a sudden that bear shows up and you feel that sensation of your organs or your stomach dropping in your belly. Well, what’s happening is that in that moment is your body has perceived a threat. So all of the blood flow and electronic signaling through the nerves is being shunted away from the organs and to your muscles of your body, and that’s a necessary function so that you can again run away from the bear or fight the bear to protect your life. It’s so wonderful that we have this system. It’s very pretty brilliant, if you ask me. The problem is, is that our central nervous system cannot distinguish between the threat of a bear and work stress, or relationship stress, or some sort of traumatic event.

Molly Bachmann 00:20:35 Your central nervous system is going to work the same way. So again, coming back to the digestive system, when you’re more in that sympathetic nervous system, that blood flow and nerve ending activation is more in the muscles and lessen the organs. And what that means is your colon is not moving poop along at an appropriate speed, because your body is more focused on running away from the bear than digesting. So when it comes to work stress, just as an example, if you’re somebody who’s working 80 hours a week, three jobs, trying to make a buck, trying to live in this world that is hard to navigate, sometimes That likely means that your sympathetic nervous system is more active than your parasympathetic nervous system. These are the people who often get diagnosed with IBS, specifically either constipation or diarrhea, or sometimes mixed right. And they take all these different meds and nothing is working. Well, likely it’s because you haven’t addressed the root cause of the problem. Why is it that your body isn’t digesting well? Sometimes it’s because of a central nervous system problem, and therefore the appropriate interventions for those people are going to be very different than the people who have something like a Sibo, a bacterial problem, or an infectious problem or some sort of pathological issue.

Molly Bachmann 00:22:14 and this is I see so many people who come in frustrated. I don’t understand why I can’t get help from physicians or whomever. Listen, the job of physicians is very important. Their skill set is trained to look for these pathological issues. If you don’t have a pathological issue that’s causing your symptoms. That physician may not be the best person for you. They should either be referring you to somebody else, or maybe you have to do some investigation on your own, some critical thinking and trying to interpret what your body is trying to tell you. So I think it’s very important to bring up this central nervous system point, because I see a lot of people who are very dysregulated in their central nervous system and therefore don’t get a lot of success with various treatments because, again, they haven’t addressed the root cause of the problem.

Jessie Wong 00:23:08 I love you mentioning all of this because it is true. And that’s what we see in our clinic as well. And when we talk about the central nervous system, we are really meaning adjusting a person’s lifestyle or maybe finding things that you can tweet, maybe even just small tweeting, right? Like sitting down to eat a meal and really focus on you instead of getting distracted, or maybe taking a walk during the day or earlier on in the day to really activate your body’s system or waking it up and, all of those things.

Jessie Wong 00:23:34 So having a good night of sleep, I think that’s something people always overlook. Well, I think most people knows how to how important sleep is, but how to get to a better sleep, that’s a different thing, right? But all of those things together can really help us improve our central nervous system. And not just relying on maybe medications to, you know, suppress the symptoms. Correct. And yes, like you said, the root cause, right. What is really causing all of your symptoms and how do you get to it? How do you address it? It’s maybe not by medications like some medications may help, but, you know, if you’ve tried medications, they didn’t help you. You know, they’re still the diet and lifestyle approach that you can try. And it really does work. There was actually a research that came out recently saying that diet and lifestyle works a lot better than medications in terms of IBS. And of course, you know, we are all cheering that on.

Jessie Wong 00:24:28 And of course, pelvic floor is a huge component to it because a lot of people with IBS will have some sort of pelvic floor dysfunction, and it’s always good to get an assessment with a pelvic floor, someone who is very specialized in this area. Exactly. Yes. Let’s move on to our third point, which is commonly misdiagnosed. Pathology contributing to or causing bowel dysfunction. endometriosis, menopause, Sibo and what is the role of pelvic floor therapy in these cases?

Molly Bachmann 00:25:04 Yeah, so I specifically chose these three diagnoses because I just see such a high rate of people who’ve been diagnosed with IBS, but actually have one of these three things. and I think from a general education point, it’s important to bring these up so that people can advocate for appropriate testing. specifically with endometriosis. And I was just explaining this to a patient this morning. historically, we have considered endometriosis to be a condition that just affects the uterus, and the symptoms would be extreme Heavy bleeding. Extreme pain during your periods and infertility may be pain with sex.

Molly Bachmann 00:25:53 The problem with that historical thinking is that what we now know today is that endometriosis is actually a whole body disease, and it has been found in every organ in the body, including the brain. And I think this is important to bring up, because I have certainly seen people who have serious period issues and also constipation or diarrhea. But I have also seen people who have perfectly wonderful periods, and their only symptom is constipation. And the constipation is particularly worse in and around the menstrual cycle. The period cycle. These are really important clues that what you’re experiencing may not necessarily be a true IBS issue, but it may actually be that you have endometriosis on your bowel. Sometimes this can also cause painful bowel movements or painful digestion. It may also cause pretty extreme bloating when you eat food. the tricky part about this diagnosis is that unless you happen upon a wonderful doctor who’s very, very up to date and has a really robust understanding of endometriosis, you may not be getting this diagnosis until you see and endometriosis excision specialist who is really well qualified to examine and treat endometriosis on these various parts of the body, including the bowel.

Molly Bachmann 00:27:33 So I bring that up a lot because I’m always screening for endometriosis when I’m working with people who have bowel issues, especially if they have a history of period issues as well. but this is something that’s that’s really important for people to consider when they’re on their IBS journey, is that there may actually be something there that hasn’t been seen before. And the tricky part is, is that if you see a colorectal doctor or a gastrointestinal doctor, what they’re trained to do is look on the inside of the intestines. But endometriosis is on the outside of the intestines, so this is something really important to consider. There is still a significant role for pelvic floor therapists for these particular patients. And again this goes back to the musculoskeletal system. It goes back to that fight or flight system. When you’ve experienced medical trauma, medical gaslighting, when you’ve experienced pain and discomfort and dysfunction for a long time, your muscles are going to have the same reaction as when you put your hand on a hot plate and retract your hand away really quickly.

Molly Bachmann 00:28:43 Those muscles want to protect you. They want to keep you safe. It’s a beautiful thing. They’re trying to keep you safe from something they perceive as a threat. In the case of endometriosis, that is threatening to the musculoskeletal system and nervous system. So we tend to see a higher correlation of pelvic floor muscle tension or tension in the pelvic girdle area, even the abdomen in these cases. Now me as a PT, I can’t take the endo out of your body. I wish that I could, but I can really help you deal with the collateral damage of endometriosis, certainly if people are getting surgery. But even if not, we can really help to manage some of those secondary symptoms that come up like pain and tension in the musculoskeletal system. So endo is a big one. I’m very passionate about it. I probably could spend a whole weeks worth of podcasts talking to you about about endo. But the studio.

Jessie Wong 00:29:46 Oh yeah. So we’re going to talk about endo resources for patients who may be listening to this.

Jessie Wong 00:29:50 So there is a website is called Nancy Snook and Dotcom. So n a n c s n o o k and dotcom. Nancy Snook has a directory where you can look for providers who specializes in endo. And on there you’ll find a lot of pelvic floor therapists on the list as well that maybe can help you, or maybe help you get to the next step of where you need to go with your diagnosis. And like Molly said, this is actually something we see very often gets diagnosed as IBS. And then, but it’s a lot different than IBS because there is physiological change in the body, in the organs. So you should always see a specialist and get the right test. And however, there’s not a whole lot of tests. I think the only way to diagnose endometriosis is doing a, endoscopy. Know what to do?

Molly Bachmann 00:30:50 laparoscopic surgery. So, yes. and I will add to that to that list. I care better. Dot com is a newer but very well curated and vetted list of surgeons of dietitians, of physical therapists, who really want to be treating people with endo.

Molly Bachmann 00:31:15 There’s lots of people who are pelvic floor therapists who don’t necessarily want to specialize in the pain syndromes, and some of these more harder ones to treat. It’s called I care better, I care better.

Jessie Wong 00:31:30 Okay I’ll put it in the show notes.

Molly Bachmann 00:31:33 That’s my go to resource. Yeah. So resources like that are really wonderful to look at. And again this is a disease that really needs to be treated holistically. Meaning from a multimodal approach, you should be working with a surgeon and an ob gyn and a pelvic floor therapist, and a nutritionist or dietitian and maybe some other services, because, again, it’s a whole body disease. It’s not just something that affects one part of the body. And then the next topic that I want to talk about is menopause. So this is also a time of life where I see people, sometimes for the first time, developing IBS symptoms. and certainly there can be probably multiple reasons why. But one of the major reasons why is because we actually have estrogen receptors in and along our GI tract.

Molly Bachmann 00:32:33 And so when we’re entering menopause and we start to lose estrogen in our body, we lose some of the motility in our colon, which can affect our digestive function, either causing constipation or diarrhea. Though I tend to see more constipation issues. I would say we have new and emerging, research about menopause. beyond just the loss of a period. Again, this is something that affects the entire body, including our brains. We have estrogen receptors all over, including in our joints. We tend to see a lot of people get diagnosed with fibromyalgia when really it’s menopause. And so these are people that, specifically in the first ten years of losing your period, really need to be on some sort of hormonal replacement therapies as prescribed by a menopause specialist, and you can find one near you through the North American Menopause Society website, NAMs for short and AMS. and those are people who are uniquely qualified to work with people in menopause and have gone through advanced training know how to prescribe these medications safely and appropriately. again, these are people who should also be working with pelvic floor PT similar to endo, when your body is perceiving a threat or a change, the musculoskeletal system is going to react.

Molly Bachmann 00:34:06 And so pelvic floor therapists have a unique position not only to provide education and referrals and get people to the right providers, but to also work with and treat the surrounding musculoskeletal system that may be contributing to their symptoms, helping them develop healthy routines, etc., etc..

Jessie Wong 00:34:26 Right? Okay. Thank you for sharing that resource out. Definitely include it in our show notes. All right. Last but not least Sibo small overgrowth.

Molly Bachmann 00:34:37 Yes. So this is also, I think, an what I would say more of a newer diagnosis in the consciousness of, of physicians. And it’s an overgrowth of a bacteria in the small intestines. It is typically diagnosed through a breath test, where you’re breathing into a machine. these people may need some initial antibiotic treatment from specific antibiotics. occasionally I see people who need multiple rounds, to address that bacteria. What I often have a problem with is that, physicians may not always refer these people to highly trained dietitians. who really understand the gut microbiome in a way that not everybody understands.

Molly Bachmann 00:35:30 And so, again, if the only thing we’re doing is getting rid of this bacteria, but not promoting certain things to create good bacteria, then we may very well end up in this cycle again. And when again when it relates to pelvic floor therapy, we see a high correlation of people who have Sibo, who also develop pelvic floor muscle dysfunction, either because of the habits they’re forced to use to have a healthy bowel movement, or because of, again, this central nervous system relationship to the surrounding musculature. sometimes I see people who have Sibo who I touch their belly and their belly is cold. meaning their their abdomen isn’t actually getting enough blood flow, and those organs aren’t getting enough blood flow. That is certainly a a really good person to be referred to pelvic floor therapy. because we can help with that. if Sibo is causing constipation. same thing. We see a lot of really tense disconnected muscles. Those things can be retrained and corrected, to help with those with those symptoms. So that’s all I have to say about Sibo right now.

Jessie Wong 00:36:46 Absolutely. And I think with Sibo, we see a lot of those in our clinic as well. And oftentimes, like you said, people have been on multiple rounds of antibiotics. Now, for anybody else listening, antibiotics is an important first step to really help you remove the bacteria and remove the overgrowth. But ultimately you need to understand what is causing the overgrowth to happen in the first place, or else recurrence rates with Sibo is really high. And what we tend to see is patients being put on extremely restrictive diets, like the elemental diet or the low fermentation diet, or even the simple diet after they’ve been treated with antibiotics for multiple times and still not success. And then they are put on these diets in the hope to suppress the growth of the microbes. However, you know, what we tend to see is once we understand what may be contributing to the microbial overgrowth and stop that from happening, people don’t have to stay on extremely restrictive diets and are able to expand their diets, which is why, as a dietitian like Molly, you said, you know, it should be referred to a highly trained dietitian.

Jessie Wong 00:37:50 As a dietitian. We really do not recommend any long term restrictive diets because in the long run, what works to help replenish your gut microbes is by eating a good variety of plant based food. And all of these diets that I mentioned about just now, they remove the variety. And when you are not eating a good variety, it’s really difficult to re-establish a good gut microbiome. And why? Most of the time you will hear dietician talk about the low Fodmap diet and the low Fodmap diet. We love it because it’s not a long term diet. It has reintroduction phase for you to understand more about what you tolerate and how much of it you tolerate, so that you can continue to eat the food that helps re-establish your gut microbiome, right? Depending on how long, how many times you’ve had antibiotics or how long you’ve been on a restrictive diet, we want to slowly reintroduce the better foods that foods that actually are gut microbes ferments in your gut. Now, if you have stable right now, if you have overgrowth in your small intestine and you eat high Fodmap foods, it’s going to ferment in a small intestine is going to be very uncomfortable.

Jessie Wong 00:38:58 It’s going to cause a lot of discomfort. But once you understand or remove the overgrowth and really help improve the gut motility, which is what we see a lot in Sibo, then you’ll be able to tolerate those foods again. So thank you so much for bringing that up. Sibo is one of those really, annoying diagnosis because it never seems to go away unless you know what is going on, what’s causing the motility change and causing the shifting gut microbiome? Exactly right. Oh my goodness. This is amazing. Thank you for sharing your knowledge with us. And I’m sure our listeners are learning a lot. And, you know, think about something else they can do is going to have an evaluation with a pelvic floor specialist. And also knowing all the conditions you mentioned about above, they can advocate for themselves if there are something that may not be IBS, but or may have overlapping symptoms as IBS. Now, Molly mentioned to me before we recorded the episode that you are going back to school to study, PhD in public health, right? So global health.

Molly Bachmann 00:40:09 Yeah. So I will be, attending the University of Michigan to get my PhD in health policy with the hopes of gaining a robust amount of research skills so that I can influence how evidence based practice is disseminated to physicians and therapists and dietitians. Dietitians. Right now, the gap between when clinical research is created and when it’s actually implemented into practice, on average is about 15 years, which in some cases is deadly for some people and certainly causes needless suffering. so my hope is to be able to influence policy, whether it be hospital policy, federal government policy, state policy, local policy that affects implementation, what we call implementation science and pelvic health. and I also will be studying bioethics, which is the study of how we make moral decisions about health care. I know we have kind of alluded to it on and off, but, the the patients that I care for in the world of pelvic health really have been neglected by this medical system. There are a lot of very explicit historical reasons why that has been, and certainly has been influenced by our society and our culture.

Molly Bachmann 00:41:38 And I’d like to better understand that and be an agent for change to again manipulate some of those biases in how we treat and allocate resources for people with pelvic floor issues.

Jessie Wong 00:41:50 Thank you for going into it and doing this. You are going to change America for better. Especially in the area of pelvic health. Yes and yes. There is a huge lag right in the medical system and how we implement what do we call it, tertiary supports or allied health supports, especially in the GI area or in the pelvic floor area. Exactly. Thank you for doing that, and we wish you the best luck in your PhD and getting through all of it. Yeah. All right. We want to end the episode with five rapid fire questions. Are you ready?

Molly Bachmann 00:42:27 Yes.

Jessie Wong 00:42:29 All right. What is your go to weekday dinner?

Molly Bachmann 00:42:33 Thai green curry.

Jessie Wong 00:42:35 Love that. Okay. Coffee or tea?

Molly Bachmann 00:42:38 tea.

Jessie Wong 00:42:39 Early bird or night owl?

Molly Bachmann 00:42:43 Midday. Yeah.

Jessie Wong 00:42:47 Favorite way to relax after a long day?

Molly Bachmann 00:42:52 Cuddling with my dog and reading a good book.

Jessie Wong 00:42:57 Well that’s kind of my next question. What’s the last book or TV show you binged?

Molly Bachmann 00:43:04 TV last TV show that I binged was the first four episodes of the third season of Bridgerton on Netflix. And the last book that I just finished, is a book called I’m Glad My Mother Died. which sounds very morbid, but it’s a memoir written by Jeanette McCurdy, who was a childhood actor. and it actually has given me a lot to think about in terms of trauma and the central nervous system functions that we were talking about. And some of the patients that I see.

Jessie Wong 00:43:39 Well, that’s amazing. I need to look up that book. I mean, especially in the age of social media, right? There are a lot of parents accounts where the kid is the center of focus without actual consent. That is happening, and I wonder how much if that would play into trauma later in life. Wow.

Molly Bachmann 00:43:59 I have a feeling that there’s probably going to be, unfortunately, a lot more people like that.

Jessie Wong 00:44:05 Okay, so tell me the book’s name again.

Molly Bachmann 00:44:08 I’m glad my mother died. Okay. It’s it’s a very intense, like, book title, but it definitely draws you in.

Jessie Wong 00:44:17 Okay, so for anybody who may be able to handle a stressful book situation, that could be a good read, but it may not be for everyone.

Molly Bachmann 00:44:25 Correct.

Jessie Wong 00:44:26 Right.

Molly Bachmann 00:44:27 Yeah.

Jessie Wong 00:44:28 Thank you so much for joining me today. And for, you know, sharing your, what I said, your wisdom with us because it is very helpful for patients with GI disorders to hear the pelvic floor side of things. And what are some of the things that they can take action on to advocate for themselves, to maybe actually get better treatments that they need. So thank you so much, Molly, for joining me today. And thank you, our audience, for joining us as well. All right. Again, thank you so much. You.

Molly Bachmann 00:44:58 See you later.

Jessie Wong 00:44:59 Thank you for tuning into the IBS nutrition Podcast. We hope today’s episode has brought you closer to understanding and managing IBS.

Jessie Wong 00:45:07 Remember, you are not alone on this journey and finding freedom is possible. For more on IBS, make sure to follow us on your favorite podcast platforms and please leave us a five star review! We would really appreciate that you can access links mentioned in this episode in the show notes, to learn more about your type of IPS and how to identify your own food or lifestyle triggers, Register for a free IBS masterclass. Three steps to IBS relief for our proven, holistic, three steps approach to managing IBS once and for all, head to IBS dietician. Com forward slash masterclass to register. Until next time, take good care of your gut and here’s to your health and happiness.