DROPPED! (00:03.296) Okay, great. We're doing it. I'll just wait for Matt to leave. Okay, great. Great, so yeah, we're recording and I'm gonna start just, I'm gonna ask you both to introduce yourself and then we'll get into the flow of the conversation if that's okay. Lindsay, sorry, did you have to be away at a particular time? Have a hard stop at 10. Okay, brilliant. So that is, let me just look at my proper. hour and 17 minutes. DROPPED! (00:33.442) and now I'm sorry, brilliant, okay, I'll work to that. Well, so thank you both so much for joining me. I'm really excited about this conversation. I'm gonna ask you first of all, just to introduce yourself, starting with you, if that's okay, Yeah, absolutely. It's a pleasure to be here. And thank you for having me. So I'm Lindsay McKernan. I'm an associate professor of psychiatry and behavioral sciences at Vanderbilt University Medical Center. So great to have you. I've got so many questions for you about the field of Euro-psychology, which is a term that I read on the internet that you've coined. So I can't wait to get into that. And Saoirse, I'd love to hear a little bit about you. Yeah. So my name is Sersha. I'm a women's health coach and I specialize in endometriosis. I'm also a yoga teacher and a massage therapist. And I'm the director of LiveUTI Free, which is sort of like a patient advocacy and research organization focused on women's pelvic health. Fantastic. So, I mean, this episode, we're gonna dive into, I suppose, the link between emotional experiences, the bladder, the pelvis, and how the two meet each other. And I'm particularly keen for this conversation because I think for a lot of people, they tend to recognize that stress, emotional discomfort manifests in the body, you know, when we say... DROPPED! (01:55.074) we are stressed, we might say, yes, my jaw's tight or my shoulders are clenched, the other way around, my jaw's clenched, my shoulders are tight. But often it feels slightly unusual to think about emotions having an impact on our bladder or our pelvic floor. Hopefully that started to shift. But perhaps starting with you, Lindsay, this term, uro-psychology, just to give some context, I found Lindsay. I didn't discover Lindsay, but I found Lindsay, fortunately, when my husband and I were going to Nashville back and forth for his music career. And I was thinking, could I live here? Is there anything going on in the world of health psychology? And it just so happened that Lindsay McKernan at Vanderbilt University was doing research in the precise area that I was super interested in, which was how psychology impacts bladder. experiences and so since that many years ago now we've been back and forth collaborating and liaising with each other so I'm really excited to hear more about your research and what you've been doing but I heard that you'd coined this tenuropsychology and I'd love you to talk a bit about this. Yeah, absolutely. As you know, working in health psychology, there are many subspecialties of health psychology that exist, for example, in GI. And that hasn't happened in urology quite as quickly as these other areas of health psychology. And I think part of it is because of the area of the body that we're talking about. It's difficult for some to talk about or to... acknowledge that relationship between stress and the body and the bladder. But there's so much that can be done from a psychologist's point of view to help support people that are going through urology treatment, both to help with symptom coping and management, but also to help with addressing some of the in-office procedures that happen. And we can talk about that depending on if we need to. DROPPED! (04:06.669) Yeah. some of the in-office procedures that happen and then just general support for what it's like to live with the kind of syndromes that we're going to be talking about today. And yeah, could you say a little bit more about the in-office procedures? What you mean by that? yeah, gladly. So often, you know, things that are done to help manage the bladder might be involving injections into the bladder or sometimes diagnostic testing that involves having a scope put up your urethra or being catheterized or sometimes you have to go through a test that looks at the pressures in your bladder and pelvic floor that can be very uncomfortable. particularly, I know we're going to be talking about trauma. So if you think about people who have had trauma to their body or physical insults, and sometimes that trauma has been of sexual nature, it's an extremely sensitive and vulnerable area of your body, and these procedures all involve that area. And so we want to make sure that a person feels safe and in control and also can keep their stress down as much as possible, because the more stressed you are during these procedures, your body reacts in kind. lyndsey fhy8ka1ag (05:20.397) and can clamp down and that can make the procedures more uncomfortable. There are some procedures that people have the option of going in for as an outpatient or as an inpatient and they're repeated procedures. And so when you're looking at something that's managed over the course of time, you really don't want to go under anesthesia every four to six months to have these injections in your bladder, but it's very uncomfortable. Yeah, absolutely. lyndsey fhy8ka1ag (05:44.575) If you can tolerate it for five minutes in the office, then you don't have to have repeated anesthesia, which is very bad for your brain. So that's one of the other ways that we can help support through things like relaxation exercises and clinical hypnosis, trauma-informed care to help tolerate those procedures better. Mm. DROPPED! (06:00.99) Amazing and I'm going to ask you about those processes and how they can help and what they look like a little bit. I guess just to reflect on that personally and professionally, I shared about my own experience with Eurodynamic testing. So where you get catheterised and they are looking at, they fill your bladder up with the dye and then they're looking to see how your bladder's functioning right. it was probably such a standout memory from my whole bladder experience of going here, not really knowing what was going to happen. And I was very excited actually for the diagnostic test because I was like, finally we might see that my bladder is functioning differently. But I wasn't prepared for the level of discomfort that it would cause. And also my bladder was obviously very hypersensitive, so it caused huge irritation. is to the degree that when, quote unquote, the test was normal and he couldn't see anything going on nefarious with my bladder, he was like, yeah, it's all normal, pulled out the catheter and everything. what I imagine happened is my bladder went into spasm and maybe the urethral muscles as well. And I got extreme pain and was like, I need to go to the toilet now. And he was like, well, you don't tap it on the screen being like, look, there's nothing in there. I was like, well, this is exactly my problem. This is why I've come. But I definitely need to go to the toilet now because it feels immense. So I had this backless gown on and he was very perturbed and showed me out to where the toilet was, but it opened into a waiting room where there were people. So I was like flashing my bum, trying to hold this gown shirt into the toilet. lyndsey fhy8ka1ag (07:30.368) Yeah. DROPPED! (07:50.252) and then just there trying to wait for this urgency to pass, urgency and pain. And I was obviously there for a little while and the nurse was then wrapping on the door being like, excuse me, come out. It was terrible. But I remember Lindsay, when I came to the urology clinic that you visit and have input into, you know, to help people with some of these procedures. And I remember my mind being blown because I, as part of that, observed multiple urodynamics testing. DROPPED! (08:18.39) And the way that the nurses were with the patients, there was this one woman and she looked like she was meditating. And afterwards I remember I was like, how was that? She was like, yeah, totally fine. Because she'd been told what was going on. I remember the nurse kind of telling her, this is what we're looking at. This is what's happening. And it just made obviously such a big difference. So it shows, you know, on that physiological level, just the communication can make such a difference too, right? Absolutely, you know, even as you tell the story first, you can hear how difficult that was and how important of a memory that is to your own medical journey and the many opportunities where that could have been different. You know, part of that is being informed before you start helps you feel more in control and even seeing the equipment can make a difference. Mmm. DROPPED! (08:57.271) Yeah. lyndsey fhy8ka1ag (09:06.655) and then having somebody walk you through the steps and when they responding to your suffering as well when you're saying, I'm struggling right now instead of questioning and saying that there's not a physiological cause or I don't see this on the scan. That's not the point. The point was that you were in pain and you needed support in that moment. Yes. DROPPED! (09:22.595) Yeah. DROPPED! (09:26.272) Yeah, it's so interesting how there can be so often this disconnect, right, between what is expected in your experience from healthcare professionals quite often in these illness experiences versus what you're experiencing and what a big divide that can create and how unsafe that can then feel. Sersha, I'd love to hear a little bit from you about your own journey because you've had us. DROPPED! (09:56.098) Yeah, a long journey with symptoms. Yeah, so I probably had my first acute UTI, maybe age 14. My mother brought me to the doctor, very routine. They gave me antibiotics, she brought me home. Thought nothing of it. And then I got the next one, however many months later and thought nothing of that. And then I got the next one, however many months later and nobody around me was highlighting that you shouldn't be having bladder infections this frequently. And my mother didn't particularly want me taking repeat courses of antibiotics either. So I was, started dealing with them by just drinking lots of water and using like bicarbonate of soda to neutralize the singing. And this worked in theory, you know, the, the ETIs would resolve within one to three days. But I was having, you know, sort of three to four acute ETIs a year. And I couldn't really pinpoint a reason for them. And I suppose it wasn't really until they became chronic that I was like, okay, so clearly this isn't normal, you know? But at that point, going to the doctor, like I had, did actually have initially a positive culture, but then I had three days of antibiotics and from then on all of my cultures were negative despite the fact that I had continuing symptoms. So that's like, that's a really sort of scary, confusing experience. You start really doubting your... body, you start doubting yourself, you start doubting the feedback that you're receiving from your body. And unfortunately in Ireland, there aren't really any sort of chronic UTI specialists. Like of course there are urologists, but no matter who I was being sent to, they were referring back to these negative tests and it's like, okay, you know, so you're kind of at a little bit of a dead end. did end up, that's how I began working with LiveUTI Free actually, is that I found the LiveUTI Free website. Saoirse Graded2 (11:52.108) And Melissa, the founder, gave me a list of clinicians in England who specialize in chronic UTI. And I was able to go to England and get treatment from a doctor there. So I had the first visit in person and then all subsequent consultations were online and I was sending samples back and forth. And that obviously, that was several years of antibiotics that I was on. I was actually able to avoid the urodynamic testing, which I know it can be really valuable for some women, but as you said yourself, it can be quite traumatic in some ways and it comes with its own set of risks if you're having to use catheters and things. So although I was really not pleased at the thought of long-term antibiotics, I am pleased that A, they worked and B, I was able to avoid a lot of the more invasive testing. Yeah, absolutely. And it's hard as well. We've had experts on talking about the testing for UTIs and how the common tests that are used for UTIs were actually developed for a very specific population, which was like pregnant women on the verge of kidney infections as opposed to these UTIs that tend to be more common. So... Again, there's difficulties there with, to say something different to what you're experiencing. And you mentioned there about that disbelief in your own body. Yes. Yeah, it's funny, isn't it? Because you are getting the feedback from your body quite clearly, but you're going to clinicians that you're taught trust your whole life. You know, doctors are the be all and end all for, you know, all things health related. And they're telling you that that you're okay because nothing's showing up on the test mice. That is really, really bizarre apart from anything. But it's also really quite scary. And I think it can leave you feeling really, really hopeless. And it's really, really hard to heal. Saoirse Graded2 (13:47.968) if you feel hopeless and you feel powerless. And especially if you're doubting your own body, if you don't trust your body and you don't trust your capacity to heal, it's going to be really hard to access. And that's kind of the position that you're left in. I remember when I had that, you know, I had my first positive test and then my second negative test and you're kind of, you're spinning because you're like, what on earth, you know, and it can lead you to, you know, not pursuing further testing as well, if you take that test as gospel. it's quite, Yeah. Saoirse Graded2 (14:17.654) It's quite a dangerous kind of position to be in for both your mental health and your physical health. Yeah, absolutely. And Lindsay, you know, thinking about that fear and the uncertainty and the bodily disbelief that comes with that, could you perhaps help us understand the link between those emotional experiences and then bladder experiences and physiology perhaps itself? Yeah, so. You know, if we take the UTI example that was just given, your body is experiencing infection, you're having more pain, you're maybe not sleeping as well, just your resources in general are getting depleted from chronic discomfort and pain. And there's a lot of uncertainty about when it's going to go away. If it's, you know, like we were just hearing about, I'm experiencing this, but I'm not seeing it on the test. So it's validity and then also its intensity can vary. So it's not just coming and going. Within the infection, there are days that are worse than are better and they're very hard to predict sometimes. mean, some of us have really clear triggers and others don't. And so you have something ravaging your body that is unpredictable and also being questioned. So it's very unsettling and causing a lot of pain. Saoirse Graded2 (15:40.865) Even. at the same time. So just that circumstance is going to put you on edge. I how could it not? You you think about our psychological makeup, how could that not put you on edge to have something that's causing you harm in your body and you don't know when it's coming, it's going to put you on alert. And when you're on alert, a lot of things happen in your body and brain, just beginning with how we hold our body. It's like we're ready for a threat. And so we're going to be more clamped down. Our muscles will be more tense, like we're expecting something to happen. As if you knew when you get up, it was going to hurt your pelvis, you would sort of brace yourself just from the beginning. So your muscles are going to be more tense. If the pain is in different areas of your body, it's also going to be actively processing pain in your brain. And that's going to put you on alert as well. And so these systems, they kind of cross pain processing and stress. And it can affect affect your tension in your body, which can in turn then worsen what's going on in your bladder. know, your pelvis is encased with a lot of muscles, for example, and if they're squeezing on it, that's going to make it hurt more if it's inflamed. Yeah. And it's hard, isn't it? You know, because that physiology is very real and it significantly potentially adds to the bladder pelvic pain experiences. Saoirse, in the context of UTIs, did you make that link? And well, let me start with that question. Did you ever make that link? lyndsey fhy8ka1ag (17:06.679) Yeah. Yeah. Saoirse Graded2 (17:19.374) You know, I think at the time, no, I think at the time I, you know, something was happening in my body and I was certain of that. I hadn't particularly linked it to my emotional or mental state. In hindsight, absolutely. It's abundantly clear that not only something very traumatic had happened to me, I'd lost my mother when I was 21. I was looking after my brother full time. He was nine. I had obviously been experiencing the acute UTIs before then, but the chronic UTI came after that event. So obviously in hindsight, absolutely. And it's also clear that the more stress I felt, the more fearful and hopeless I felt with the worsening of my symptoms and the lack of support that also then the worse the symptoms got. So in hindsight, it's very clear. I think at the time it wasn't so clear and it was through the experience of being chronically and well and then doing the things to support myself like getting psychotherapy and learning about nutrition and yoga that it became clear. But yeah, it wasn't super clear to me at the time. Yeah. Yeah. So you go, Lindsay. I was just thinking one of the other things that I didn't mention that's just so apparent in your story is that when you are experiencing pain in a part of your body that can't be seen or doesn't show up on medical tests, it puts this additional pressure for you to have to advocate for yourself and somehow justify your experiences, which is extremely difficult to do when you're already suffering. Like explaining why you hurt to someone when you were hurting so much. You don't even really have the cognitive energy to do that because you're in so much pain. Saoirse Graded2 (18:39.276) Yes. Saoirse Graded2 (18:46.304) Yes, that's a really big, yeah, and I think that's part of the problem with not being believed and not having your symptoms taken seriously when you go to the doctor is that then the illness is on you to go back and to research and to be comprehensive when you're going to the doctor and listening to everything that you're experiencing. And you don't necessarily have the energy to do that because you are in pain. And as you say, there might be things like you're not sleeping well. So it's a really challenging position to be in. It's really challenging, isn't it? Because we've talked a bit about this on the podcast as well of that striking the balance to be believed. On one hand, you want to go with clarity of what's happening and give the data and understanding sufficiently explaining the impact and how that's having a negative impact on you functionally, maybe emotionally. On the other hand, know people are also very wary of being too quote unquote emotional and giving too much detail because then they might be judged for making it up or, you know, embellishing or it's very hard as a patient. you know, we do know that there are gender health inequalities, which maybe we'll be able to touch on a little bit as well, because I Lindsay and I have done some interesting research on this in the context of interstitial cystitis, but just broadly, we know it's very hard to be the perfect patient, you know, to get the, and again, that in a sense that it's us that has to be the perfect patient to get the right outcome from the consultation, which of course it shouldn't be that way around, but you feel that pressure. Yeah. DROPPED! (20:28.174) And Zercha, just in terms of your patient advocacy work and your work as a health coach, what do you observe in people that are experiencing bladder issues and perhaps that emotional, physical overlap there and how they come to process it? Yeah, I actually think that by the time I speak to a lot of women, they've been suffering for quite a while, you know, and I deal with women that have like bladder issues, but also endometriosis. And they've often been suffering for quite a while already and therefore have done a lot of their own research and reading. And I find that women are actually quite open to the fact that emotional stress and mental health can affect their physical symptoms. Like I say, because they've been struggling for so long, by the time I talk to them, they've... you know, a lot of the time they've noticed that pattern themselves. And I also think that, you know, with social media, there's a lot more of this information is accessible online. mean, it was when I, you know, it was only sort of seven years ago when I was quite sick. So it's not that it wasn't accessible then, but it is becoming more and more and more common to see social media posts and podcasts and dealing with this, you know, the whole idea that the mind body connection and that stress affects your physical health. So actually I would say that, Most women are either, you know, because it's women that I deal with, are either aware of this already or when I bring this up with them, they're really quite open to the concept that perhaps stress in their life or their mental health or, you know, trauma has an impact on their physical body. Yeah. Is that the same for you, Lindsay? Or do you find that you have to do a bit of work to help people understand that interrelationship? lyndsey fhy8ka1ag (22:12.525) I think for the most part it's understood as a factor. It's very important for people to have the distinction that it doesn't mean it's the sole reason or the only reason why pain exists because that's one of the stigmatizing viewpoints that people fight as they go through these medical visits that, you're just stressed out. If you get your stress under control, this is going to go away or it's all in your head. Yes. Thank you. lyndsey fhy8ka1ag (22:42.477) which is a very dangerous perception for somebody to carry for the reasons that we're talking about, know, especially when you're you're really suffering and that's being questioned. But people often do acknowledge that stress can influence flares of these conditions, that they may be more active in periods of transition or life stress where you're more vulnerable to pain as well. And consequentially, when you experience these symptoms, you do have stress reactions to, like, not again, you know, or when is this going to go away or how long is this one going to happen and that hopelessness that Sersha is talking about too. Yeah. DROPPED! (23:23.874) Yeah, it's such an important distinction that it's, you know, as we explore the psychological elements and factors in these bladder conditions and the range of them, you know, from chronic UTI to interstitial cystitis to hypertonic pelvic floor, that it doesn't mean that's the primary cause necessarily, but it's part of the picture that can exacerbate if we're not taking that into account. I think it can be hard for people to you DROPPED! (23:54.11) recognize the role of it without their brain doing that thing that brains do of dichotomizing a being. If I acknowledge it, means it's the only thing. But I saw your example there as well of in retrospect, in hindsight, you'd been through a lot of stress, know, bereavement, which I'm really sorry to hear about, and then caretaking for your brother. And then a past history of recurrent UTIs, then it turned in chronic. And that really fits fits the pattern of what I see as well in private practice, in clinical practice, where there are these, like perhaps a biological predisposition, recurrent infections or a sensitized bladder. And then there's some kind of psychological, social stresses that interact and then things change trajectory. Yeah, because I also found, so I have endometriosis, I have a clinical diagnosis of endometriosis, I haven't had surgery yet, but you know, I had some of the typical symptoms, I had, you know, heavy painful periods, but other than that, I wasn't particularly symptomatic throughout the rest of the month until this bereavement and then the chronic UTI started, you know, getting worse and then the endometriosis symptoms started to ramp up as well. And again, in hindsight and with everything that I've learned, I understand stressors and the hormonal cascade and inflammation in the body. I understand, but at the time that wouldn't have been super clear to me. But like I say, the conversation around that is more common and it's broadening, but I think you made a really good point, Lindsay. Like we don't want to, that's the whole point of these conversations is understanding that it's a mind-body connection, that it's a whole person. know, oftentimes we're told it's completely physical and you know, medicine sometimes separates you into body parts or systems. But then you also don't want to believe that it's completely in your head. It's really an interplay between both systems, you know. DROPPED! (25:48.878) Absolutely, and I do think understanding some of the ways that trauma can affect these sorts of symptoms can actually help people grasp that nuance a little bit better. So, you know, we've got lots of research showing that in patient populations with bladder conditions, pelvic conditions, there tends to be a higher prevalence of having experienced trauma. And Lindsay, you've... done some really interesting research looking at the overlap of PTSD in populations of people with bladder conditions. Could you tell us a bit about that? Yeah, we can start really broad, you know, and we've done PTSD screeners in our clinics, optional, of course, you know, you don't have to answer these questions, but it may be helpful, especially when you're going into a visit that might involve a pelvic exam for us to know so we can be sensitive to your needs as well. So in the people that did complete those screeners in our clinic, 42 % of the population met. Mm-hmm. Bye! DROPPED! (26:46.734) Thank you. lyndsey fhy8ka1ag (26:56.831) screening criteria for PTSD. is so significant, know, such a significant proportion of any population to have that. Mm-hmm. Yes, it's very high. there's a difference between trauma exposure and PTSD. 90 % of us are exposed to some type of trauma throughout our lifetime. And only about 8 % go on to develop post-traumatic stress disorder. So it's a response to the stressor. So it's experiencing something that is horrific or life-threatening. And then after a period of time, having symptoms of being activated or avoiding reminders of the event. having memories of things come and go without you really having control over that, disturb sleep and mood changes as well. And other symptoms, sort of the symptom constellation of a stress response that happens. DROPPED! (27:52.93) And I think generally people might have a conceptualization of PTSD from, you know, people going to war or people who've been involved in a car accident or something like that where there's a single incident and it's very, you know, pronounced the kind of physical damage that happens in that moment. And then, you know, as portrayed in media and films and things like that, there's these... flashbacks that take you right back to the incident and then it has this impact on your life. So I think it can be hard for people to catch when they do have PTSD because it's not always like that. I wonder if you could perhaps illustrate a little bit what PTSD might look like when it doesn't fit that media type presentation. Yeah, when it doesn't fit the war-torn survivor story. So trauma happens across the whole spectrum. You know, we can be at war and experience violence, but we can experience violence behind closed doors in our households as well. As a child or as an adult, there can be insults on the body that happen in other ways that are horrific, like having a botched medical procedure. Mm. Yes. DROPPED! (29:08.867) Hmm. or waking up in the middle of a procedure where anesthesia isn't working and you're aware of what's happening in the room. I've worked with men and women who have had that circumstance as well of traumatic surgeries. So there, and you can also have PTSD in response to secondary trauma when you learn about a traumatic event or for first responders or people that work in hospitals that witness violence and horror. And so it doesn't always fit the traditional mold. Something important also is the distinction of what is something that was traumatic versus post-traumatic stress disorder. The PTSD comes with a functional impact on your relationships, your social world, your work life. And it really does start to interfere with your day to day. That's kind of where you know where the line is between am I struggling? Am I having a Yeah. lyndsey fhy8ka1ag (30:07.885) understandable response to difficult circumstances that we can work through over time, or is this persisting and is this now impacting my life and my relationships in some way? I hope that fully, I don't know if that fully answers your question. It was kind of a long answer to what you asked. Yes. DROPPED! (30:26.631) No, it's a great answer. I was just kind of thinking about an example of those distinctions, right? Because I think one thing that you pointed out that's really helpful is we might have a particular idea of what constitutes trauma and then therefore dismiss things that we've experienced that would have an impact and stay with us. even the experience of UTI, Saoirse, I don't know, about your experience, but they can be really traumatic when you're stuck on the toilet and you can't do anything and you're in that degree of pain and you're trapped. That can easily constitute a trauma if we understand trauma as like extreme stress and we've got limited control. Yeah, well, I mean, like, I still say to this day, you know, I do have more endometriosis symptoms now. I do have incredibly painful periods and I have back pain and other things. And I am still much more terrified of getting a UTI. And I would say honestly terrified of getting a UTI. I would take the rolling around on the floor and agony on my period any day over. Mm. Saoirse Graded2 (31:29.58) Because as you say about trauma, it's not just the experience of the UTI itself, it's the experience of going to your doctor's and being dismissed and not getting any answers and then having to spend so much time and energy and money on researching other ways to help yourself, you know, and finding different clinicians and buying different supplements. So absolutely, I think something like recurrent infections, recurrent UTIs, especially something that becomes chronic and you're kind of being told that there's no evidence for that. Hugely traumatizing. Yeah. And it's interesting what you said there as well, Saoirse, about the impact of it afterwards of not being believed or knowing that you're going to have to fight because a lot of the time when I'm working with people in my clinic with bladder issues or pelvic floor dysfunction or other kinds of physical health issues, actually, we might have identified a moment in time where the physical intensity has been particularly bad and that has been extremely stressful. but a lot of the time what we end up processing is the dismissal or the sense of powerlessness that's come from that process, which shows just how stressful that can be. Yeah, well, like I say, you know, I remember the appointment I had with my doctor, the second appointment where the test came back clear. And she essentially was like, well, you know, that's it, you're good. And I was like, well, I don't feel good. And so she put me on the waiting list to see a urologist and that waiting list was three years long. And I remember leaving that appointment and like, that's what's terrifying because you're like, you're left in this complete limbo with no answers. And it's really, yeah, as you say, it's, that is definitely a traumatizing thing and that I can totally understand why those are the kind of moments you end up processing with clients because that can be just as traumatizing as the physical experience. Absolutely. DROPPED! (33:24.39) And Lindsay, in terms of, as you were saying, that differentiation between experiencing trauma and then the PTSD type symptoms, I suppose then to make that differentiation, you might go through that kind of experience and that be deeply unpleasant, but you're still able to present to the healthcare system, for example, and you're still able to push. Whereas perhaps somebody that has ended up getting PTSD from something like that, it might be that. they end up still going, but they get extreme panic attacks every time, or they completely avoid going. So it has that impact on the rest of their trajectory. Yes, that's right. Yes, or something like recurrent, know, recurrent thoughts about it or fears about it or it's coming up in your dreams and you're having nightmares. Mm. Yeah, yeah. And would you mind as well explaining, because I think one of the criteria of PTSD is re-experiencing, so nightmares, flashbacks, that kind of thing, but they can also be somatic re-experiencing, Yeah, explain a little bit more about that if you wouldn't mind. lyndsey fhy8ka1ag (34:28.53) yeah. lyndsey fhy8ka1ag (34:36.075) Yeah, know, re-experiencing, think, is one of those symptoms that can also be, the narrative can be affected by Hollywood movies. You know, like it's a memory and then all of a sudden we're back 30 years ago and reliving it as it happened. Now that does happen to some people, but for most of us, the re-experiencing can happen on a different level. It may be that you're having thoughts about the symptoms and their impact at Yes. DROPPED! (34:52.493) Yeah. lyndsey fhy8ka1ag (35:05.229) during the day that you don't expect it and these memories are walking through your mind and then you're going through a reel of memories in your mind that you're having trouble controlling. You know, so it's like an intrusion in that way. You can also have re-experiencing symptoms. This is where it gets really complicated with pain because there is hyperarousal that happens in response to the memory. You know, you get... Yeah. lyndsey fhy8ka1ag (35:29.933) activated, you might have some of those acute anxiety symptoms like the tingling. I did this in my fingers, the tingling in your fingers and your face and you get flushed and you're breathing more frequently. And for the people that experience a lot of acute pain, you could then be experiencing pain in your bladder at the same time or be more aware of it because of this activation that's happening in your body. And so you're having physiological reminders in the moment of what has happened to you or some of these treatments. it's like it feels, you know, people describe this to me of being able to escape it in some ways, you know, where you could just go somewhere in your mind and be somewhere else. You were in your body and you're getting these reminders constantly. And it's very frustrating for people to develop loving relationships with their body when that happens. Hmm. lyndsey fhy8ka1ag (36:28.349) You know, there's a disconnect that happens. You often will distance yourself. I see Saoirse nodding. You distance yourself to cope. know, so sometimes there's a disconnect where you try to separate how you're feeling from what's going on in order to just move through the day. You know, it's really, it can be really adaptive for a while, but then you lose sort of awareness of that connection over time. And then sometimes you can get really angry about it because of that not... Yeah. DROPPED! (36:53.134) Mmm. escaping the sensations and being reminded of the pain and discomfort constantly. Because if we think about PTSD in the context of, let's say a war zone and you come back and there are triggers of loud noises. So people might naturally try and avoid being around unpredictable environments where there's gonna be loud noises. And we know that that's not a great strategy because it ends up feeding into the maintenance of the anxiety and PTSD, but people have it as a choice. Alright. DROPPED! (37:31.534) But what you're saying there is the reminders are coming from your own body because you're still symptomatic, you're still having these sensations. And so that then automatically triggers like a somatic flashback, if you like, which then creates its own cycles. So that's a really difficult place to be where it kind of piles on top of each other and goes round in a loop, an amplifying loop. Yeah, and so much what we are talking about, you're of connecting a theme between this, is about the threat response in the body. And I think that that's an important differentiator when we think about how stress and trauma affect our symptoms now. So much of the literature is moving towards understanding the stress response. And you trauma can, of course, prime the system. You know, even when it's earlier, and there's a research study I can talk about with this that we're starting to work on here that has some information with this, but how we respond to the stresses in the moment seem to really influence our pain experiences too. Would you mind telling us a bit about that? Yeah, so it's a newer data set, whether we're working to replicate this. But some of our early findings are showing that we've taken this group, and it's going to take me a minute to explain this, so bear with me, of individuals who have been observed going through treatment over an 18-month period, a very large cohort of people with interstitial cystitis or chronic prostatitis, so under the umbrella of urologic chronic pelvic pain syndrome. So they were observed at DROPPED! (38:49.454) It's okay. lyndsey fhy8ka1ag (39:08.727) baseline six months and 18 months. What we've done in that sample is we've taken the individuals who experienced life-threatening trauma as a child. So in childhood, if you had life-threatening trauma, yes or no. And then we look at at each data point, are you under stress or have you experienced recent stress? And for the people with life-threatening trauma that experienced recent stress, their pain symptoms are higher. Their healthcare utilization is higher. And their pain intensity is higher as well. So that the widespreadness of the pain, so how many places it in the body, how intense it is, whether or not you've been to the doctor more, if you've been under recent stress when you've had that traumatic background, that's all higher. So the people that also had that life-threatening trauma that weren't under recent stress, those symptoms weren't elevated in the same way. But everybody's pelvic pain was higher in that group. So also, like we're talking about, there are primers to having, like you said earlier, Sula, the sensitized bladder. And then if you add recent stress on top of it, the stress response is activating things in the body. Now, the person that I'm working with is connecting this to an inflammatory response as well. Mmm. DROPPED! (40:12.846) Mmm. lyndsey fhy8ka1ag (40:36.359) neuroinflammation, you know, though he's a psycho neuro immunologist. And so he's looking at this as a very complex system in the body that may have been adapted from childhood. And here's how it shows up now. But there really are some notable differences when we experience recent stress versus not, particularly if we've had that threat as a child. Like there's a wiring change, you know, that's the thought there's a change in our wiring. So it's not anything that you've done or that you're responsible for. is literally your system is different because of it. And so we all have to work to understand how we can work with this, with our pain. So shall I see you smiling? Yeah, I just, find this so fascinating and I know that obviously there are a lot of people talking about this kind of research and you know, there's Bessel van der Kolk and you know, and there's Gabriel Massey and there's people talking about the neurological changes that can occur when you've been exposed to a lot of trauma in childhood or even, you know, there's like sort of phrases like big T, little t trauma, but even if the trauma wasn't big T trauma, it wasn't life threatening, but it was consistent, you know, and the changes that can occur in the mind and body. know that, you know, people who score high on the A scale, the adverse childhood experiences scale are more at risk of developing chronic disease in general, more at risk of like inflammatory disease. So I find, I find this research, it's really fascinating. And I think it's really, really valuable for understanding just health in general, but particularly the health of those who have experienced some traumatic. Saoirse Graded2 (42:14.336) events in childhood. Yeah. What I liked as well about what you were explaining there, Lindsay, is it really clarifies that it's not that stress or trauma quote unquote caused the pelvic or bladder issues. It's that there are primers, trauma might be one of them. There might be other things that are going on physiologically that mean that you get bladder symptoms versus other things. But then... the combination with the experience of life-threatening trauma in this instance of the study, then starts to change your body's wiring, which I think is a really helpful way of putting it, which then means your body becomes more reactive to stress. sounds like that's sort of the situation here, which then interferes with the pain circuitry. Yeah. Yes, a lot of this has to do with the stress response. So it changes the way that you also think about treatment. I'm sure that Suresh can talk about this and you too, Sula, that when you are in front of someone after, you might have waited three years for that urologist, as you were saying, and you're told you need to relax more. How that lands. DROPPED! (43:19.231) and Saoirse Graded2 (43:32.972) Yes. is awful and contributes to that invalidation cycle that we're talking about. And there are interventions that are directed towards self-regulation that are really important for the bladder and for the pelvis. And for many that might have endometriosis and chronic migraines and widespread pain throughout their body and as part of a bigger constellation of symptoms, that intervention's directed at adjusting that threat response that may be a hair trigger in your body or you're just wired that way that you actually have to do a little extra work that could help you get some more control over your pain symptoms. And there's some of these treatments that are coming out of emotional awareness and expression therapy, EAET, and pain reprocessing therapy as well. You're starting to see data from these interventions that are directed towards recognizing the response to pain activates that threat response. and adjusting it in the moment and seeing some real differences in how you are experiencing sort of your day-to-day pain goes down. And same thing with the research that we've done on our psychotherapy for interstitial cystitis. We did this whole patient-informed symptom coping and management program. And a lot of people responded to this after. Thanks. Saoirse Graded2 (44:39.502) Okay. lyndsey fhy8ka1ag (45:00.309) eight weeks, we had a really significant response. 37 % of the people that went through this therapy felt they were definitely better afterwards. And this was a randomized trial. These folks had their pain for an average of 14 years in this trial. So it's not that you've just gotten interstitial cystitis and you need to do this immediately. Great, that would be wonderful if it's earlier on. But this can help people at all stages in their pain. Mm. DROPPED! (45:13.9) Yeah, wow. DROPPED! (45:22.082) Mm-hmm. lyndsey fhy8ka1ag (45:26.219) And it wasn't the people that got better. wasn't that they were less anxious or less depressed. We looked at that because I was curious. It was that their pain symptoms were improved and less interfering in their day to day life. You I think that much of this is about you may still have the experiences, but how you respond to them changes and you feel more in control of what's going on in your body and able to handle it. It's like that unpredictability that we've been talking about today shifts. Hmm. Hmm. DROPPED! (45:48.546) Hmm. DROPPED! (45:55.406) Yeah, it's like automatically, understandably, the pain or the symptoms, whether that's bladder urgency, creates this automatic embedded powerlessness because of the nature of the symptoms and perhaps because of prior experience. what you're changing there is, I guess, partly at least self-efficacy of going from powerless to, I have some choices around this. And then that itself can physically change the experience with symptoms. Sersha, I'd love to hear your experience because you kind of had to figure it out on your own, right? How to work with your body in that way. Tell us a bit about that journey. Yeah, well, as I say, I did find a clinician in England who could treat the infection, which was incredibly valuable. And, you know, I'm so grateful that I was able to access that. But I am definitely someone who would identify as having a difficult childhood. And there were a lot of other things happening in my life, as I've mentioned. I needed a lot more support than antibiotics, you know, from my general mental and physical well-being. But as you say, you are kind of on your own in figuring that out. Mm-hmm. DROPPED! (46:54.755) Yeah. Saoirse Graded2 (47:03.618) there's no, at least over here, I couldn't have gone to my doctor and said, help me with my childhood trauma and how that's manifesting. wouldn't, nothing would have really come of that. So I was doing lots of things. was, you know, seeing various different nutritional therapists, which again, super, super valuable, still kind of working on the physical body, not the mental health, but super valuable. I did start seeing psychotherapists. I was going once a week, I think. for maybe two years and that was incredible, you know, for mental health, but also for seeing a change in how my mental health was affecting my physical health. Like we're saying, you know, having a little bit more space when you're feeling unwell in your body and not going straight to panic and anxiety and fear or anger, you know? And I also found that yoga was really, really valuable for that. And I didn't even mean for it to do that. It was just that yoga was the only exercise I could do at a certain point. I couldn't do impact. I couldn't do weightlifting. Mm-mm. Saoirse Graded2 (47:58.988) So I was doing yoga, but actually that was also really, it was great for giving a sense of power back to me that I could move my body in a certain way, but it was also really valuable, like the yogic breathing and the sort of meditation aspect was really valuable for sort of nervous system support. And I guess like over the years, cause you know, this is over a span of maybe four or five years doing all of these different things and really noticing a difference in both my physical health and my mental health. Mm. Saoirse Graded2 (48:29.228) That's what led me to study health coaching and then endometriosis specific coaching and yoga, because I just saw how valuable all of these things were, but how long it took me to access them all. Because as you say, it's like, I'm just Googling. I'm just at home Googling and reading and listening to podcasts. So after years of doing that and seeing how positive the impact was, that's what made me want to go study so that there could be. a point of contact for people who are struggling where you get all of that information a lot more quickly and it's a lot more supportive. But yeah, it's like a whole host of different things that I was doing on mind and body that really helped me in the end. It's that exploration journey as I think of it, as you try things and you then puzzle pieces start to fall in place. what I liked as well about what you said about you weren't necessarily doing yoga for that purpose, but that materialized from it, that almost can set you up better sometimes, I think, for finding the benefits from some of these practices rather than I'm doing this to get rid of my pain or I'm doing this for this specific thing because you've got that curiosity and that can then make the practice feel safer. Could I ask you specifically about the yoga experience and how it changed your relationship with your body because as Lindsay was saying and as you've reflected as well, that Yes. Yeah. DROPPED! (50:02.924) relationship with your body can really change because you felt so unsafe and you've had these symptoms and also perhaps the external experience has made it feel even more unsafe. How did yoga change that if it did for you? Yeah, it definitely did. I think, yeah, that's, it's such an important thing. And it's something that I work with all of my health coaching clients on sort of coming back to your body and viewing it as a friend rather than as a foe, because it's going to be really hard to heal a body that you hate or that you feel is actively working against you. And yoga was definitely part of that for me. Like, as I say, I kind of, I kind of came to yoga, my mom had practiced yoga, so I'd seen it in my home. She didn't practice it, you know. all day, every day, but she would do it at times and she would talk about feeling better. So I already had that experience with it. And then when my bladder was bad, you know, I could walk, but I certainly couldn't run. couldn't jog. couldn't weight lift. But I wanted to move my body. So I started doing yoga from YouTube at home. And then, like, especially when I went and did the yoga teacher training, it kind of really allowed me to explore my physical boundaries. and then gave me a chance to practice respecting my own physical boundaries. And that kind of paves the way for you doing that out in the world as well, not just at home and not just with your physical boundaries, but with your emotional boundaries, your energetic boundaries, like, you know, and I, I feel like yoga really was the first thing that I did that really started to make me feel like I could, instead of hating my body or being frustrated or angry. or scared of my body, that I could actually work with my body in a way that felt good, that I could like try a pose or I could hold a pose and I could listen to the feedback that I was getting from my body and adjust if needed. And like, I think it just really like fostered a sense of self-respect, you know, which might have been lacking before or was affected by being, you know, chronically ill or having this chronic condition. Saoirse Graded2 (52:07.38) It was actually really hugely valuable. then even more so when I did the training, I had a really amazing teacher and she really like, yeah, created that environment where you could really explore. And I just think it's just such a beautiful thing. And I do, I don't always do yoga with coaching clients. That's up to them whether they'd like to do it, but I find it a really valuable tool for people and women with chronic pain to practice, you know, looking after their body and viewing it as a friend, like I say. It's such a powerful switch and it can feel so hard or impossible at the outset, I think, when you do have that adversarial relationship with your body, but it's so fundamental for creating that sense of safety. Thanks. Saoirse Graded2 (52:49.024) Yeah, sorry. And one other thing I would say is, the type of yoga that I practice or that I would do with other people is not maybe the sort of class that you would go to. We're not like all keeping up with each other and holding poses and pushing our bodies and you know, it's actually quite slow and gentle. And again, that's like that exploring boundaries and respecting the boundaries that your body has in the moment. And especially if you're chronically ill, you're not going to be able to do an hour long class necessarily where you're holding a pose and you know, so I find that doing, and I have to say I've done that with women who have like pelvic pain conditions and they get so much more from the slow, gentle, explorative approach than from the sort of like class setting and the pushing to perform approach. Yeah. And it's interesting that word boundary searcher, because it's making me think of that paper we collaborated on, Lindsay, when we looked at the differences in gender, women and men with interstitial cystitis. And so this was a qualitative study and we were looking at just broadly the experience of interstitial cystitis, what it was like. And one thing that really stood out as a contrast, understandably so, is when women were exploring the impact on their lives of having this condition. There was a consensus of, I'll withdraw from things or I won't do the thing in case it has an impact on other people and that's just unconscionable and I wouldn't want to do that. So their lives got smaller and smaller. so I guess the... the social desirability outweighed like what their needs might be to still engage in everyday life and just require a bit of understanding with people around them. And in contrast, I remember this quote in particular from this one guy in the study who was like, yeah, I'll still go on the road trips. You know, I'll just tell whoever I'm going with, we might have to stop 10, 15 times because that's just the way it is. And I just thought there was such an interesting contrast in genders and socialization of DROPPED! (54:52.108) Boundary is assertiveness, what you're able to do, what you're not able to do. Yeah, Lindsay, do you remember that study and have you got anything to add? I Yeah, yeah, I remember that. And I remember another instance where they were talking about just not doing things anymore or going to the movies because you filter everything through whether or not this is going to how where's bathroom going to be? Do I have an exit? How long is it going to be? Who's going to be there? I'm going to disappoint them if I might have to cancel last minute. What's going to be the social consequence of that? You know, the sort of that matrix that gets filtered through. And the men would say, well, I'm just Mm. DROPPED! (55:11.928) Yeah. DROPPED! (55:23.758) Extra load. lyndsey fhy8ka1ag (55:29.835) I'll go and I'm gonna wear a diaper. And that was it. But what these come down to, was just a different coping style of being assertive and proactive with social friends about needs. And that can be very awkward for women in general. We're not socialized to do it the same way as men are, but also we're talking about a very sensitive part of our body. Yeah, that's just the way it is. DROPPED! (55:45.612) Yeah. lyndsey fhy8ka1ag (55:55.211) And so the language that we would normally have if we were talking about a headache, for example, we don't have for our pelvis. How do we talk to our boss about that, for example? Or explain to a new romantic partner that you've just met and you're on your third date and you're thinking, okay, how is this going to go about what's next? We just don't have the language. So part of the work is getting comfortable with speaking up and finding the words. Yeah. lyndsey fhy8ka1ag (56:23.093) what you might feel comfortable saying. If you don't want to be completely open, know, where is the line to opening it up a little bit to where you feel more comfortable and like you can be genuine in yourself out in social situations too. You don't have the physical and emotional space for the additional pressure that that's gonna cause and stress you out. If it's gonna stress you out, it's gonna make you more miserable. You know, and this whole point is to do it to be more active or to feel engaged with others. So. Mm. DROPPED! (56:46.082) Yeah. lyndsey fhy8ka1ag (56:52.129) Finding words, consistently, and Sula, I'm sure you have a lot of this in your clinical practice, the response is, I feel unburdened and empowered. I don't usually hear, I am embarrassed by this. Usually, the response we expect from the people around us is the one we fear in our head. And we need confirmation of that when we say things out loud that we need with people in front of us to say, OK, I understand. And you don't get that shame that you're experiencing. Mmm. lyndsey fhy8ka1ag (57:21.633) to feel more empowered and freed up by this. So I really do encourage people to work on finding some language that they feel comfortable with or helping them find those words so they can start doing things again. Absolutely, because the shame just gets so embedded as we're only alone with our own projected experience of what might happen and we don't get that opportunity to get it disconfirmed. I wanted to ask you as well, Lindsay, when you were making the point about a big part of potentially changing the experience of symptoms is changing some of those coping responses. So we've talked a little bit about going from being adversarial with your body to finding perhaps a different way to relate to it that's more compassionate and collaborative to being assertive and experiment with boundaries. From the research that you've done and the clinical trials that you've done, what are the other kind of changes that you would be exploring with people making? goodness. There are so many things to do, but I think we should start with something Sears just said earlier about getting space between your physical experience and your response to it. So when you are in intractable pain for a long time, everything is noise. You cannot really figure out what triggers your pain, what makes it worse. what makes it better, you can't even really feel the fluctuations in your pain because it is so high and intense for so long. And part of it is doing some self-regulation work so you can get that space first and foremost. So whether that is meditations for some, know, some people don't like mindfulness and meditations, especially when it's in the body, so guided imagery or... lyndsey fhy8ka1ag (59:11.441) yoga or something that can help your system come down so you just get a little bit of distance from your pain experiences. Then you can start picking up on other nuances that are going on of what else is influencing my pain or it's at a seven today versus an eight and what are those differences when it flares. How a flare starts. So again, that's something that's really hard to identify when you're in a pain crisis. So the first thing is getting out of a pain crisis, and then picking up on the nuances and shifts of a flare starting. Now, if you have disconnected, as we're saying, to cope and you push through the days, that's one of the downsides of constantly white knuckling it until you get to bed and then you lie down and you're in agony. It's actually consciously checking in with your body throughout the day and looking for those fluctuations. Once you look for them more, you really start to find where can I intervene as early as possible, is what I would say. As early as possible, at the time when you don't feel like you should respond because it's OK, but it's shifting, that's when you'll get the most out of doing more conscious self-regulation work. So think about it as a flare management kit. For example, this is one of the sessions that we have. I know, Sula, you and I have talked about this. you lyndsey fhy8ka1ag (01:00:34.935) What are 10 things that you can do or have on hand that help bring you comfort, that help make your body feel just a little bit better in the moment, and that are relaxing? This could also involve your rescue medicines that, by the way, you might forget to take. Because when you're in that high of pain, you just can't think. And you're not doing anything wrong. Your brain is in a different mode. So it's the planning it out in advance that really makes a difference. I'm not saying that a person doesn't know all of these things. I'm saying let's put them together in a nice package for yourself by your bed and in your car. And then if you notice these differences in your symptoms, that's time to pause. So it's more of a moving from a reactive response to pain to being proactive and responsive earlier. Yeah. Saoirse Graded2 (01:01:20.243) So. lyndsey fhy8ka1ag (01:01:30.443) that can make a difference in time. So we can talk about a lot of different things. I'll pause there, Sula, but that's such a big one for these flaring conditions, especially inflammatory ones like endometriosis, but chronic UTIs of catching it on the front end can really make a difference. And I loved how you put that of white-knuckling it throughout the day. And then, you you get a big flare up and it might not be white-knuckling throughout the day. It might be through the week and then on the weekend it flares up. But that coping response of, me just get my head down and pretend it's not happening sort of thing. And then inevitably it all flares up. It's a very hard pattern to shift, isn't it? Because acutely it can feel like it's working because you're distracted or you've got the adrenaline. And so making that link of actually long-term, this is not working for me because it inevitably creates this flare-up is, I suppose, as you're saying that, Lindsay, just even recognizing and observing that pattern so that you can see it's one that you need to shift. Yes, and seeing value in it, you know, in making the shift and trying. And part of this is we're talking a lot about self-regulation and helping your body, like actively helping your body come down and stay down so that you're not in a heightened state of alert. You know, I saw a woman last week. I'm never, I'm never gonna seek to be, I'm always amazed. Mm. DROPPED! (01:02:58.094) Mm. lyndsey fhy8ka1ag (01:03:06.178) at the people that I see in clinic and what they are able to do and how they are able to live in spite of what's going on in their body. I have so much respect for this. met a woman last week who goes to the bathroom 60 times a day and has, since she was 15, she has had 30 surgeries, never once asked for leave from work and what's going on. Mm. DROPPED! (01:03:22.67) Gosh. DROPPED! (01:03:26.111) one. DROPPED! (01:03:32.866) Wow. you know, seeing value in that shift and not being afraid of what's going to happen if you do like loosen the grip. It's a shift in approach here because what we are capable of if we do push through is something like that of going to the bathroom 60 times a day and planning your surgeries around your own vacations for years. Mm-hmm. DROPPED! (01:04:03.372) Yeah, Sasha, I can see you kind of reflecting on that. Yeah, I just, it reminds me of, you know, the concept that we're talking about, you know, seeing your body as a friend, because, you know, you wouldn't, you wouldn't make a friend do that. You wouldn't force a friend to push through and be like, I don't care what you're feeling, go to the bathroom and then get back to work. And, you know, like it's really, if you, if you can't see your body as a friend and if you can't trust your body as well, you know, cause there's like in that story, it makes me feel like she doesn't Mm-hmm. Saoirse Graded2 (01:04:36.046) that her body knows what it should be doing. You know, there's some kind of like assumption that, well, my body doesn't deserve the rest or my body just don't know what it's doing, so I'm going to push through what it's telling me. And I just, I know from my own experience and from working with other women, it's gonna be really, really hard to get any healing done when you're coming at it with, you know, from that perspective. So, and it just really makes me feel for her as well to think that she didn't feel she could prioritize her own. health and her own needs, you know, and I just think that is such, it's like a vital part of healing. It's not optional. It's really vital. Yeah. Yeah, and this person hasn't had a change, a meaningful change in their symptoms in a very long time. And I think treating yourself as a friend, it's like an exercise in self-compassion. And it's very hard to do when you're so used to being hypercritical of what's going on or just pushing. And so the question to ask is exactly what you said. Would you ask a friend to do this? If you're a parent, what would you say to your kid? Yeah. DROPPED! (01:05:33.774) Hmm. Yeah. lyndsey fhy8ka1ag (01:05:43.14) right now if they were in a chair in front of you and this is what was going on. And it just gives you a moment of, wow, here's the difference between what I expect of myself and then what I might be telling someone else to do. How can I soften my expectations of myself a little bit, adjust them. I don't say lower them, you know, but just soften a little bit because we do go so hard on ourselves. and DROPPED! (01:06:12.726) It's definitely a theme that I see in people with pelvic conditions, bladder pain, high self-criticism, lots of self-subjugation, high sense of responsibility. And I know we've explored this already in the episode, but I suppose just to kind of spell it out, Lindsay, if you would, what might the mechanisms be? If we're saying, you know, one of the things that is really important is trying to increase self-compassion over self-criticism. And with that opening avenues for emotional regulation that can help that activated state, how does that sort of psychological intervention translate potentially into improvements in bladder symptoms or experiences with bladder symptoms? Yeah, and I was just thinking that's one of the topics in the treatment. You asked me about the different interventions and building self-compassion is one of them. I think this all goes back to what we were saying earlier about responding to your symptoms as opposed to reacting. And this is kind of a theme amongst getting a little bit of space in order to respond. Mm. fantastic. Saoirse Graded2 (01:07:15.064) for us. lyndsey fhy8ka1ag (01:07:26.188) softening the way that you respond to yourself, choosing more proactive pain management strategies in response to early symptoms. All of that can reduce the impact of your symptoms. The planning in advance is responding to your symptoms. So not just planning for flares, but perhaps planning for sexual interactions or being more proactive in conversations with potential sexual partners or friends that you want to go out to, out with, know, speaking up, they're all part of responding to your symptoms. Collectively, that can reduce their impact over time. If you do have symptoms, you've got things that you're ready to use to help, you have tools to use, but also you feel more in control of what's happening. If something happens, here's what I can do to help myself because it's laid out in advance too. So that's where you do start to see the change over time. And I think about that across multiple mechanisms, right? There's the increase in variety in life, which makes your body feel safer. You get that increased social connection, for example, which we know is one of the biggest buffers against the physiological effects of stress, which is gonna have an impact systemically. You get increased pleasure, which is gonna change things on that physiological level too. But also, as you were saying, that there's kind of... Thanks DROPPED! (01:08:56.566) I suppose different elements that can then feed into how your body's responding so that if you feel more prepared, for example, it's less likely to go into that automatic threat response and it's, you you've trained it or you've given it some kind of reassurance that there's an alternative path to go down. And so your body starts kind of evolving its own response with you as you're showing it something different. Yes, you are not helpless and you are in control. You're making the choice. When you're in a reactive place, things are happening to you. And you don't know when they're coming or their intensity, and it's unpredictable and very alarming. When you're in a responsive place, you may experience them and you're in control of how you choose to move in relation to it versus just sort of Mm. lyndsey fhy8ka1ag (01:09:48.112) doing what you need to do to get through the day. Yeah, I mean, I wish we had so much more time because I'd love to just explore this topic forever, but maybe we'll do another one. But, but, Sersha, I'd love to hear kind of, I suppose just your reflections and what's, yeah, if there's anything that you want to add from this conversation so far or anything you've been thinking about as we've been looking at all these different things. I think we've covered some really, really valuable things and things that are still maybe emerging in public conversation, things like trauma and how trauma that might have happened years ago can actually be affecting your physical health right now. And just that kind of self-compassion and being a little gentler with yourself, I think that is so, so valuable. Because like you say, you you've seen that theme in your work. I know that was true for me. I know it's true for a lot of the women that I coach being so, hard on themselves and really pushing through and not giving themselves any sort of self-compassion, any rest, any space. And I just think that it's a conversation that we need to keep having. Like I said earlier, there's a lot of access to information now on social media and podcasts, and it's great that people have the access to that information. But I think the conversation that still needs pushing is... that sort of self-compassion and how you think and feel about yourself and your body and how important that is in maintaining, improving and maintaining good health. And I just think it's just so valuable that we keep talking about that. DROPPED! (01:11:23.599) And I suppose for anybody listening, Seshad, if there was one place that somebody is resonating with this and thinks, okay, yeah, I can see how that might play a role. If there was one place you'd suggest them to start to shift that relationship, have you got a thought about where that might be? There's so many different things. There's so many resources. think like sometimes people can feel like there's a financial barrier there. You know, they might be like, well, I can't, I can't go and get therapy or I can't do this and I can't do that. But actually, I think being intentional about the accounts that you follow on social media and the podcasts that you choose to listen to, there are some really, really fantastic accounts. Like your account is fantastic. And there's the holistic psychologist. I think her name is Dr. Nicole Lepira. Thank Saoirse Graded2 (01:12:10.742) She has some really great stuff and there are podcasts out there which are just super, super accessible. You know, a lot of this is free and it's kind of bite-sized a lot of the time and you can cut, you know, your book, like I've been listening to your book on Spotify. So that's a really fantastic avenue to start accessing some of this information and starting to digest it, especially if these concepts are quite new, you know, you might not. feel like you trust the concept well enough to go and invest in a new psychotherapist or a new doctor. So just maybe taking a little bit of time to find a couple of accounts on social media and a podcast or an audio book on Spotify or wherever you listen and kind of dipping in and out and just letting it start to settle a little bit and just like exposing yourself to these new ideas. think I did a lot of that. I I was also in therapy. But I found the podcasts and books that I was reading to be super, super helpful as well. So they can't be underestimated, Absolutely, no, I totally agree. Because even just, even if you're not doing anything yet, just absorbing that information can really start to change how your brain responding to things as well without making a big behavioral shift. Yeah, thank you. And Lindsay, I'd love to hear from you. If anybody can really get the sense that yes, my bladder and how I'm feeling is... Yeah. Saoirse Graded2 (01:13:18.828) Yeah. DROPPED! (01:13:35.584) linked. I want to understand a little bit more what would you suggest to them? I would agree first that knowledge is so empowering. You I find myself often reading to learn more about what's happening, learn the science behind it as well, like we're talking about today. Then I would suggest just beginning with a couple of small things. You know, you can, of course, go and approach getting more support or talk to your PCP, but just on the day to day, begin with monitoring how you're doing and tie it to things that you do every day. Yeah. lyndsey fhy8ka1ag (01:14:09.038) So if you have a cup of tea in the morning, every morning, when you sit down and you have your cup of tea, head to toe, how are you? Where are you feeling discomfort in your body? What's the quality of it? How did you sleep last night? Are you under any other particular stress? How's your energy levels? Then same thing at lunch and at dinner, just to start to track and bring awareness to your regular rhythms. Because when you do that, you can start to pick up the nuances and the shifts in them. So I would begin with just basic self-monitoring and then encourage you to start small. When it comes to relaxation or activities, things like that, explore things on YouTube, some breath work or get the calm app and see what you like, knowing that it's different for everybody of what they like. Try a five minute meditation and then begin to pair that in the morning. That is where I would begin, is just building awareness. So building knowledge and then building internal awareness. Because that will help you decide how much of this can I do if I work on it myself to where I need to reach out and try to get the help of a professional or do a program that's supported through an app, for example. My ultimate goal with this is to scale as much as what we're doing and talking about. to the general public so we can reach more people because these conditions have been under-researched and under-treated for so long that we have to do more to work on resource access for people. Absolutely. And Lindsay, you really are a pioneer in this area of kind of bringing that multidisciplinary input, incorporating psychology into these bladder conditions and pelvic conditions. it's so lovely to be speaking with you about this. lyndsey fhy8ka1ag (01:16:00.852) And the field seems to be changing and shifting. I've really experienced it over the past 10 years where people want this, the providers want this too. And they're trying to figure out how do I do this? How can we financially do this in our clinics so we have more mental health providers on site? So that's also working on that too. Yeah, that's incredible. Yeah, amazing. That's the dream. That's what we want. But thank you so much, both of you. As I say, I could have talked for hours more, but I really appreciate your time and expertise. yeah, thanks so much for being here. It has a real pleasure. Thank you for having me. Yeah, thank you. Yeah, I've really enjoyed it. Thanks guys, take care. Lindsay, I think you have to rush off, but is it all right? There's gonna be like a upload, probably says like 90 something percent on your side before, in fact, if I, I think I stopped the record.