Dr. Sula Windgassen (00:00) In this episode, I was joined by Sachin Malde, consultant urologist, specializing in functional female urology, bladder pain syndrome and chronic urinary tract infections, and Clare Bourne, pelvic and digestive health physiotherapist, specialist in biofeedback and author of Strong Foundations. We covered everything from whether there is such a thing as a normal bladder, habits that you might have that can actually change the physiology of your bladder and your pelvic floor.  And everything that you need to know when your bladder starts acting out of the ordinary. This episode will help you understand what is happening when you get that urgent need to go, why you get urinary tract infections, and the down low on UTI testing. We also spoke about the overlap between the bowels and the bladder and why what started your UTI might not be what keeps it going. I hope you enjoy this episode.  It's really lovely to have you both here. I'm very excited to be discussing all things to do with our bladders. What's normal, what's not normal, when things go wrong, what happens as a consequence of that and what we can do about it. I'd love you to introduce yourselves first of all, so starting with you please.  Sachin Malde (01:16) Yeah, well, thank you, Sula. It's great to be here. So I'm Sachin Malde. I'm a urologist. So I focus on men, men and women's kind of bladder health. But my specialist interest really is in bladder conditions, bladder conditions, but bladder pain, infections and incontinence. It's kind of the main areas I've been focusing on over the last few years.  Dr. Sula Windgassen (01:38) Yeah, we're really excited to have you here because of that exactly.  Clare Bourne (01:42) Thanks for having me as well. I'm Clare Bourne. I'm a specialist pelvic health physio. So I work with women, men and children, so anyone of any age with anything relating to the pelvic floor. So it might be bladder, might be bowel, might be sexual health conditions. And I've just got a real passion for, I guess, the more complex case where maybe things have been going on for a long time, understanding just more about the individual sort of biopsychosocial model that I know you're very passionate about and sort of working with an MDT to work out how can we all bring together to provide best care.  Dr. Sula Windgassen (02:09) And I'd love maybe just to start off because when I'm working with my clients, like you say Clare, often it's kind of complex presentations. So things have been going on for a while. It's not been straightforward. Actually, a lot of people in my clinic tend to be younger and they tend to think I'm the only one that's having this kind of issue. And from these discussions, it's come to my attention that I think maybe the general public has an idea of who gets bladder issues and what that looks like. I'd love to hear your thoughts and kind of demystify who are the people that get bladder issues.  Clare Bourne (02:47) I'll go for it. Yeah. I mean, you get that so much in clinic. I get a lot of women being like, do you just see postnatal women? And I'm like, no, I see everyone of every age. And actually when you say children, they're like, what children? And I think that's what anyone who's got a bladder can have a bladder symptom at any point in their life. And I think, you know, I think sadly it's become a sort of more, when a pause or postnatal, because that's been more talked about. I mean, we weren't talking about anything for a long time. So we've done well to get that into the mainstream conversation, but I think you're right. Can still feel, or men or children can feel very alone thinking, this doesn't mean anything for me. I mean, most people don't even realise they've got a pelvic floor until they maybe have a baby. For me, the conversation is like, well, let's start there. But yeah, anyone of any age can be impacted. We all have an organ of a bladder, so it can impact us at any age.  Sachin Malde (03:31) Yeah, I completely agree. You know, we, same thing in, it's kind of a myth that people often think this is just an older person's condition, older men, older women. And you see them in clinic and they say, I must be a bit unusual in my age. But actually, you know, we see people who have had problems from childhood and then carry on into late teens, early twenties and have problems throughout their life. So I agree. It's exactly like you say, you know, it's a problem for all ages.  Dr. Sula Windgassen (03:58) And just thinking about that bladder issue starting at childhood, could you shed some light on why these things might start in childhood? I'm sure there's many varied reasons.  Clare Bourne (04:10) Yeah, we see a lot of stuff being related to the bowel. So maybe constipation that starts and then that impact. And because within the pelvis, everything is very, very close together, though a lot of our anatomical diagrams make it look like they live in separate villages. They're actually right on, you they're very, very closely connected. I mean, we know constipation is rising in children and then that can actually lead to a lot of symptoms or maybe soiling, which there might be increasing risk of UTIs. And so we see a lot of bladder and bowel existence together. So there might be other reasons, you know, there's girls who maybe have giggling continence or incontinence with exercise. And again, there's always more reasons as to why. And sometimes there are more congenital reasons, or there may be more, you know, neurological reasons or neurodiversity that might be linked in there. But those I'd say are the most common things we see presenting, which as you say, once they start young, then habits form or things. We don't deal with it that well as well. I'm sure you see this in clinic, I see a lot of adults. The reason I was quite passionate to treat kids is I see a lot of adults like, well, I've had this since I was four. And you're saying, gosh, if we dealt with it better at four, maybe we wouldn't have got to such a persistent position in your 20s, 30s, 40s. Yeah, I guess that's what I see.  Sachin Malde (05:16) Yeah. And I think that it's quite hard in the pediatric world because the diagnostics that we have, at least in adults, it's very different in pediatrics. And I think there's not the same kind of level at the moment of detailed investigation. So it's quite hard to get the right diagnosis and the right access to the right treatments. So I think that's a massive area in pediatrics to really focus on.  Dr. Sula Windgassen (05:41) And is there a sense of like almost normalizing that kids have bowel, bladder issues, which maybe means that some of these things aren't handled as well. I'm curious actually, Clare, when you said we don't deal with it as well.  Clare Bourne (05:56) I think it's very hard for as a parent to sometimes know when does it become a problem? You know what I mean? And I think we have a real problem, if I'm really honest, in our whole approach to potty training or gaining continence. No other developmental process does a child learn in three days. You don't learn, you don't go on a walking program to walk in three days. The child naturally learns through exploration, getting it wrong, falling over, then learning. But with potty training, this real expectation that you're two and a quarter, the nursery says you're ready to go and you stay home for three days and you nail it. And to me, as a parent, I've got two children who potty trained completely differently.  You know, there is no one way of doing it. So I think my feeling is, is that our whole approach to that sort of bladder and bowel health is, but then parents don't really know. Don't, it's no parent's fault. And then maybe children do get constipated, but we're not then managing it in primary care particularly well. That's quite well known that it's not maybe dealt with a hundred percent.  Don't get me started on schools and children not being able to go to the toilet when they need to go to the toilet. I mean, I've talked to my kids about this so many times. So I think it's tricky. Know, then the parents are like, well, if they're wetting their beds at seven, is that a problem? When do I go help? And then they might go and ask for help. And then it's medication, but they're worried about medicating their children. So I guess that's what I mean. It's like this snowball effect. And I just think if we could actually educate more on kind of, guess what we're trying to do, bladders, bowels, normal, how can we support, how can we detect early on when constipation a problem when is it not? I think we could be more preventative.  Dr. Sula Windgassen (07:33) Absolutely and in terms of because I guess maybe your average listener wouldn't really make that easy link between constipation and bladder. Yeah, could you explain that a little bit?