My reflections on bladder, stress and the mind body connection following episode 1

DROPPED!: Welcome back to the How We Really Feel podcast with me, Dr. Sula Wingassen. In this episode, I'm reflecting on the conversation with Sachin Malday, consultant urologist and Claire Bourne, pelvic health physiotherapist. There was so much that stood out from this episode and I wanted to start with the hope, the hope which really resonated when Claire said, as much as you can change to get to this place where your body's gone down a route that you didn't expect it to. You can also change to get you out of this place to improve things, to get better. And this really speaks to this concept of neuroplasticity and bioplasticity, how our body is constantly reshaping itself, adapting, upgrading or downgrading, devolving, evolving, and how we can have a role in what happens there, which can feel a lot of responsibility. It can feel scary, but it's also so full of hope and I think from the episode with Claire and Sachin, there was so much to explore in terms of how we might influence that change, that change in the direction that we would desire. And so I suppose as important as it is to recognise the hope, what naturally comes up with that hope, which I see a lot in my clinic, is the threat that comes with the uncertainty around hope. So when we feel hopeful that things can change or that things might get better, it automatically brings your attention towards the seed of doubts or the big grains of doubt that that might not happen. And it can feel very protective for us to back off from that. That's embedded in our culture, right? I don't want to get my hopes up. it's better to expect the worst and hope for the best. But inherent in that sentiment is actually not hoping at all, generally speaking, in how it translates to how we relate to our day-to-day things. So we have to acknowledge the role of uncertainty and the threat around that and how learning to tolerate that uncertainty can actually open up much more hope and with that much more choice. And I suppose to make that a bit more tangible. One really lovely illustration of leaning into hope and curiosity and openness that Sachin explored was around these UTI tests. The fact that UTI testing is so flawed and so if you get a negative test back you can feel like that's the end of the line. But when you're aware that these tests are flawed Naturally, the natural progression is, let me go and find out if the test was inaccurate. Let me see if there are more tests that can give me more information and then maybe that will open up more options. This is such a lovely, tangible example of how being curious, finding out more information, persevering, advocating for yourself can then open up more avenues for changing and improving things. But I have to acknowledge that process comes with costs and it is difficult. It's difficult to open yourself up to the hope and the uncertainty that comes to threat. It's difficult to maintain the energy and the perseverance to ask those questions. It's difficult to put yourself in situations where you don't necessarily feel safe to ask questions. But in terms of what it means for improving things, getting better, helping change your situation, it's absolutely fundamental and crucial. And I suppose when we're thinking about this uncertainty, the threat, the impact on us, the interconnectedness of the body, this is an example of the psychobiological loops where the biological experience of being ill feeds into the psychological experience of uncertainty, feeds back into the biological experience because our body reacts to feeling unsafe and feeling threatened. And so we get these... snowballing progressions of experience, change physiology, more questions, more anxiety, more stress and so on and so forth. So to me that really shows that one of the targets that we have to be working on as we navigate these complicated health journeys is tolerating that experience of uncertainty so it's less physiologically arousing and less psychologically threatening. And I understand that's a very hard thing to do, but so, so important. The other thing that really stood out to me that Sachin said, which I thought was so refreshing, especially to hear from a physician, was considering that these tests are unreliable and a lot of the time being used very inappropriately, the best measure of whether there is something going on, whether it does merit further testing, is actually your own physical experience of symptoms. The patient knows best. And I mean, so many people will find that so refreshing to hear that because so often the experience in the healthcare system is vastly different from that. The tests, the check boxes, the standardized protocols, they're the primary thing that tell you whether it warrants further testing or not, not your lived experience. And that's something that causes so much frustration, so much fear, so much demoralization in patients that I see in my clinic. So it was... So powerful to hear consultant neurologists such in mild day say, no, we've got to be listening to the patient's reported experience of symptoms. I know that it's so hard for you to feel trust in your body, especially when you've been dismissed, you haven't been heard, your account of what you're experiencing hasn't quite been accepted. That does erode internal trust with yourself, with your body. alters your sensory perception. I talk in my book, It's All in Your Body, about this process called multi-sensory integration where our brain is combining data from lots of different physical signals in our body, neurotransmitters, organ functions, brain activations, deactivations, etc. But it's also combining that data with our knowledge, with our memories, with our perceptions, with messages that we're getting and our social experiences. And it has to use all of that data to determine this is what you're feeling. This is the state of the situation. So you could imagine just how hard it is for the brain to make those calculations and make them accurately when we're getting such contrasting experiences. We're getting these physical signals, but we're getting outwardly contrasting messages from those around us. So this can actually then feed into your physical symptom experience as well as the impact that it would have on you. on your own confidence, your mood, et cetera, et cetera. All this is to say, we need to be working on that bodily self trust. And that is really, really hard when A, you might be getting dismissed, B, your body's telling you all sorts of alarming things. But there are lots of different things that we can do to build up that bodily trust. And one of them in its own right, using all of the things that came up in this episode is just advocating for yourself in the healthcare system to get. the explorations, the tests, the information that you need from your healthcare practitioners, and to learn how not to take no for an answer. Again, I know it's really difficult, but it's so important as you navigate the healthcare journey. And I suppose the last dimension that I'm gonna reflect on from this episode is how both Sachin and Claire pulled together from their extensive experience how interconnected the pelvis and the bladder and the bowels are with our wider psychological experiences, all of the different mechanisms that were discussed in this episode from our autonomic nervous system, which facilitates our stress response, whether or not we're feeling psychologically stressed. When we sense that there are demands or when our body senses there are demands, it gets activated. That activation has a physical effect on our bladder because our bladder is innervated by that autonomic nervous system. Claire was talking about the role of pelvic floor. muscle tension and how that tensing and squeezing, which can happen automatically when we're feeling threatened, when we're feeling stressed, feeds in also then to our experiences of pelvic symptoms, hypertonic pelvic floor, pelvic spasms potentially, even symptoms that feel like UTIs potentially. Satchin was talking about this brain overactive bladder versus bladder overactive bladder. And so there was this shared conceptualization and understanding that we can't just be looking at our body as purely biological and separate from our lived experience. The two are constantly interacting with each other. And when we recognize that, we can start to work with the lived experience side of things, potentially to shape the biological side of things too. There were so many different takeaways from this episode from the importance of recognising that a negative test is not the end of the road, it's just the beginning to finding out more information. Something that really illustrated that as well was when Claire was talking about as a pelvic health physiotherapist how alongside her physical pelvic physio interventions that she might prescribe or the manual manipulations that she might do with her patients, she may well be prescribing. other things like pleasure, giving the home practice of go and do something, go and connect with your friends, go and do something that gives you a sense of feeling good about yourself. this one just made me love Claire even more, but to really showed how these psychological experiences that we have around our symptom experiences really can have an impact on the symptom experiences themselves. How can our body feel safe if all we're getting is the experience of being trapped with the symptoms, is the isolation that the symptoms bring, is the threats and the social threats that the symptoms bring. If we can have some kind of a role in interacting with our world in a way that makes us feel safer, that can really feed into the work that we're trying to do with our physiology, which will include medicine most likely, some kind of... ⁓ physical intervention perhaps, but we can't ignore the other side of things. And so on that note, I'll bring this solo reflective episode to an end. I hope you've enjoyed it. I hope it pulled out some points that maybe you've been reflecting on and finding interesting and wondering where you take that next. If you're enjoying this podcast so far, we are offering founding listener member perks. and you can find more information about that in the show notes and there's a link to sign up to become a founding member. The perks include an evolving resource document of all the different references and resources that are being collected as part of this episode season and there are so many. They'll be found on the website for everybody but you'll get your own downloadable, lovely formatted copy of them. You'll also get the opportunity to ask anonymous questions. If there's particular experts you want to put them to, I will put them to the experts and create blog posts around that. And would also love you to have input in the podcast's direction. This season is all about bladder and pelvic health, but we are planning future seasons and we'd love to hear from you. So thanks again, take care, look after yourself. This conversation connects closely with the work I'm doing with Convetech Continence Care and their Me Plus program, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. If this is of interest to you and you'd like to find out more, visit convetech.com and access the Continence Care Me Plus resources. Links can be found in the episode description.