By Kim Buonomo, DPT, PHRC Lexington
What is fiber and why is it important to a pelvic floor physical therapist? The American Physical Therapy Association has stated that diet and nutrition are key components of many conditions managed by physical therapists. Nutrition can directly affect recovery and function while an individual is under a physical therapist’s care. Thus, PTs should be concerned with and address nutritional intake and eating patterns of their patients and clients. I argue that diet and nutrition are especially important to consider in the realm of pelvic floor PT and here at PHRC we are lucky to have access to great nutritional resources, especially our Integrative Functional Nutritionist, Jandra Mueller.
Since my personal passion is bowel function, I have done a good deal of research into dietary factors that affect the digestive tract. Before I tell you all about fiber: a pop quiz!
- Do you know how much fiber you should have per day?
- What does fiber do for you anyway?
- What foods are good sources of fiber?
- Can fiber help patients with irritable bowel syndrome or constipation?
By the end of the article, you should have all of these answers!
Fiber is a great way to help improve bowel function. Fiber is the indigestible part of plant foods that travels through our digestive system, absorbing water along the way and easing bowel movements. There are two types of fiber: soluble and insoluble.
Soluble fiber slows down the absorption of sugar and fats in the blood, which helps regulate blood sugar levels. This type of fiber binds with and removes cholesterol from the bloodstream, which helps lower LDL, or “bad” cholesterol.
Common Sources of soluble fiber include:
- Oats
- Oat bran
- Barley
- Dried beans
- Peas
- Strawberries
- Apples
- Potatoes
- Citrus
- Prunes
Insoluble fiber is described as roughage. This kind of fiber does not dissolve in water. It acts like a sponge. It is capable of absorbing up to 15 times its own weight in water and makes a person feel full longer. Insoluble fiber attaches to waste in the body, making it bulkier and easier to pass. Your intestines contract more when there is pressure on the inner wall of your colon. By bulking stool, it creates more pressure on the inner wall, or lumen, and facilitates contraction of your intestines to help “sweep” stool along.
Common Sources of insoluble fiber include:
- Fruits with skins
- Uncooked vegetables
- Nuts
- Legumes
- Bran
- Brown rice
- Whole-grain flour
Fiber can be thought of as your body’s broom. It sweeps through your intestines to pick up unhealthy bacteria and excess waste and helps you eliminate it.
How fiber helps you:
- Protects against heart disease by reducing cholesterol levels.
- Slows the speed at which food passes from the stomach to the rest of the digestive system – this can make us feel full longer and can help with weight management and prevent blood sugar spikes in those with type 2 Diabetes.
- May have protective effects against breast cancer.
- Can lower the risk of prostate cancer progression. It does this by decreasing levels of testosterone, which helps decrease tumor growth.
- Fiber-rich foods help prevent diverticulosis by contributing bulk in the colon, so that less forceful contractions are needed to move things along.
- Fiber can reduce your risk of colorectal cancer.
- Fiber increases bulk in the intestinal tract and may help improve the frequency of bowel movements. It may also reduce the risk of developing colitis and hemorrhoids.
How much fiber to have:
The National Academy of Sciences’ Institute of Medicine recommends daily intake levels of 38 g of fiber for men and 25 g for women under the age of 50. For those over 50, the recommendations are 30 g for men and 21 g for women. On average, Americans consume 15 g or less of dietary fiber per day. This is less than half of the daily recommendation for men of any age, and six grams fewer than the minimum recommendation for ANY group.
But don’t go reaching for that Metamucil quite yet: too much fiber can cause negative health effects. For example, if a person eats too much fiber or increases too quickly (or doesn’t drink enough water as they are increasing their fiber), they can experience:
- bloating
- abdominal pain
- flatulence
- loose stools or diarrhea
- constipation
- temporary weight gain
- intestinal blockage in people with Crohn’s disease
- reduced blood sugar levels, which is important to know if you have diabetes
This can also interfere with your body’s absorption of other minerals. So be sure to increase your intake slowly and listen to your body, and if you have questions about specific nutritional choices for you, schedule a virtual integrative health and nutrition appointment today.
Appropriate fiber intake has tons of health benefits (as you should know by now) but if that’s not enough…
- High-fiber foods also happen to be major sources of important micronutrients. That’s why you want to concentrate on whole plant foods, not just fiber pills or supplements.
- If people who normally get little fiber suddenly doubled their intake through wiser food choices, they could lower their risk of colon cancer by 40%, according to research involving data collected from 10 European countries.
- Associated with weight loss and increased feelings of fullness.
- A study at the University of Cardiff in the United Kingdom found that people who had higher levels of fiber intake had higher feelings of well-being.
- Scientists show that those who eat the most fiber have significantly lower risk of dying of any cause. The National Cancer institute concludes that for every 10-gram increase in fiber intake, risk of death drops 15% in women and 10% in men.
- Reduced severity of sxs in patiests with IBS with increased fiber intake.
- Five RCTs looked at stool frequency and found either a trend or a significant decrease in favor of the treatment group, and increased number of stools compared with placebo
- 85% of patients with normal physiology improved or became symptom free with increased psyllium.
So by having good amounts of fiber, you’re going to lose weight, feel better, feel fuller longer, have a ton of health benefits and basically be a rock star. What’s not to love about that?
Now that you’re excited to get more fiber in your diet, how do you do it?
Here are some ways to increase your fiber intake:
- Eat Whole Grains
- Choose High-Fiber Breakfast Cereals
- Eat Beans a Few Times a Week
- Work in Fruits Whenever You Can
- Try to get several servings every day. Add fruit to your morning meal, enjoy it as a snack, and garnish your dinner plate with it. You can even have fruit with — or instead of — dessert!
- Work in Veggies Whenever You Can
- Include a vegetable with lunch, have raw vegetables as an afternoon snack or pre-dinner appetizer, and enjoy a big helping with dinner.
- Yes, there are plenty of over the counter fiber supplements you can take as well.
There are also plenty of websites that you can use to track your fiber intake. Again, aim for several servings every day. And make a point of having vegetarian entrees several times a week.
What did you learn about fiber today and how are you going to use this information to change your diet and improve your life? Let us know in the comments below!
References
http://www.fiberguardian.com/coffee-can-improve-fiber-intake/
https://www.benefiber.com/about/
https://www.metamucil.com/en-us/articles/Fiber-101/how-does-metamucil-work
https://www.canyonranch.com/blog/nutrition/the-amazing-facts-about-fiber/
https://www.factretriever.com/fiber-facts
https://www.webmd.com/food-recipes/features/get-the-facts-on-fiber#1
http://www.nutritionaustralia.org/sites/default/files/Fibre-2014.pdf
https://www.medicalnewstoday.com/articles/146935.php
https://www.eatright.org/food/vitamins-and-supplements/nutrient-rich-foods/fiber
https://www.healthline.com/health/food-nutrition/too-much-fiber#TOC_TITLE_HDR_1
Bijkerk, C., de Wit, N., Muris, J., Whorwell, P., Knottnerus, J., & Hoes, A. (2009). Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ, 339(aug27 2), b3154-b3154. doi: 10.1136/bmj.b3154
Portalatin, M., & Winstead, N. (2012). Medical Management of Constipation. Clinics In Colon And Rectal Surgery, 25(01), 012-019. doi: 10.1055/s-0032-1301754
Shariati, A., Maceda, J., & Hale, D. (2008). High-Fiber Diet for Treatment of Constipation in Women With Pelvic Floor Disorders. Obstetrics & Gynecology, 111(4), 908-913. doi: 10.1097/01.aog.0000308660.48204.7f
Yang, J. (2012). Effect of dietary fiber on constipation: A meta analysis. World Journal Of Gastroenterology, 18(48), 7378. doi: 10.3748/wjg.v18.i48.7378
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Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836
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FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
This article about Fiber: What is it and Why is it important? by K. Buonomo is presented in a well thought out manner that puts it into prospective that resonates beyond just being healthy. Thank you for the insights and ways to improve the diet to help live longer and better.
Thank you for taking the time to read through the article! We are happy to be able to put this information out there for people to read.
Great article Kim! I’m definitely going to make it a goal to get more fresh fruits & veggies and add a fiber cereal. Those are some statistics to reduce death rate just by adding fiber. Very useful information.