GASTROINTESTINAL CONDITIONS
Peptic ulcers Peptic ulcers are ulceration of the mucosa lining of the stomach and more commonly the duodenum affecting about 1/10th of the U.S. population. The cause may be attributed to use of NSAIDS that include aspirin, ibuprofen, and naproxen. Infection with Helicobacter pylori ( H. pylori ) accounts for about 70-90% of the cases. They are characterized by symptoms of stomach pain and discomfort. Acid-peptic diseases include gastroesophageal reflux, peptic ulcers (gastric and duodenal), and stress-related mucosal injury. Ulceration or mucosal erosion occurs when caustic substances (like acid, bile, and pepsin) in the gastrointestinal tract overpower the defenses of gastrointestinal mucosa (mucus and bicarbonate secretions, blood flow, prostaglandins, and cellular regeneration after injury) (Harvard Health Publishing, 2014). Manual therapy of the affected area in individuals with peptic ulcers is contraindicated, although manipulation of the reflex areas of the lower spine and stress-reducing therapeutic massage may be useful. Require a doctor’s consultation and approval before performing manual techniques. Irritable bowel syndrome (IBS) Irritable bowel syndrome is a chronic, recurring disorder in which the individual experiences abdominal cramping and bloating with diarrhea, constipation, or both. Abdominal pain is usually associated with increased frequency of bowel movements. IBS can be associated with recurrent abdominal cramping, pain, and/or a diarrhea-constipation cycle. IBS may be stress-induced or exacerbated (Mayo Clinic, 2023). In some cases, gentle clockwise abdominal massage may be helpful in reducing symptoms; deep therapeutic massage of the lumbar, gluteal, and thigh muscles may reduce referred pain. Treatments are typically focused on the relief of pain and normalization of bowel function. Individuals suffering from constipation can use fiber supplements to soften the stools, but this may result in excessive bloating and gas, increasing abdominal discomfort. Instead, laxatives are often used to soften and increase stool frequency. Individuals experiencing diarrhea may find loperamide (see subsequent discussion) offers some relief, reducing urgency and frequency of bowel movements (Mayo Clinic, 2023). Therapeutic massage, particularly abdominal massage, is helpful for individuals who suffer from IBS if they are suffering from the bloating, gassy, and constipation symptoms that are commonly associated with this condition. If patients are actively experiencing diarrhea, then you want to avoid the stomach altogether and make sure your patient knows that the bathroom is available to them at any point throughout their session. Crohn’s disease Crohn’s disease is a form of inflammatory bowel disease. It is categorized as an autoimmune disease, meaning that the body has developed an autoimmune response, thinking that there a foreign invader in the body. Instead of attacking a virus or foreign pathogen, it starts attacking its own tissue, particularly within the GI track (Crohn’s and Colitis Foundation, 2023). Obtain doctor’s approval before beginning any body work for an individual with Crohn’s disease. If approved, relaxing abdominal massage may be beneficial. Crohn’s disease can range in severity and symptoms but can affect anywhere in the GI system. Symptoms mostly present in the forms of abdominal pain and diarrhea. Fatigue, fever, anemia, arthritis, and skin rashes can also present themselves. Location, ethnicity, age, and genetics all affect the probability to be diagnosed with Crohn’s disease (Crohn’s and Colitis Foundation, 2023).
Gastrointestinal (GI) conditions affect the majority of the American population of all ages, races, shapes, and sizes. Chronic conditions that require repeat or consistent medication should be paid closer attention by a therapist for the well-being of your patient. You may want to change positions with your patients on the table, working only with them in a supine or side lying position to help ease any abdominal discomfort, keeping a bathroom open and accessible near the treatment room available during the session. Some plain snacks and plenty of water available may be a couple good general considerations you can implement in your practice when working with someone with GI condition. Disorders of the stomach and intestines include gastroenteritis, an inflammation of the intestines and stomach that may cause nausea, diarrhea, and abdominal pain. Possible causes of gastroenteritis include a viral or bacterial infection, allergic response, or exposure to irritating particles. Disorders of the esophagus include esophagitis, an inflammation of the esophagus that may be accompanied by heartburn. Esophagitis may be caused by infection, trauma, irritation, or the ingestion of certain foods and/or acid reflux. Soft tissue work may be contraindicated in cases of esophagitis, gastroenteritis, gastritis, and/or hernia. In each case, have a consultation and approval by the doctor before performing manual interventions. With gastritis, it is best to avoid the immediate area of the stomach, but therapeutic massage of the thoracic and lumbar spine may bring relief. Light clockwise effleurage to the abdomen, to induce relaxation, may be beneficial for cases of gastroenteritis. Heartburn Heartburn is a very common GI condition that affects many Americans. It is characterized as a burning sensation in the chest, acid regurgitation, and stomach discomfort. It is a very treatable condition with both over-the-counter and prescription medications, as well as lifestyle and diet changes. Occasional heartburn is no cause for concern and is a common occurrence for many individuals who have consumed a new or spicy or greasy food. Chronic heartburn is described as symptoms that presents more than twice a week. When this point is reached, it is advised to talk to a doctor about long-term solutions. Chronic heartburn can also be characterized by difficulty swallowing, persistent nausea, and/or vomiting. With chronic heartburn, over-the- counter medications do not often suffice, and there can be significant weight loss due to inability to eat normally. Treatment can include both over-the-counter and prescription antacid medication, diet change, and lifestyle changes like reducing stress and eliminating alcohol and smoking. In more severe cases, a surgery on the esophageal sphincter is needed (Cleveland Clinic, 2023). Manual therapy doesn’t have any significant direct short-term benefits or contraindications for treating heartburn. However, it could be argued that the benefit of stress reduction from receiving regular therapeutic massage can contribute to help improve and prevent heartburn. Healthcare Consideration: When working with someone who is actively experiencing heartburn, do not apply manual pressure the upper abdominal area. Instead, downward effleurage may soothe the stomach and abdominal muscles.
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Book Code: MTX1325
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