| Howard McCollister 2006-02-28, 5:53 pm |
|
"Pete" <pete@nospam.net> wrote in message
news:1209isoovn1e39@corp.supernews.com...
> Howard McCollister wrote:
>
> Howard...would you expand on that a little please. Hell, when I cough or
> clear my throat, I can feel everything tensing from my throat down to my
> pelvic floor (including a whole much of abdominal muscles), and I have
> some urological stress incontinence as a result (due to previous uro
> surgeries) if I am not careful.
>
> So what I am saying is, if Mike is powerlifting, I can only imagine a
> whole bunch of muscles being stretched or tightened (ie expansion versus
> contraction). Are you saying that weightlifting wouldn't effect the
> various muscles in the esophagus. But it seems when I simply cough or
> clear my throat it seems like the effect is permeating into the esophagus
> also (along with the muscles I mentioned above). I'm probably all wet
> here, but I don't understand.
>
> I guess you are saying the 6-8 week post op wait puts everything back like
> in "original equipment". If its that simple, okay, but it makes me
> wonder, especially for something as significant as power lifting...Pete
Straining has nothing to do directly with the esophagus. It's muscle system
is intrisinic and involuntary, mediated by a reflex arc from the spinal cord
as part of the swallowing reflex. However, it's not quite that simple.
The relationship between the esophagus and stomach is entirely the related
to the pressures in the compartments in which they reside and the ability of
the lower esophageal sphincter to keep the two organs separate. The chest
cavity, where the esophagus lives, has negative pressure - let's say
about -6 mmHg pressure. The abdominal cavity has positive pressure - maybe
+6 mmHg. That means that there is a gradient of 12 mmHg across the LES
trying to get gastric contents into the esophagus. That means that, at rest,
the LES has to have a resting pressure of at least 12 mmHg pressure in order
to keep the esophagus pinched off from the stomach. Obviously, then, things
that increase the intraabdominal pressure above +6 mmHg can blow gastric
contents right by the LES because that pressure gradient exceeds the
pressure of the LES. So, obesity for example, where there is more
intraabdominal content, will exacerbate the liklihood of an excessive
pressure gradient. So will bending over, for example. Even a full stomach
may upset that gradient if the LES is abnormally weak.
So, obviously, would power lifting - where abdominal straining can put
tremendous pressure on the stomach, and cause reflux across the LES if the
LES isn't up to the challenge. The concept behind fundoplication is
reinforcing the LES to increase its resting pressure, AND to prevent it from
being able to relax too much when pressure is put against it. Because that
fundoplication wrap is done using a part of the stomach (the fundus) that
normally relaxes during swallowing just like the LES does, the incidence of
difficulty swallowing is (theoretically) minimized - it will still relax
enough to let food through. So, the problem with power lifting is that too
much abdominal straining too soon can put too much pressure against the
wrap. This is a potential problem with patients that have a fundoplication
that is done badly - where the wrap is too loose, or secured too low on the
esophagus, or it there is unrecognized/unaddressed shortening of the
esophagus. But if done properly, abdominal straining such as in power
lifting should not be a problem after things have healed.
HMc
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