Yes - it has become my reality.  As a pelvic floor physiotherapist, for all populations, I talk about bowel movements.  A lot.  Just ask my kids, my husband and my clients.  But the reason being is it lends a lot of information on the health of our foundation - the pelvic floor!

Constipation in Kids
Recently I gave a talk about conditions I see in the pediatric population and constipation or retention of stool came up as a topic.  Especially after children become potty trained and we stop going to the washroom, we lose track of what our kids our are doing on a daily basis when it comes to bathroom habits.  That being said, even as a child is potty training, it is important to know what a bowel movement is looking like. Reason being, even though a child may be having a bowel movement daily, they may be constipated!  How you may ask?? It is how the bowel movement looks!

Signs A Child is Constipated
There are a few common things that may not seem obvious when seeing if a child is having difficulty with bowel movements.  

• Extra large "Holy Cow" poops - a sign that the rectum has stretched out over time due to prolonged constipation, turning the rectum into a "holding" vessel rather than a sensory organ, signalling when it is time to empty the bowel.  These types of bowel movements may actually plug a toilet!
• Firm poops - what we call the Type 1 and Type 2 poops, that look like pellets, or a bunch of grapes.  It is ideal to see a long snake
• Belly pains - too much stool retention can create a stomach
• Frequent urination - a sign that the bowel is pushing on the bladder and taking up space in the bladder, so it has difficulty retaining fluid
• Incontinence - either urine or bowel related - a child will have difficulty interpreting what they are feeling when they are constipated, leading to events where they are unable to make it to a washroom 
• Body odour or frequently passing gas
• Loose stools or diarrhea - a sign that the bowel is unable to soak up anymore fluid, so it bypasses or goes around the constipated stool in the rectum.

So why or how can a child become constipated?  Kids are  funny things in that if the bathroom looks unpleasant or they feel embarrassed to do something, they may not do it.  Usually they do not feel the need to stop playing and use the washroom.  Also, hydration plays a huge factor - the more dehydrated a child or person is, the more likely they will become constipated.  Of course, this is only a small list of reasons, as there can be many more and potentially complex reasons, but it lends the idea that caregivers can help!  For example, a child should consume 1 ounce of water for every kilogram of weight. So a 24kg child would drink 24 ounces of water or 3 cups per day! What usually helps is a reminder for the child - before you go play, at recess, after recess, after you go to the washroom, have a drink of water.  A couple ounces a time, multiple times a day will go a long way!

If anything to take away from this write up, it is be open to talking with your kids about their bowel habits! A little conversation can go a very very long way.  And if issues are happening, believe it or not, Physiotherapy Can Help!  

~ Michelle, PT

Tinnitus is defined as the perception of sound without the accompanying external stimulus.  
Tinnitus, or ringing in the ears, affects a significant amount of the population at one time or another in their lives. While it is normal for someone to experience intermittent episodes of buzzing, ringing, or tonal sounds in the ear from time to time, some people experience a condition which is much more persistent and sometimes more bothersome. Prevalence is estimated between 5-42% of the population.  

The condition itself does not have one root cause or pathology associated with it. It can be caused by noise trauma, physical trauma, disease, aging, and as a side-effect of some medications. A number of different structures and conditions can contribute to the presentation and the symptoms that an individual experiences. This can include cardiovascular, neurological, mechanical, and inflammatory disease states. These factors will produce a sensitivity in the nervous system, leading to changes in the brain that can produce the phantom sound or make it increasingly difficult to shift our attention elsewhere.  

From a cardiovascular perspective, an increase in blood pressure can sometimes result in the ability to hear a thudding or pounding, drum-beat like sound. This can occur unilaterally or bilaterally. This can also be the result of inappropriate formation of small blood vessels in the inner ear and surrounding tissues which does not allow blood to flow through them smoothly in all situations. Anything that is of a vascular nature will require assessment and investigations as recommended by the appropriate physician and/or specialist and is outside the scope of physical therapy.  

From an inflammatory basis, a number of structures in the face, head, and ear can contribute to the perception of sound if they become irritated or sensitive. This include various nerves, the sinuses, eustachian tubes, and even the middle ear bones that conduct sound to the eardrum. The eardrum itself can be a source of irritation if it becomes inflamed or scarred as well. The treatment for this typically is medical in nature to try and reduce swelling/inflammation in the specific tissues.
 
The neurological mechanism is the most common pathway that relates to idiopathic tinnitus. Idiopathic referring to an onset of symptoms with no known injury or mechanism. This can be due to sensitization of the peripheral nervous system, central nervous system, or a combination of the two. This is typically treated through a combination of medication, education, and stress-reduction strategies.  

Mechanically, the upper cervical spine and jaw joints can contribute to a presentation of tinnitus in some cases through their connection into a cluster of nerves referred to as the trigeminocervical complex. Since the trigeminal nerve has connections to the other cranial nerves, overwhelming stimulus of these pathways can contribute to the intensity and frequency of symptom presentation. On the bright side, appropriate mechanical treatment and education surrounding these tissues can sometimes provide improvement in the tinnitus symptoms that are experienced. Not everyone has a mechanical presentation, but since treatment and therapy are non-invasive, it can be worthwhile to consider assessment by a trained healthcare practitioner.  

Another useful avenue of assessment for those suffering from tinnitus is a comprehensive hearing assessment through an Audiologist. This will assist with understanding the unique features of a patient’s presentation and help other practitioners determine an appropriate course of action. Audiologists also have the ability to treat some aspects of tinnitus with assistive devices that can create white noise, amplify normal hearing, and try to retrain the brain/nervous system to ignore the tinnitus itself.  

One of the most important things to note regarding tinnitus is that the amount of distress or the perceived volume of the sound does not relate to the severity of the condition. Louder tinnitus does not mean that someone is at greater risk of harm or injury/disease.  

~ Trent, PT

 References: 
Somatosensory tinnitus: Current evidence and future perspectives. Ralli, M. et al. Journal of International Medical Research. 2017.  

Maladaptive plasticity in tinnitus - triggers, mechanisms and treatment. Shore, S., Roberts, L., Langguth B. Nat Rev Neurol. 2016. 
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Current insights in noise-induced hearing loss: a literature review of the underlying mechanism, pathophysiology, asymmetry, and management options. Le, T., Straatman, L., Lea, J., Westerberg, B. Journal of Otolaryngology - Head & Neck Surgery. 2017.
 

Today I was at the dentist for both my kids and for myself. And holy smokes, my 3-year-old was talking a mile a minute! He was very excited to tell the dentist how he is brushing his teeth every day. Talking is just one of the many activities that the jaw has to be able to do. Talk, chew, open up for a yawn, and smile, to name a few things. And these are some of the things that my patients have told me their jaw pain is interfering with.

Want to know something else that is interesting? The jaw is also involved with trying to handle our stress. Sometimes, when we sleep and even when we are awake, we can clench our jaw or grind our teeth. We hold tension here either temporarily or prolonged in response to stress, frustration or simply out of habit. So when I got to have the discussion with the dentist and dental hygienist that I needed to think about getting a night guard to protect my mouth due to signs of clenching I wasn’t surprised. Generally I feel like I manage my daily stress well, but sometimes I wake up in the mornings feeling like I have to move my jaw around to loosen it up. I also catch myself feeling a little more tense when I am rushing to get the kids out the door or things of that nature (I am sure I am not the only one to feel this way sometimes).

When we clench or grind, even without meaning to, there are a few things that can happen. Apart from possible wear on our teeth and gums (can you believe that you can cause gum recession or tooth fracture by clenching and grinding?!), there is also joint irritation and muscular overuse and imbalance that can occur around the jaw, which can lead to local and referred jaw pain. What does that mean? Jaw pain can feel like an ear ache since your joints are located just beside your ears. It can also feel like a tooth ache because pain from the jaw can refer to your teeth. It may also present with a headache or ringing in the ears due to muscular tension or joint pain. Lack of muscular coordination and control can lead to muscular strain and joint irritation. They begin to have trouble with things like opening, chewing, and talking which usually brings them to their dentist or their doctor, and then to me, because they are just not sure about where to go and they are a little afraid of what treatment entails when they are already having pain and difficulty with such important things that they have to do multiple times per day.

So let me talk about assessment and treatment for a moment. When I am looking at someone’s jaw, I want to know their history. I am talking more about clenching and grinding above, but sometimes there are other things that can lead to jaw pain. After discussing more about what brought them in to see me, I look at how the neck moves and how the nervous system is functioning through reflexes and cranial nerve testing. I then get into looking at the jaw. I look at how a person is opening and closing, other movements that their jaw can do, and how irritable their jaw appears to be. With many people I am also able to assess how the joints, ligaments and muscles are functioning by feeling inside of the mouth and “wiggling” the jaw around. How I approach assessment and treatment with people depends on the degree of irritability of their jaw, their goals for treatment, and what they are doing in their lives. Are they a musician? A teacher? A student? Retired? What is their dental and neck history? All of these things are important for me to know to effectively treat someone’s jaw.

So, if you are having some jaw pain, clenching or grinding during the day and/or night and issues with jaw muscle coordination may be playing a role. Paying a visit to myself or Trent can help to set you in the right direction. Feel free to give me a call if you have any questions about what may be going on with your jaw and what physiotherapy can do to help.

~ Kristyn, PT

People.  What is happening?  It's currently -33 as I'm writing this blog.  It was - 48 earlier this morning.  I know, I know.  We live in Saskatoon.  We are going to experience all 4 seasons, some longer than others.  It's winter and it's cold.  But there is a difference between it being cold outside and it being freezing.  This is ridiculous.  When it's cold you can suck it up and not wear mittens while you are driving  or even skip wearing socks in your boots.  However, when it's freezing you wear layers to get the mail.  If you grew up on a farm you pull out your ski-doo suit and wool socks (not because you are going ski-dooing but because you want to pack them in your car trunk in case your car decides it doesn't want to run anymore).  Vanity and style take a back seat to your warmth. 

When it's cold you still think about Dairy Queen and Slurpee's.  When it's freezing you think about warm soup and hearty stews that burn your tongue.  When it's cold you are still able to go skating or tobogganing.  You are able  to go Cross Country skiing, snow shoeing, ice fishing, skidooing (especially with a sled tied to the back and you wear ski goggles to help protect you from the debris that's flying at you).  You can participate in activities that involve the temperature to be below zero.  When it's freezing....................you binge watch Netflix  (Chef's Table, The Office, Outlander and Workin Moms are my fave's).  You Marie Kondo your closet ( do NOT do this by yourself.  I repeat.  DO NOT DO THIS BY YOURSELF).  You start google-ing hot destinations and research how far $70 West Jet dollars can get you (Not even to Regina in case you are wondering). 

If you live in Saskatchewan you have 2 different types of wardrobe.....summer and winter.  Summer wardrobes are typically filled with bright colours, fun designs, and pieces of clothing that shows less skin.  Winter wardrobes are typically filled with down, wool, anything that is water resistant.  No one cares about colours when its -50 outside.  Did you know that you can purchase a down onesie????????  YES!!!  It's a real thing ($1500).  The best part of it being that cold is that everyone that you see looks the same.  Big parka, winter boots (with removable liners), puffy gloves, and sometimes even a fur trapper hat.  But even through all of this we hold out for that sweet promise of spring.  Where we can see the rest of the brown gritty snow mound melt in the parking lots and see actual concrete on the roads.  Where the sound of the water dripping from your eaves is all around you (I mean that in a poetic sense, not literally).  I have gone to the green houses a few times over the winter to remind myself that everything lasts for a season.  That there will be new growth happening.  Patience is not something I am strong in.   So I'm writing this just as much for me as for you.  We will get through this.  Before we know it there will be the faint hint of green in the sky from the trees and allergies acting up from all the snow mould.  There will be families going on bike rides and getting coconut dipped ice cream cones  from Chardon's (if you haven't had one you NEED to go).  Just remember that we are all in this together.  We are all experiencing the cold and the freezing.  So let's cheer on the melting and the end of this blasted winter. 
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~ Sheri, Admin