probiotics and digestive health · possiblecausesofibs-like symptoms,suchascoeliacdisease, bowel...
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UNDERSTANDING ENDOMETRIOSIS,
IRRITABLE BOWEL
SYNDROME AND CHRONIC PELVIC PAIN
Probiotics and Digestive Health:
A Guide from The Gut Foundation
A Guide from The Gut Foundation
At a glanceEndometriosis, irritable bowel syndrome (IBS) and chronic pelvic pain are common conditions affectingwomenduringtheirreproductiveyears.
Itcanbedifficulttodiagnoseeachof the conditions, and some of their symptomsoverlap.
IRRITABLE BOWEL SYNDROME
ENDOMETRIOSIS CHRONICPELVIC PAIN
Thereareoftenlongdelaystoaccuratediagnosis.
Effectivetreatmentsareavailable.
A response to treatment can confirmthediagnosis.
Information,helpandsupportisavailableforwomenexperiencingendometriosis, IBS or chronic pelvic pain.
Back to basicsThe lower abdomen and pelvic cavitycontainorgansofthegastrointestinaltract(thecolonandrectum),theentirefemalereproductivesystem(includingtheuterus,ovariesandFallopiantubes)andtheurinarysystem(thebladder).Theyareprotectedwithinthemuscularabdominalwallandthebonypelvis.Thepelvisis attached to the lower part of the spinalcolumn(backbone).
Problemsinanyoftheorgans,muscles,bonesandnervesinthisregioncanleadtopainanddisability.Itcansometimesbedifficulttoidentifytheexactproblem,soitcantaketimetomakeanexactdiagnosisandworkoutthemosteffectivetreatment.
FEMALE REPRODUCTIVE SYSTEM
www.gutfoundation.com2Understandingendometriosis,irritable bowel syndrome and chronic pelvic pain 3
During the normal menstrual cycle the lining of the uterus (the endometrium) is lost through menstrual bleeding. In many women small amounts of endometrial tissue sometimes move in the wrong direction and escape into the abdominal cavity through the fallopian tubes.
EndometriosisWhat is endometriosis?
In a minority of women, the endometrial tissueattachestopelvicorgansincludingtheovaries,Fallopiantubes,uterus,bladder,bowelandperitoneum(theliningoftheabdominalcavity).
Thetissuedevelopsandthencontinuestorespondtothehormonalchangesofthemenstrualcycle.
ENDOMETRIUM
What are the symptoms of endometriosis?Endometriosis can lead to a wide rangeofsymptoms.
Theyinclude:• Pelvicpain,especiallyjustbeforeandduringamenstrualperiod.Unlikeusualperiodpain,itoftendoes not respond well to standard treatmentsuchasanalgesicsandoral contraceptives
• Irregularand/orheavymenstrualcycles
• Dyspareunia-painduringoraftersex
• Infertility• Voidingdysfunction–problemswithfullyemptyingthebladder,leakingassociatedwithurgency,painwhenpassingurine,difficultyholdingonwhenyouhaveafullbladderandhavingtogofrequently
• Painduringabowelmotion• Othergastrointestinalsymptoms,especiallybloating,butalsonausea,constipation,vomitingandrectalbleeding
• Bleedingafterintercourse• Strainingatthebeginning,during
and at the end of defecation and voiding
• Historyofhaemorrhoidsand/orfissures
• Rectalpainduringorafterdefecation
• Difficultiesinstartingabowelmotion,andinfullyemptyingtherectumandbladder.
How common is endometriosis?Aboutoneintenwomenofreproductiveage(thatisbetweenthe onset of periods as a teenagerandmenopause)haveendometriosis.Noteveryonewithendometriosiswillhavesymptoms.
How is endometriosis diagnosed?The history of symptoms, the findingsonphysicalexaminationandinformationfromanultrasoundofpelvicorganscansuggestthepresenceofendometriosis.
Currently,theonlywaytomakeadefinitediagnoseistoidentifyabnormaltissueduringalaparoscopy.Thisinvolvespassingathintubularinstrumentthroughthewall of the abdomen to physically inspectthepelviccavity.
The bleeding and breakdown of endometrial tissue each month can lead to scar tissue and adhesions between pelvic organs.”
www.gutfoundation.com4Understandingendometriosis,irritable bowel syndrome and chronic pelvic pain 5
How is endometriosis managed?Treatment for endometriosis is carefullyadaptedtotheneedsofeachindividual.Itaimstoreducepain and other symptoms, and to improve fertility for women who wanttobecomepregnant.
Duetotheimpactofendometriosisin the abdominal and pelvic cavity,pelvicfloorphysiotherapyand physical activity can prove aneffectivepainmanagementstrategy,particularlyinDysmenorrhea (period pain)
Standardmedicationslike paracetamol and nonsteroidal anti-inflammatorydrugssuchasibuprofen(‘Nurofen’)canhelpcontrolpain.Ifpainreliefisnoteffectiveforwhatsemstobeperiodpain,thenitsuggeststhatotherproblemsmightbethecause.
Hormonal treatments include standard oral contraceptive pills, progesterone-like medications, and gonadotrophin-releasing hormone agonists which regulate the menstrual cycle. The choice of the best medication will depend on person’s exact needs.”
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Ifthediseasecausessevere problems and has not responded to other treatments, then some womenwillconsiderhysterectomy.Thisdecisionshouldnotbetakenlightly,anditisimportanttonotethat this may or may not solve the problem,withsomewomen’spainpersistingafterhysterectomy.
Anumberofhormonaltreatmentscanhelptoreducesymptoms.Medicationwhichreducesthenumberofmenstrualperiods,orstopsthemcompletely,canreducethecyclicalchangesinendometrialtissueandtheresultingsymptoms.
Theywillnotgetridoftheendometrialtissuethatisalreadyinplace.
Surgerysuchasexcisionsurgerywith an excision specialist to removeendometrialtissuewillsometimes be recommended, both torelievepainandimprovefertility.
Endometrialtissuecanre-growaftersurgery,sosymptomscanoccuragainafterafewyears.
Thereisunlikelytobeasinglecause.FactorsthatmightcontributetoIBSinclude:
•differentlevelsofmuscleactivityinthewalloftheintestine-theymaycontractmorestronglyorlessstronglythanusual
•differencesinhowapersonperceivesnormalmusclecontractionsandstretchingofthebowel
•anattackofgastroenteritisor other infection in the past (accountingforabout25%ofcases)
• stress and anxiety• food intolerance•changesinthebacteriawhicharenormallypresentintheintestine.
Duetothepelvicfloorinvolvementin the mechanisms of continence, inIBSthepelvicfloorincreasesitscontractiontopreventusfromleakingstoolsand,inIBS,adyssynergicpelvicfloorthatcannotrelaxwillperpetuatethecycleofIBSbyinhibitingthedefecatoryurgeandcontributetoanincompleteemptyingoftherectalampoule.Thesesymptomsarealsolinkedwithendometriosis.
How common is IBS?About5-10%ofadultsarelivingwithsymptomsofIBS.Upto30%may have symptoms at some time intheirlives.MorewomenthanmenexperienceIBS.
IBS is a disorder affecting the large and small intestine. It can cause cramping, abdominal pain, bloating, gas, and diarrhoea, constipation or both.
Irritable bowel syndrome (IBS)What is IBS?
IBS is called a ‘functional disorder’ as it affects the function of the intestine even though there are no obvious physical changes in the body to explain why it occurs.
What are the symptoms of IBS?KeysymptomsofIBSare:
• abdominalpain,crampingorbloating.Itisusuallyrelieved,fullyorpartly,bypassingabowel movement
• anurgentneedtopassabowelmovement
• excessintestinalgas• diarrhoea or constipation, or sometimesalternatingboutsofdiarrhoea and constipation
• mucusinbowelmovements• neverbleeding• strainingatthebeginning,during
and at the end of defecation• difficultiesinstartingabowelmotionand/orfullyemptyingtherectum
• dyspareunia(painduringorafterintercourse)asaresultofpelvicfloortension
• voidingdysfunctionasaresultofpelvicfloortension
• history of haemorrhoids or fissures.
SymptomsofIBScancomeandgo.Theymightsometimesimproveoreven disappear completely, only to returnfornoapparentreason.
Symptomscanbetriggeredbysomefoods(althoughtruefoodallergyisrarelyacause),stress,and hormones (symptoms are worseatparticulartimesinthemenstrualcycle,similartoendometriosis).
www.gutfoundation.com8Understandingendometriosis,irritable bowel syndrome and chronic pelvic pain 9
www.gutfoundation.com10Understandingendometriosis,irritable bowel syndrome and chronic pelvic pain 11
How is IBS diagnosed?DiagnosisofIBSisbasedmainlyon the distinctive pattern of symptoms.
ItisimportanttoruleoutotherpossiblecausesofIBS-likesymptoms,suchascoeliacdisease,bowel cancer (especially in older patients)orcolitis.However,thetestsorinvestigationsneededtoexcludeotherconditionsneedtobeadaptedtotheindividual.Inmost cases, people with a typical pattern of IBS symptoms will need onlyalimitednumberoftests.
As symptoms of endometriosis can overlap with IBS, the possibility of endometriosis needs to be considered in women of reproductiveage.
IBSshouldalsobeconsideredinwomen whose main problem is chronicpelvicpain.
Possibleinvestigationsincludeanantibodyscreeningtestforcoeliacdisease,checkingforparasitesandinfections, and, less commonly, colonoscopyorendoscopy.
Colonoscopyisessentialifyouhave had bowel cancer or polyps, if youhaveastrongfamilyhistoryofbowelcancerorpolyps,youhaveanybleedingfromthebowel,orifyouhaveunexplainedanaemia.
How is IBS treated?•Understandingtheconditionand developingstrategiestocopewithit.Ifyouhaveconcernsthatsomedisease may have been missed, youshoulddiscussthisopenlywithyourdoctor.Improvementinsymptomsmaynotoccuruntilyouareconfidentthatseriousdiseaseshavebeenexcluded
•Identifyingfactorsinyourlifewhichmightaggravateit,suchashighlevelsofstressoranxiety,drinkingtoomuchalcohol,medicationswhichcancauseconstipation or diarrhoea, or a low level of physical activity
•Changestoyourdiet,whichshouldbebasedonhealthyeatingandguidedbythemosttroublesomesymptoms(for example, constipation, diarrhoea, orbloatingandexcessivegas).An accredited dietitian will be able to provide clear advice, and thefiguregivessomegeneralguidance.The‘FODMAPS’diet,undertheguidanceofadietitian,mayhelptoidentifytriggersofIBSsymptoms.
AnumberofmedicationsandotherpreparationsareusedinIBS:
•‘Bulkingagents’likepsyllium(forexampleinMetamucil),ispaghulahuskderivatives(forexampleFybogel)andsterculia-basedproducts(forexampleAlvercol)canbehelpful,especiallyfor constipation
•Antispasmodicssuchas mebeverine (for example Colofac) canreducepainandtheneedforurgentbowelmotions.Forbesteffect,antispasmodicsshouldbetakenthreetimesaday,long-term,ratherthanjustwhentherearesymptoms.OtherantispasmodicsincludeBuscopanand Donnatabs
•Tricycliccompoundsincludingamitriptyline (Tryptanol) were developedasantidepressants,butwhentheyareusedinlowdosestheyhaveaseparateeffectonnervesandmusclesinthebowelandbladder,andareoftenhelpfulinrelievingpain
• If the main problem is watery diarrhoeathenmedicationssuchasloperamide(Imodium)andLomotilareoftenuseful
•Iberogastisamixtureofnine medicinal herbal extracts that helptorestoregutfunctioningand relieve the discomfort of IBS, especiallybloating
• Some people with IBS have foundthatprobioticscanreducesymptoms.Moreinformationisstillneededonwhichspecificorganisms,andwhatdoses,areeffective.
Diarrhoea
Bloating/Flatulence
GeneralIBS AdviceStopunnecessaryrestrictions
Don’tovereatatmeals
Regularmealpattern
Healthyeating
Consumeplentyoffluids
Taketimeatmealschewingfoodsproperly
Reducedietarysolublefibreto tolerance level
ReducingsomeoftheFODMAPfoodsmaybeuseful
Minimiseirritants(caffeine,spicyfood,fattyfoods,alcohol,&sweetenerse.g.sorbitol/fructose)
ConstipationIncreasesolublefibre(fruits,veg, legumes,oats&barley)
Increasefluidintake
Ifexperiencingsymptomsofconstipationaloneincreaseintakeofallsourcesoffibre(bran,fruitandvegwithskins),alongwithfluid
Reduce‘windy’vegetables
(brassicas,onion&pulses)
Reducealcohol
ReducingsomeoftheFODMAPfoodsmaybeuseful
Reduceresistantstarch(cookedandcooled potato, pasta, ready meals, & processed foods)
IBS and endometriosisHealthprofessionalsmightnotthinkofendometriosiswhenawomanfirstseekshelpforgastrointestinalsymptoms.Symptomssuchasbloatingandpelvicpaincanoccurinbothconditions.
•InanAustralianstudyofwomenwithsuspectedendometriosis,90%hadgastrointestinalsymptomsandabout20%hadpreviouslybeendiagnosedwithIBS.Bloatingwasthemostcommongastrointestinalsymptom,followedbynausea,constipation,diarrhoea,vomitingandrectalbleeding.
•Asummaryof13differentstudiesconcludedthatwomenwith endometriosis are two or three timesmorelikelytoalsohaveIBScomparedtowomenwithoutendometriosis.
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How common is chronic pelvic pain?Estimates of the proportion of women who experience chronic pelvicpainrangefrom15%to25%.
What are the symptoms of chronic pelvic pain? Thefeaturesofchronicpelvicpain canvarywidelybetweenwomen.Itmay be felt across the entire pelvic region,butissometimesfocussedinasinglespot.Itcanbemildorsevere,persistentthroughoutthedayorintermittent,eitherdullorsharp,andsometimescauseasensationofcramping.Itcanbeassociatedwithpainduringsex,painwhilehavingabowelmovementorurinating,orpainwhensittingforlongperiodsoftime.
How is chronic pelvic pain diagnosed?Thepathwaytoeffectivetreatmentof chronic pelvic pain depends on anaccuratediagnosis.
Possiblecauseswhichmayneedtobeinvestigatedincludethefollowing:
• Period pain is very common, affectingmorethan90%ofwomen.Musclesoftheuterustighten,causingcrampingorheaviness in the pelvic area, lower abdomenorlowerback.Itneedsto be assessed in more detail if itlastslongerthanafewdaysand does not improve despite takingpainreliefortakingoralcontraceptives.
•Endometriosisoftencausespelvicpain,especiallyaroundthetimeofamenstrualperiod.
Chronic pelvic painWhat is chronic pelvic pain?
Chronic pelvic pain is pain in the lower abdomen and pelvic region that is present on most days for six months or more. It can be a symptom of a specific disease that can be diagnosed or treated. In some cases no specific cause can be found, so the goal of treatment is to reduce pain and other symptoms and improve quality of life.
• Adenomyosis is similar to endometriosis, except that cells fromtheendometriumgrowintotheinnermusclelayeroftheuterus.Symptomsincludeabnormalorheavymenstrualbleeding,painfulperiodsandpainfulsex.
• Irritable bowel syndrome can causebloating,constipationanddiarrhoea, which can lead to pelvicpain.
•Muscle,jointandbonepaincanoccurinthepelvicregion.Conditionsthatcancauseproblemsincludepelvicfloormuscletension,inflammationofthepubicjoint,andpainaffectingthelowerspine.
• Urinary tract infections (UTIs) are very common in women and typicallycauseaburningpainwhenpassingurine,oftenwithmore widespread pelvic or lower abdominalpain.
•Interstitialcystitis(painfulbladdersyndrome)causesrecurrentpainandafrequentneedtourinate.Pain often increases as the bladderfillsup,andthenreducesasthebladderisemptied.
•Psychologicalfactorssuchasdepression, stress or a history of abusecanincreasetheriskofalltypesofpain.Emotionaldistresscanworsenpain,whichinturnworsensthedistress,leadingtoaviciouscycle.
•Somepelvicpainisduetolowbackproblemsandcanbereproducedbybendingtotherightorleftorhyperextending.There may also be tenderness overthesacroiliacjoints.Physiotherapyistheanswer.
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Flexion Extension Lateral Bending
The tests and investigations used to diagnose a specific cause of chronic pelvic pain will depend on each woman’s pattern of symptoms, history of problems and other individual considerations.
They might include a physical examination, laboratory tests, ultrasound and other imaging such as CT or MRI, and perhaps laparoscopy to check for conditions such as endometriosis.
Remember, though, that a clear explanation might never be found.
How is chronic pelvic pain treated?
Ifitispossibletopinpointaspecificcause,suchasendometriosisorIBS,thentreatmentwillfocusonthatcause.Ifacausecannotbeidentified,thentreatmentislikelytoincludeanumberofstrategiestoreducepainandimprovequalityoflife.Formanywomen,thebestoutcomeswillrequireamultidisciplinaryteamprovidingacombinationoftreatments.
Medications may be recommended, dependingonthecause:
•Painrelieversareoftenthefirststep,startingwithover-the-counterproductsandthentriallingprescriptionproductsifneeded.However, pain relievers alone a rarelyacompletesolution
•Hormonaltreatmentsincludingoral contraceptives can help relieve pain that is associated with themenstrualcycle
•Ifaninfectionisidentifiedasacause,thenitmightneed antibiotic treatment
• Some antidepressants can be helpfulforchronicpain,evenforpeople who are not depressed
• Medications for endometriosis and IBShavebeendiscussedearlier.
Other approaches to treatment includephysiotherapy(onceagain,focussingonthecause),trigger-pointinjectionsoflong-actinganaesthetic(ifaspecifictriggerpointcanbefound),andpsychologicaltherapiestoreduceanxietyanddevelopstrategiestocopewithpersistentpain.
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Olivia Briggs, aged 26, is well acquainted with the issue of chronic pelvic pain.
Starting at 11 at the commencement of menstruation, her pain was so severe that she regularly experienced cramping, fainting and vomiting.
It was not until she was 18 that she was finally diagnosed with endometriosis.
“NotknowingwhatwaswrongwithmeandbeingtoldIjusthad‘badperiods’wasreallytough,”shesays.“Itwasarelieftobeabletoputanametomypainandtofindawayforward.ItturnedoutIwasriddledwithendometriosisfrommyuterustomydiaphragm.NowonderIwasinsomuchpain!”
Olivia’sexperienceofsevenyearsfrom the onset of symptoms, to a diagnosisofendometriosisisrightonaverageaccordingtoastudybyOxford Academic*.
Oliviaisunfortunatetohavearangeof other health conditions, two of which are irritable bowel syndrome andchronicpelvicpain.Shesaysshecan’trememberwhenshelasthadadaywithoutpain.
“It’shardtoholddownajobwhenyouhavetotakesomuchtimeoffforflareupsorsurgeries,”shesays.“Mypresentemployerisveryunderstanding,butinthepast,Ihave had to leave jobs where they eitherdidn’tbelieveme,ortheycouldn’taffordtogivememoretimeoff.
Peopledon’treallyunderstandEndometriosis and Irritable Bowel SyndromeandIhavehadtoeducatealotofpeopleabouttheconditions.It’salsoexpensiveandsociallydifficult,butthroughpaintherapy,IhavelearnttomastermythinkingandreshapehowIlivewithmypain.It’sapartofme,butitdoesnotdefineme.
“ForsolongIdoubtedmyselfandwhatmybodywastellingme,butgettingofficialdiagnosesreallyhelpedtounderstandmyconditionsandfindwaystolivewiththem.IhavedevelopedtruegritandresilienceandI’mproudtosayIhikedover800kmsontheCaminodeSantiagotrailinSpainin2016-thatwasarealachievement.
IhopethisnewreportfromTheGutFoundationwillhelpwomenlikemegetaquicker,moreaccuratediagnosispairedwiththecorrecttreatment,sotheydon’thaveto experience so many years of unnecessarychronicpelvicpain.Myhopeisthatwitheducation,womenwillbeequippedwithmoreknowledgeabouttheirsymptomssotheycanasktherightquestionstohelpreducetheirpainandsuffering.”
www.gutfoundation.com18Understandingendometriosis,irritable bowel syndrome and chronic pelvic pain 19
Elle Watmough is on a mission to educate women about getting to the bottom of chronic pelvic pain.
For years she suffered from excruciating periods which caused pain in her pelvic area, back and legs. She was told she just had ‘bad periods’ and there wasn’t much that could be done about it.
Shehadalsobeentryingunsuccessfullytogetpregnantforfouryearsandwentthrough10IVFprocedures.
Finally,afterdoingherownextensiveresearch,sheaskedherdoctorifendometriosismightbetheproblem.Investigativesurgeryrevealedthatwasindeedthecaseandshehadsuchbadendometriosis that some of her organshadfusedtogether.
Followingaseven-hoursurgerytoremove the endometriosis, Elle fell pregnantonher11thIVFcycleandherdaughterJagger,(nowagedfour)wasborn.
“Iwantgirlsandwomentoknowthatmenstruationpainshouldn’tbeagonising,andifitis,thenaskyourdoctorifitmightbeendometriosisorsomeotherissuesuchasirritablebowelsyndromecausingofyourpain,”saysElle.
“OnceIknewwhattheproblemwas,atleastIcoulddosomethingaboutit,”saysElle.“Itwouldhavesavedmeandmyhusband,Anthony,yearsofangst,heartacheandmanythousandsofdollarshadIbeenaccuratelydiagnosedinthefirstplace.
WeabsolutelyadoreandloveJagger,butIcan’tbeartogothroughthewholeIVFprocessagain,sowewon’thaveanymorechildren.Ihopewithmoreeducation,thatwomenwillbeempoweredwithknowledgetoaskthepertinentquestionsabouttheirhealth,sotheycanstarttogeton the road to recovery, or at least toaccesstherighttreatmentstolessentheirsuffering.”
www.gutfoundation.com20Understandingendometriosis,irritable bowel syndrome and chronic pelvic pain 21
www.gutfoundation.com22Understandingendometriosis,irritable bowel syndrome and chronic pelvic pain 23
The Gut Foundation Board.Our Board is made up of Gastroenterologists and a number of professionals from various fields, that are dedicated to improving the digestive health of all Australians through the treatment and prevention of gastrointestinal diseases and conditions.
The Gut Foundation’s mission is to improve the digestive health of all Australians.Through this mission we aim to prevent gastrointestinal conditions and disease through research and increased awareness about prevention, detection and treatment.
FoundedbyProfessorTerryBolin&theGastroenterologicalSocietyofAustraliain1983,TheGutFoundationwascreatedtohelpinthepreventionofdiseasethroughresearchandeducation.
TheFoundationisanotforprofitorganisationspecialisinginresearchandeducationintoallaspectsofgastrointestinalanddigestivehealth,forboththepublicandfellowmedicalpractitioners.
TheGutFoundationworkswithresearchers and health professionals alloverAustralia,tobuildawareness,improvecommunityunderstanding,educate,improvescreeningfordigestivediseases,improve standards in practice and researchandtoengagein,andencourage,scientificresearchinrelationtodigestivedisease.
The Importance of digestive health:
Thecomplexityofthegutanditsimportancetoouroverallhealthandwellbeingisatopicofincreasingresearchinthemedicalcommunity.
Largelyresponsibleforthecriticalfunctionsofthebody’sdigestiveandimmunesystems,beneficialbacteriainyourdigestivesystemhavethecapabilityofaffectingyourbody’svitaminandmineralabsorbency,hormoneregulation,digestion,vitaminproduction,immuneresponseaswellasyourbody’sabilitytoeliminatetoxins.
Oureducationalandmedicaleffortsfocusonprimarypreventionthroughrecommended dietary and lifestyle changesforall.
Martin CooperBA LLM
Secretary of The Gut Foundation
Professor Emad M El-Omar
BSc (Hons) MB ChB
Dr Ross WalkerMB.BS(hons),FRACP,FCSANZ
Professor Terry BolinMD(NSW)BS(Syd)FRACP
FRCP(Lond)FRCP(Edin)DCH(Lond)President & Founder of The
Gut Foundation
David CambridgeB.Bus(Acct./Fin),CPA,CTA
Treasurer of The Gut Foundation
Dr Fiona NicholsonMBBSFRACPPhD
Paul NicolaouBA,MCom(UNSW)FAMICPM
Professor Melvyn G Korman
MBBS(hons)PhDFRACP
Eliza CurbyCEO of The Gut Foundation
Dr Jeffery L EngelmanMBBS(Hons)FRACPMD
Fady DaherB.Ec
Contributors & AcknowledgmentsProfessor Terry Bolin OAMAssociateProfessorofMedicineatUNSWConsultantEmeritus,ThePrinceofWalesHospitalSydney,Australia.MD(NSW),BS(SYD),FRACP,FRCP(Lond),AGAF,FACGFRCP(Edin),DCH(Lond)
Professor George CondousAssociateProfessorofGynaecology&HeadofDisciplineofObstetricsandGynaecology,SydneyMedicalSchoolNepean,UniversityofSydney.MBBS(Adel),FRANZCOG,FRCOG,MD(Lon)
Professor Emad El-OmarProfessorofMedicineatUNSWConsultantPhysician,StGeorgeHospital,Kogarah,Australia.BSc(Hons),MBChB,MD(Hons),FRCP(Edin),FRSE,FRACP
Chloe McLeodAccreditedPracticingDietitian,AdvancedSportsDietitian.BachelorNutrition&Dietetics,MasterPublicHealth
Martyn BakerGeneralPractitioner,Obstetrics&Gynaecology,Hypnotherapy,Musculo-skeletalmedicine.MA, MB BChir, D Obst RCOG, DCH
Aline FilipePractisingPelvicFloorPhysiotherapistCommitteememberoftheAPAWMPHgroupBSc.Physiotherapy(Portugal),PGDip.Women’sHealthPhysiotherapy(Portugal),MClinPhysio(Curtin-majoringinContinenceandWomen’sHealth,TBC2020)
SourcesAmerican College of Obstetricians and Gynecologists. Endometriosis.https://www.acog.org/patient-resources/faqs/gynecologic-problems Enck P et al. Irritable bowel syndrome. NatRevDisPrimers2016;2:16014.
Evans S. Management of persistent pelvic pain in girls and women. AustralianFamilyPhysician2015;44:454-459.
Gut Foundation. Irritable bowel syndrome. Diagnosisandmanagement.
Jean Hailes Foundation. Pelvic pain. https://www.jeanhailes.org.au/news/pelvic-pain-know-the-differences-and-when-to-seek-help
Maroun P et al. Relevance of gastrointestinal symptoms in endometriosis. AustNZJObstetGynaecol2009;49:411–414.
Mayo Clinic. Chronic pelvic pain in women. https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/symptoms-causes/syc-20354368SaidiKetal.Asystematicreviewandmeta-analysisoftheassociations between endometriosis and irritable bowel syndrome.EurJObstetGynecolReprodBiol2020;246:99–105.
Zondervan KT et al. Endometriosis. NatRevDisPrimers.2018;4:9.
The Gut Foundation
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Probiotics and Digestive Health:
A Guide from The Gut Foundation
This contribution is facilitated by the support of Susan Maple-Brown AM & editorial commentary by Tony James
Disclaimer: ThisdocumenthasbeenpreparedbyTheGutFoundationandeverycarehasbeentakeninitscompilation.ThebookletisintendedtobeusedasaguideonlyandisnotanauthoritativestatementofeveryconceivablesteporcircumstancewhichmayorcouldrelatetothemanagementofEndometriosis,IrritableBowelSyndromeandChronicPelvicPain.TheGutFoundationandthecompilersofthisdocumentshallnotbeliabletousersofthedocumentnortoanyotherperson,firm,companyorotherbodyforanyloss,direct,indirectorconsequential,onwhatsoeveraccountforanyomissionornegligentmis-statementcontainedthereinorbyreasonof,arisingfromorinrelationtoanysuchuser,byanyotherperson,companyorbodyrelyingoractinguponorpurportingtorelyoractuponanymattercontainedthereinorarisingthereout.Thispublicationiscopyrightandallrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,transmitted,reportedorcopiesinanyformorbyanymeans,electronic,mechanicalorotherwise,withoutpriorwrittenpermissionofTheGutFoundation.Theinformationcontainedwithinthisdocumentshouldnotbeconsideredtobeasubstitutefortheadviceofahealthcareprofessional.©Copyright2020TheGutFoundationABN14084315380