Question about lower back pain.

SI joint pain can be excruciating but often missed by physicians. SI joint dysfunction is a frequently missed by physicians who do not have the joints’ importance on their radar.

Seriously, I have had patients who have undergone total hip replacements and microdisectomies only to have their pain remain.
Simple evaluation of the SI joint and a a series of exercises and stretches sometimes with a corticosteroid medrol pack . . . And these people were newly restored.

Look up on the internet for basic SI mobilization exercises/stretches. These are simple, basic postural stretches. No human pretzel maneuvers.

The body needs to move. Lack of daily movement is a prime reason for SI joint dysfunction. It becomes stiff and does not glide. As the articulation between the lower pelvis and sacrum, it is an essential fulcrum of normal kinesiology.

Move. And move some more. Start gently, if you are more sedentary. But know that the body is designed to move to be at its optimal health.

Bowel and bladder “problems” related to lumbar or sacral nerve roots would NOT be IBS symtoms. Sacral and lumbar nerve root involvement that would be urgently concerning would be symptoms of urinary incontinence (“leaking” of urine) and/or fecal incontinence. The voluntary bladder and anal sphincters are innervated by the lower cauda equina nerve roots and their compression is noted by worrisome and fairly dramatic incontinence of urine or feces.

IBS is just what it’s name says - irritable bowel syndrome. It implies a functional disorder of thr synchronized motility along the intestinal tract. It can vary from cramping, feeling like the intestine is moving in painful waves that are disordered, constipation, diarrhea, and almost everything imbetween.

We take a bit of food and expect that it’s passage down and through the intestinal tract will be a routine process. The functional motility of the intestines (how it moves and does its “job”) is highly complex and is regulated by a stream of endocrine hormones. The intestinal tract has embedded receptors and glial cells that bind with endocrine hormones. GI receptors specific to adrenaline, seratonin, and dopamine are embedded in the mucosa of the intestinal tract. It is this hormonal interplay that largely determines how the intestine is moving or not moving, the functional motility of the GI tract. Functional disorders of the intestine are very common. More so in our age of high stress, always on the go mentality, bombarded by incoming 24-7 news and iPhones that provide a steady steam of incoming stimuli. The mind-body connect is very real and alive in influencing the GI tract and its functionality.

Opiates, too, have a direct effect on the GI tract. There are opiate receptors, as well, in the intestinal mucosa. Opiates will bond directly not only in the central nervous system but in the gut as well. The effects on opiates in GI function can be problematic, even at low doses.

Anyone on an opiate should consider taking an osmotic laxative as a daily regimen. If not an osmotic laxative, other options: a. Warmed prune juice, 8-10 oz; supplemental magnesium citrate, 500 mg 1 or 2 times a day; aloe Vera juice, 2 tablespoons. It is important to facilitate the intestinal tract to move along when taking an opiate. The degree of fecal back-up due to intestinal slowing can be impressive and nightly unpleasant when it finally manifested itself.

Miralax and Milk of Magnesia are both osmotic laxatives. They can be safely taken for long-term use without risk of laxy colon or dependency. An osmotic laxative draws water into the large intestine and provides a kinetic/movement nudge to encourage the intestine to move with better frequency. The largest problem with opiates in the gut is imposed gut slowing. The intestines move like a snail. Fecal back-up accumulates, growing. The intestines become distended and fecal matter decays. The intestine responds with rebound contractions, cramping, diarrhea as liquid is able to squeeze through past the retained fecal matter, followed by constipation. It is a real problem with real health consequences. People do go to the ER, in acute abdominal pain, due to opiate induced GI distress.

You do NOT want to take a stimulant laxative (Ex-lax and Dulcolax) not a stool softener. A stool softener adds water to fecal mater in the low Colon but with no motility effect. The end point of a stool softener: Stool sits in the rectum like wet cement.

You have 20-30 feet of small intestine. The small intestine is where all of the body’s absorption of nutrients occurs. The small intestine sits under an apron of fat, the omentum, and constantly glides and squiggles like a snake, 24-7. The fatty omentum provides a moist covering that allows the small intestine to squiggle with ease.

You have 4-4 feet of large intestine. The large intestine is basically a holding facility for the rements of digested food material. The role of the large intestine is limited to storage of fecal matter and to drawing water out of the fecal matter as it passes toward the rectum for final exit. The large intestine moves differently than the small intestine. While the small intestine moves 24-7 squirming like a worm, the large intestine moves only 4-5 times a day in what is called paristaltic waves.

Women tend to have more problems with IBS them men. Women tend to have longer long intestines and large intestines with more redundancy and twists and turns.

The intestinal tract, at its most basic, is a long tube of smooth/involunatary muscle (not under your volitional control). As a muscle, the intestines rely on the general movement and exercise and daily activities of the body at large for its own motility and health. A person who is sedentary will tend to have a gut with slow motility. A gut with slow motility is an unhappy camper. It will rebell as fecal back-up accumulates. With 30 feet of intestine, there is a lot of landscape for fecal back-up and fecal retention. The intestine will react with IBS symptoms in an attempt to clear the accumulating back-up. Then a period of agonizing constipation. Repeat. Over and over.

For anyone on an opiate, find a daily bowel management program that works for you and stick with it. Miralax, Milk of Magnesia, Magnesia supplement, aloe Vera juice (think of this as intestinal lubricant), warmed prune juice, wheat germ added to yogurt. Whatever works for you.

Fecal retention due to opiates (and added sedentary tendencies associated with pain) is a real problem with real health consequences that people can mistake for other health issues.

Another good avenue to explore is taking a quality spectrum probiotic. 90% of the body’s immune system is located inside of the digestive tract. “Good” bacteria strains form a normal bacterial flora that is the foundation of the immune system. Medications and illness can easily disrupt the normal bacterial flora and cause symptoms of IBS and general malaise. A quality probiotic, daily, helps to repopulate the gut with the bacterial flora that are essential to health.

I use a medical grade probiotic, VSL-3. I highly recommend VSL-3. You need not search for a finer probiotic than VSL-3. It has been the probiotic of choice for gastroenterologists in healing intestines ravaged by Chron’ and ulcerative colitis. It was available only by prescription until last year. You can now access VSL-3 by request through your pharmacy (it may have to be ordered for you as it may not be stocked as a common item) as well as online at Amazon.

Anyone with IBS symptoms should explore taking a quality spectrum probiotic. A cup of Yoplait does not equate with a quality probiotic.

OK . . . A few words on SI joints and the effects of opiates in on intestinal motility (functionality of how the intestine moves along or is slow and sluggish).

Ocean fish . . . A colonoscopy will be of value only in being able to see the inside lining of the large intestine. A colonoscopy is valuable to detecting polys, precancerous and cancerous lesions be they flat lesions or peduncular polyps, inflammation of the lining of the intestine, tissue biopsies, evidence of diverticulosis or outpocketings of intestine. A cononscopy has no value in assessing functional or movement issues with the intestine. It is not apt to diagnose functional disorders of the intestinal tract. A colonoscopy is a valuable screening tool that anyone over the age of 40-50 should have performed as a baseline for colorectal cancer.

Myself, I have an ileostomy with an ostomy pouch with complete resection of my large intestine and 1/4 resection my small intestine as well. I have no problems with opiate constipation, obviously. That is one benefit of my intestinal perforation, I guess.

Look at ways to keep your intestines happy and humming along. Your whole body will feel better for the intestinal efforts made.
Karen

Darla:
Yes, it looks as though you ordered the correct probiotic VSL-3 from Amazon. It comes packaged with an ice pack or dry ice. It is not all that expensive for the benefits gained. Give the probiotic a full month with a daily capsule. The benefits experienced will be gradual (less boating, less gas, more regular bowel movements, “healthier” appearing bowel movements).

As far as SI anoint stretches, there is no harm to be done in the basic/simple stretches you will find in line. There is no risk of nerve impingement, even if you have a mild disc protrusion. Remember, discs are gelatinous. A mild disc protrusion (if you have one) may well recede into place with some gentle movement.
Listen to your body. Yes, some pain is expected as there is likely soft tissue and ligament tightness associated. Almost everyone had a degree of hip joint capsule fibrosis and ileotibial band restriction - that benefits from being mobilized. There is a difference between “bad” pain that communicates to us a warning and “good” pain that is informative and tells us that it is needed discomfort to regain normal kinesthetic movement. Listen to your body for what it is telling you, “good” pain vs “bad” pain as you begin to move. You will have pain simply due to moving in ways that will stretch and move soft tissue and ligaments that have tightened. Such pain will usually begin to ebb as you continue with gentle sessions.

Start slow. Slow and gentle stretching. Avoid bouncing or ballistic forceful stretches. Take a posture to where you begin to feel discomfort and hold for 20-30 seconds. Gently release. Do 5 repetitions.

Select 2-3 stretches, 5 reps each. Twice a day to begin. Do not overdue as you will then hurt from the simple beginnings of exercise and that can interrupt continued effort.

Fecal incontinece or urinate incontinance involves loss of the sphincter reflex. A physician will easily test for sphincter control. A upward Big Toe, Babinski response, with a quick brushing stimulus to the sole of the foot would be another cautious barometer.

It is estimated that 33% of individuals simply walking the streets and given an screening MRI will show positive for a thoracic or lumbar disc anterior protrusion. Not all disc protrusions warrant surgery. In fact, most will recede with education on posture/positing and an individual program of stretches/exercises that address abdominal core, hip/SI joint, and posterior vertebral musculature strengthening and balancing of alternate forces.

I know I am a PT by background, but a good consultation with a good manual therapist can be immensely helpful in establishing spinal well-being. This would be worth consideration as well. PTs have exacting education on kinesiology and the biomechanics of movement. Their expertise can trump a passive MRI imaging study for evaluative guidance. Your body is not a static entity. It moves. Evaluating how your body is moving, the biomechanics of motion, is where the value of a PT with manual training provides a valuable contribution to the limits of CT and MTI imaging scans.

Try some simple, basic, beginner’s SI stretches. 5 reps of 2-3 postures or stretches. Gentle. Take to the point where you feel the beginnings of discomfort but not beyond. Hold for 20-30 seconds, a slow/sustained stretch. Avoid quick or free-wheeling movement, no ballistic bouncing type stretching. Ballistic or jerky or quick/sudden movement causes fine muscle tears. Learn to recognize “good” pain and “bad” pain. There is an inherent difference. Let that be a guide.

If in doubt, do not hesitate to ask your MD for a prescription for a PT consultation.

We all have to start somewhere. Reaching out for a PT referral is often a good starting place.

Best wishes,
Karen