If you've ever been told your tests are normal but you know something isn't right, this episode is for you.

Dr Sula is joined by Sachin Malde, Consultant Urologist specialising in bladder pain, chronic UTIs and incontinence, and Clare Bourne, specialist pelvic health physiotherapist, author of Strong Foundations and expert in complex pelvic presentations. Two of the most thoughtful clinicians working in this space.

Together, they unpick why recurrent urinary tract infections are so commonly missed, misunderstood and mismanaged and what's actually going on in your body when symptoms refuse to budge.

Dr Sula shares her own experience of unexplained bladder symptoms that spiralled during a period of major life stress, exploring the role of the mind body connection and clarifying why these very real psychobiological processes doesn’t mean symptoms are all in your head. 

Here's some of what you'll take away:

• Why a negative test doesn't mean nothing is wrong: Understanding the real limitations of dipstick testing and why your symptoms deserve a closer look
• How your nervous system keeps the pain going. The science behind why what started your UTI might not be what's maintaining it, and what pelvic health physiotherapy can do about it
• Small habits with a big impact. Practical, low-pressure shifts in how you drink, move and think about your bladder that can genuinely make a difference

Whether you're navigating chronic bladder symptoms yourself, supporting someone who is, or working clinically with people in pelvic pain, this episode will help you feel less alone, better informed, and clearer on what to do next.

For more Sachin & Clare:

Sachin Malde https://www.londonurologist.net/

LinkedIN https://www.linkedin.com/in/sachin-malde-a3a35530/

Clare Bourne https://www.clare-bourne.com/

Instagram https://www.instagram.com/clarebournephysio

Youtube https://www.youtube.com/@clarebournephysio

You can access references and resources discussed in this episode, fact checked and collated afterwards by our show researcher and trainee health psychologist here https://www.howwereallyfeel.com/episode-one 

This is a short solo reflection from Dr Sula Windgassen on what stayed with her after the first episode of How We Really Feel in conversation with consultant urologist Sachin Malde and pelvic health physiotherapist Clare Bourne about bladder symptoms, recurrent urinary tract infections and the mind body connection in chronic illness.

💡 IN THIS REFLECTION:

• ✅ Why hope itself can feel threatening and why learning to tolerate that uncertainty is one of the most important things you can do on a chronic illness journey
• ✅ Why a negative UTI test is not the end of the road. How curiosity, self-advocacy and perseverance can open up options that a tick-box system never will
• ✅ Why your reported symptoms are often the most reliable measure of what's going on and what it means to hear a consultant urologist say that out loud
• ✅ The psychobiological loop:  How feeling unwell feeds uncertainty, which feeds physiological stress, which feeds symptoms  and how recognising it can help break it
• ✅ How bodily self-trust erodes when you've been dismissed and what rebuilding it actually looks like in practice
• ✅ Why a pelvic health physiotherapist might prescribe pleasure, connection and friendship alongside physical rehabilitation 

🎙️ DR SULA ALSO REFLECTS ON:

Her own understanding of multi-sensory integration: How the brain combines physical signals with memories, knowledge and social messages to determine what you're feeling. Why being dismissed by the healthcare system doesn't just affect your confidence but your symptom experience itself.

If you haven't yet listened to the full episode 'I Can Feel It In My Waters: Bladder Symptoms, Stress and Chronic UTI' this reflection works as a companion to it and you can listen to it here.

📩 Sign up for founding member perks https://www.healthpsychologist.co.uk/howwereallyfeelpodcast 📱 Instagram.com/the_health_psychologist_

Your bladder doesn't work alone. It never did.

It's in constant conversation with your pelvic floor, your autonomic nervous system and your brain. When that conversation becomes dysregulated, the mind body connection in pelvic pain becomes impossible to ignore, and surprisingly hard to treat without understanding it.

In this episode Dr Sula goes deeper into the science of pelvic and bladder symptoms with two specialists who between them hold an unusually complete picture: Jilly Bond, specialist pelvic health physiotherapist, Masters-qualified in pelvic pain, currently completing her PhD exploring sensorimotor distortions in women with persistent pelvic pain, and a recognised voice in pelvic health education internationally. And Dr Elise De, Professor of Urology, OBGYN and Neurology at Albany Medical Center, world authority on pelvic pain and neuro-urology, and author of clinical guidelines for the American Urological Association.

This conversation moves into territory that Episode 1 opened the door to and walks through it. If you've ever wondered why symptoms persist even when tests are clear, why pain seems to travel and shift around the pelvis, or why stress and pelvic symptoms seem so frustratingly intertwined, this episode builds the picture piece by piece.

• The bladder-brain connection unpacked. How your autonomic nervous system drives overactive bladder symptoms, pelvic floor tension and chronic pelvic pain, and why treating the bladder alone often isn't enough
• When the pelvis becomes a whole-system problem. The science of organ crosstalk, central sensitisation and why pelvic pain that has spread beyond one area needs a different treatment approach
• Finding your way through a complex system: Practical, honest guidance on advocating for yourself in healthcare settings where pelvic pain is still frequently misunderstood, and what genuinely good multidisciplinary care looks like

Whether you're years into a diagnosis, still searching for answers, or a clinician wanting to understand the fuller picture of what your patients are experiencing, this episode offers real clarity on one of the most under-explored areas of women's bladder health.

Even long-standing pelvic pain and bladder dysfunction can improve. As Dr Elise De says: “Just because you've had pain for a decade doesn't mean you'll have it for another" 

You can find references and resources mentioned in this podcast here.

You can follow Dr Sula Windgassen here https://www.instagram.com/the_health_psychologist_

📖 Show notes & resources: https://www.howwereallyfeel.com/episode-two
📩 Newsletter: www.healthpsychologist.co.uk/subscribe
🔗 Jilly Bond: https://www.jillybond.com/
🔗 Dr Elise De - Facing Pelvic Pain: https://www.facingpelvicpain.org/

Why do bladder symptoms keep going even after an infection has cleared? Why does pelvic pain change, shift and evolve, sometimes feeling like a UTI, sometimes not, but never quite going away? And if your tests are coming back normal, does that mean the pain isn't real?

These are the questions Dr Sula Windgassen sits with in this solo reflection following her conversation with Professor of Urology Elise De and specialist pelvic health physiotherapist Jilly Bond.

The line that stayed with her most: just because you've had pain for a decade doesn't mean you'll have it for another. Sula unpacks why that particularly resonated for her and why, for many people living with long-term bladder or pelvic symptoms, the brain has already stopped being able to imagine it being any other way. That's not a personal failing. It's exactly how a prediction-making nervous system is supposed to work. And recognising it is the first step to something shifting.

This reflection also explores why internal pain is so hard to locate and describe and what that means for anyone who has ever struggled to explain their symptoms or felt dismissed because they couldn't quite articulate what was wrong.

Sula draws on her own experience of repeated UTIs evolving into something harder to name, the way psychological threat layers onto physical symptoms, and why understanding the mechanism behind your pain - even without being able to fix everything that caused it - can genuinely open things up.

She also points to Professor Elise De's comprehensive history-taking form from the episode as a practical tool worth exploring, with a gentle note for anyone who finds it overwhelming: you don't have to tackle everything at once.

Honest.

Personal. And quietly hopeful.

This podcast is supported by Convatec Continence Care and their Me+ Emotional Wellbeing programme. Free holistic emotional wellbeing support for intermittent catheter users. Visit convatec.com to access the Me+ Continence Care resources.

📚 Show notes and resources from Episode 2: 👉 https://www.howwereallyfeel.com/episode-two-bladder-brain-connection

📩 Mind Body Science weekly emails : www.healthpsychologist.co.uk/subscribe

📱 Instagram: @the_health_psychologist_

🎧 Full Episode 2- Breaking the Seal: The Bladder, Pelvic Floor and Brain Connection: 👉 https://pod.link/1895564493/episode/ZTJmYWY3NjMtYjIxZC00NzNhLWI1OTEtOWQ3MWE4OWU4NjY4?view=apps&sort=popularity 

Dr Sula Windgassen is author of It's All In Your Body 👉 https://amzn.eu/d/0c2J0j18

When your body becomes something to manage rather than something to inhabit, intimacy tends to quietly disappear.

Not all at once, but slowly, in the gaps where no one asks and you don't quite have the language to bring it up yourself.

In this episode of How We Really Feel, Dr Sula Windgassen is joined by two of the most experienced psychosexual therapists working in the UK today:

Kate Moyle, psychosexual therapist, author of The Science of Sex, host of The Sexual Wellness Sessions podcast, and regular BBC contributor 

Lorraine Grover, nurse and psychosexual therapist with over two decades of specialist experience, with a particular focus on sexual wellbeing in the context of illness, including prostate cancer and bladder conditions.

Together, they open up a conversation that is long overdue exploring the difference between sex and intimacy, why the healthcare system so rarely addresses either, and why the absence of that conversation does more damage than people realise.

You'll come away understanding:

• Why your brain will always prioritise anxiety over arousal and what that means for intimacy when health is difficult
• How social messages about what sex "should" look like quietly shape our ability to enjoy it
• What psychosexual therapy actually involves (it's far less daunting than you think)
• Why intimacy and sex are not the same thing  and why distinguishing them matters, especially when illness changes what's physically possible
• The practical tools Lorraine keeps in her toolbox and why they work

This episode is relevant whether or not you identify as having sexual difficulties. Because the way we relate to sex is shaped long before illness enters the picture and understanding that is where the shift begins.

Supported by Convatec Continence Care and the Me+ free emotional wellbeing support programme for intermittent catheter users.

🎙️ How We Really Feel is hosted by Dr Sula Windgassen, health psychologist, specialist psychotherapist and author of It's All In Your Body. Each episode explores the biology and humanity behind the mind-body connection for people navigating chronic illness, bladder and pelvic conditions, burnout and trauma and the clinicians who support them.

This episode is supported by Convatec Continence Care and their Me+ Emotional Wellbeing programme - free holistic emotional wellbeing support for intermittent catheter users. 💙 Visit www.howwereallyfeel.com/in-partnership-with-convatec to access the Me+ Continence Care resources.

More from:

Lorraine Grover - https://lorrainegrover.com/

Kate Moyle - https://www.katemoyle.co.uk/

📚 Show notes and additional resources: 👉 www.howwereallyfeel.com

📱 Instagram.com/the_health_psychologist_

Dr Sula Windgassen is author of It's All In Your Body 👉 https://amzn.eu/d/0c2J0j18

Have you ever thought: if that happened to me, I couldn't cope? Or perhaps something has happened and you find yourself caught in a battle with your body, with no clear picture of how to move forward?

This episode might just shift something for you.

Dr Sula is joined by Dr Niall McCann, biologist, National Geographic Explorer, mountain rescuer, and Spinal Injuries Association ambassador, who sustained a serious spinal cord injury in a paragliding accident. With him is Steve Kearle, two-time wheelchair rugby World medalist, featured in the Oscar-nominated documentary Murderball, patient advocate, and coach who mentors people navigating life after spinal injury.

Together, they have a conversation that is rare in its honesty: about the parts of disability that don't get talked about. The hidden adjustments. The internal monologue that can either hold you back or become your most powerful ally. The parts of yourself- identity, sexuality, bladder and bowel management- that nobody prepares you for. And the surprising, hard-won discoveries about what it actually means to live fully in a changed body.

Here's some of what you'll take away:

• The three phases of adjustment after injury or illness: Crisis, coping, and adaptation. Why moving through them isn't linear, and what that actually looks like in real life
• Why your inner monologue matters more than almost anything else in recovery, and how both Niall and Steve learned to shift from self-criticism to something that helped them do hard and remarkable things
• The things nobody considers in injury and illness: bowel and bladder changes, sexual function, catheterisation, and how to find your way to openness rather than shame
• What partners, friends and healthcare professionals can actually do and what tends to get in the way
• Why 'just be you' is the most powerful advice for anyone who loves someone navigating serious illness or injury
• Small, honest steps towards re-engaging with life, community, and a sense of possibility, even when that feels a long way off

Whether you are navigating a health challenge yourself, supporting someone who is, or working clinically with people in these circumstances, this episode is full of wisdom, warmth, and a kind of grounded hope that is genuinely hard to come by.

You can access references and resources discussed in this episode, fact checked and collated by our show researcher and trainee health psychologist, here: [https://www.howwereallyfeel.com/episode-four]

What if the pressure was off getting back to how things were and instead there was a curiosity to discover something you didn't know before?

In this short solo reflection, Dr Sula Windgassen sits with what stayed with her from the conversation with psychosexual therapists Kate Moyle and Lorraine Grover in The Dark Place Between My Legs, an episode about what happens to sex and intimacy when your body changes.

The concept that wouldn't leave her: recovery and discovery. The idea that when illness or physical disruption changes your sex life, the instinct is almost always to try to get back to how things were. But the assumption that before was the gold standard can quietly close off something more interesting. What if before there were issues you’d not registered? And what if turning towards this difficulty, rather than away from it, opened up a richer experience than you'd had before?

Sula also unpacks the distinction Kate made between sex and intimacy - two things we often treat as interchangeable, but which are not the same. When that difference gets blurred, losing one can mean losing both. Understanding the gap between them might be exactly where things start to shift.

There's also a reflection on something almost every clinician listening will recognise - how uncomfortable the medical setting makes it to ask about sex. And what it costs patients when no one does.

This episode ends with two quiet invitations: curiosity about your own assumptions, and a broader exploration of what intimacy actually means to you.

Honest. Warm. Worth fifteen minutes of your time.

🎧 Full episode - The Dark Place Between My Legs: Sex, Intimacy and What No One Tells You.

This episode is supported by Convatec and the me+ Emotional Wellbeing Programme — a free holistic support programme for intermittent catheter users.

Visit www.howwereallyfeel.com/in-partnership-with-convatec

What does it feel like to crawl across the floor to reach the bathroom? To carry a cushion everywhere because every chair in every restaurant has become a threat? To have a decade of your life measured in pain scores scrawled in a black diary?

This episode starts in the reality of what severe, unrelenting pelvic pain actually looks like. A reality that does not seem to be readily apparent or appreciated in lots of healthcare consults, to the detriment of many patients. 

Dr Sula is joined by two guests who have both lived this from the inside, and now work to change it from the outside. Carla Cressy OBE is the founder and CEO of The Endometriosis Foundation, diagnosed at 25 after years of being dismissed, and now one of the most important voices in UK women's health advocacy. Sheren Gaulbert is a cognitive hypnotherapist, pain and trauma therapist, and Trustee of the Vulval Pain Society, who spent a decade living with vulvodynia before finding a way through and training to provide support for many others going through these health experiences. 

Together, they explore the territory that sits beneath the diagnosis: why the nervous system stays stuck in threat long after the immediate crisis passes, how the unpredictability of conditions like endometriosis keeps the body braced for impact, and what happens when pain becomes so total that it stops feeling like something you have and starts feeling like something you are.

This conversation covers the science of why pelvic pain is particularly entangled with the nervous system, what cognitive hypnotherapy actually is (and isn't), why generic pain management approaches can actively make things worse for people with complex pelvic conditions, and how identity can begin to be rebuilt when pain has taken up the space where a sense of self used to be.

There are also honest reflections on what it means to be told "nothing's wrong"  and the very specific kind of anger, shame, and helplessness that follows.

What you'll take from this episode:

• Why the brain's predictive processing can keep pain patterns alive and how that changes the body
• How the pelvic floor holds emotional as well as physical tension, and what that means for treatment
• Why the word "catastrophising" is doing more harm than good in clinical practice
• What it means to rebuild identity when chronic illness has consumed it  and a practical way to start
• Why "find your community" is Carla's first recommendation, and what good community actually offers that online forums often can't

Whether you're living with endometriosis, vulvodynia, pelvic pain, or a condition that has never quite had the right name -or you're a clinician working alongside people who are - this conversation is for you.

Show notes and resources: www.howwereallyfeel.com/episode-5

This conversation connects closely with the work I'm doing with Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources.

Find out more at www.howwereallyfeel.com/in-partnership-with-convatec

📩 Mind body science mail: www.healthpsychologist.co.uk/subscribe

📱 Instagram: @the_health_psychologist_

🎧 Spotify | Apple Podcasts | Amazon Music | All major platforms

Sometimes the most useful thing you can hear is someone else's honest account of how they got through something you're convinced you couldn't.

In this short solo reflection, I'm thinking through the conversation I just had with Steve Kearley and Niall McCann. Two men who experienced spinal cord injuries and navigated their way, in very different ways and at very different paces, towards lives they find genuinely meaningful. If you haven't heard that episode yet, I'd encourage you to start there.

What I keep coming back to from that conversation is how much it challenges the story we tell ourselves about coping- that we either have it or we don't, that struggling means failing, that a body that works differently is a body to fight.

Here's some of what I reflect on:

• Why the adjustment process after illness or injury is rarely linear, and why moving back into crisis doesn't mean you're not making progress
• What the research actually says about harsh self-talk and why the inner critic tends to hold us back rather than drive us forward
• The quiet but significant shift that happens when you stop treating your body as the enemy
• How confidence after illness or injury builds. Why starting small isn't giving up, it's strategy
• The power of naming the things we don't usually talk about: continence, intimacy, the hidden losses that come with a changed body
• Why social connection isn't just nice to have when you're navigating a health journey and the small, specific things the people around you can do that genuinely matter

This connects closely with the work I'm doing with Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources.

Find out more at www.howwereallyfeel.com/in-partnership-with-convatec

Show notes, resources and links at https://www.howwereallyfeel.com/episode-four-owning-your-body 

What if the thing keeping your bladder symptoms going isn't just the infection, it's also what your brain is doing with the threat of it?

And what if that doesn’t mean that your symptoms aren’t real? That it instead is reflective of your body being a highly interconnected system that needs some further understanding. That is what this conversation with Dr Laura Katz and Melissa Kramer explores. 

Dr Laura Katz is a clinical health and rehabilitation psychologist whose research has focused specifically on how women cope with bladder pain and interstitial cystitis including landmark work on emotion regulation, fear of pain, and helplessness as predictors of long-term outcomes. Melissa Kramer is the founder and CEO of Live UTI Free, a PhD researcher at the University of Reading, and someone with five years of her own chronic UTI experience. Between them, they bring rigorous science and deep lived understanding to a conversation that I think fills a real gap.

For a lot of people navigating bladder and pelvic conditions, the moment anyone mentions psychology or thinking, it feels like another version of being told it's all in your head. We address that directly, clarifying terms, science and the neurobiology of thoughts. 

What this episode covers:

• Why thoughts are not fluffy or separate from physical experience -they are part of the neurobiology of your nervous system, and they have measurable effects on pain
• What Laura's research shows about emotion regulation as a predictor of quality of life in women with bladder pain- and why this is not about blame or willpower
• The word catastrophising: why both guests take issue with it, what the research actually measures, and why fear of pain is a normal, human, adaptive response - not an overreaction
• How fear of pain can longitudinally predict more pain -the chicken and egg, and what it means practically
• What helplessness does to outcomes over time, and how perfectionism and self-blame can quietly compound a flare
• Why validation must come before acceptance and what goes wrong clinically when it doesn't
• What actually helps: forward motion, community used wisely, self-transcendence, and what happened when one of my own patients tried being kinder to herself mid-flare
• Why clinicians should share the neuroscience directly with patients and how psychoeducation alone can shift fear

Whether you're living with bladder symptoms, supporting someone who is, or you're a clinician working in this space  I hope this leaves you with something that genuinely reframes things.

Show notes, references and resources: https://www.howwereallyfeel.com/episode-6-urgency-urgently-thinking-thinking-away-the-urge

This podcast is supported by Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. Find out more at www.howwereallyfeel.com/in-partnership-with-convatec

There are images from conversations that stay with you. Carla, 21 years old, crawling across the floor to the bathroom, still being told she would grow out of it. Sheren's black diary, found years later, full of red scrawl - I can't go on like this - pain rated nine and ten, page after page.

In this short solo reflection I sit with what that conversation stirred up clinically, and as someone who works with people navigating exactly this kind of pain every day.

We talk a lot in health psychology about the mind-body connection. This episode is an attempt to make that concrete. What does it actually mean for your physiology when your pain isn't believed? Why does the world start to shrink around your symptoms? And when someone says that working with the emotional or psychological side of things might help - does that mean the pain isn't real?

It doesn't. And I want to talk about why that matters.

This reflection follows episode 5 of How We Really Feel. If you haven't listened yet, I'd recommend starting there - it goes much deeper, and I think it will stay with you.

This episode is supported by Convatec and the me+ Emotional Wellbeing Programme - a free holistic support programme for intermittent catheter users. Visit www.howwereallyfeel.com/in-partnership-with-convatec

🎧 Full episode 5 — with Carla Cressy OBE and Sheren Gaulbert: 👉 https://pod.link/1895564493/episode/NTc5NWY5MjEtNmM5NS00NTIyLTg2YTgtNTgyMmM0YWM0OTY1?view=apps&sort=popularity

📚 Show notes, references and resources: 👉 www.howwereallyfeel.com/episode-five

🔗 Find the guests from the full episode: Carla Cressy OBE - theendometriosisfoundation.org Sheren Gaulbert - the-ultimate-you.com

📩 Newsletter: www.healthpsychologist.co.uk/subscribe

📱 Instagram: @the_health_psychologist_

🎧 Spotify | Apple Podcasts | Amazon Music |

This episode is supported by Convatec and the me+ Emotional Wellbeing Programme - a free holistic support programme for intermittent catheter users. Visit www.howwereallyfeel.com/in-partnership-with-convatec

⬇️ If this landed for you, please share it with someone who needs to hear it!

What role does trauma play in bladder and pelvic conditions? There's more awareness than ever that traumatic experiences live on in the body and with it, a lot of myths.

This short solo reflection is me thinking out loud after my conversation with Dr Lindsey McKernan, PhD MPH, Associate Professor of Psychiatry and Urology at Vanderbilt University Medical Center and a longtime research collaborator of mine, and Saoirse Nash, women's health coach and Director of Live UTI Free.

I sit with the findings that stayed with me most: that in one integrated clinic, 42% of women presenting with interstitial cystitis or bladder pain syndrome met criteria for post-traumatic stress disorder. And that it's not a question of whether trauma came first or the condition did. It's the interaction between past trauma and present stress that shapes pain, symptoms and how taxed the body becomes.

I also reflect on:

• Why it's so hard to heal a body you hate or feel betrayed by and what changes when that relationship begins to soften
• The story Lindsey shared of a patient who'd had multiple surgeries and relentless urinary frequency, and had never once asked for leave from work.  What that tells us about self-subjugation and the impacts on our body 
• Allostatic load: the cumulative wear and tear of never tending to what your body needs
• Moving from reacting to responding, and why gentle self-monitoring - not hypervigilance-  is the starting point
• A simple question from Lindsey that can shift everything: would you expect this of a friend?

The goal isn't to lower your expectations of yourself. It's to soften the way you respond to yourself. And there's good evidence that when you do, your body starts processing things differently.

If you haven't yet listened to the full episode with Lindsey and Saoirse, I'd recommend starting there, the link is in the show notes, along with details of Seemira, an app that syncs with your Apple Watch to help you build gentle bodily awareness through the day.

Show notes and resources: www.howwereallyfeel.com

This podcast is supported by Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. Find out more at www.howwereallyfeel.com/in-partnership-with-convatec

Seemira - learning to hear your body’s signals and regulate your nervous system - https://seemira.com/

When your bladder holds your trauma: emotion, the nervous system, and bladder health

You know your body is telling you something. But when every test comes back clear, it becomes very hard to trust what you're feeling or to understand why it won't get better.

In this episode, I'm joined by Dr Lindsey McKernan, PhD, Associate Professor of Psychiatry and Urology at Vanderbilt University Medical Center and pioneer of uro-psychology, and Saoirse Nash, women's health coach and Director of Live UTI Free. Together we explore something that doesn't get nearly enough airtime: what happens to the bladder and pelvis when the nervous system has been under sustained stress, or when trauma has never fully been processed.

Saoirse shares her own journey from recurring acute UTIs in her teens to chronic symptoms that no one could explain, including the link she made between her mother’s passing and the way her body responded. Lindsey brings the science: why childhood adversity and trauma change the way the nervous system processes pain, how the stress response directly affects bladder function, and what uro-psychology, the field she has spent her career building, offers to people who haven't found answers in standard care.

This conversation covers:

• Why emotional history can show up as physical symptoms in the bladder and pelvis and what that actually means for treatment
• What PTSD looks like in a urology clinic, and why it's more common than most clinicians realise
• How sustained stress keeps the nervous system in a state of threat and what that does to pelvic muscles and pain processing
• The research behind psychological interventions for interstitial cystitis, and why outcomes can improve even after 14 years of chronic pain
• What it means to move from being at war with your body to working with it

This episode will resonate deeply with anyone who has long suspected that it is their bladder or pelvis holding the score. It is also essential listening for clinicians looking for a more integrated framework for supporting people with bladder and pelvic pain.

This podcast is supported by Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. Find out more at www.howwereallyfeel.com/in-partnership-with-convatec

There's a moment of significance in so many health journeys that rarely gets explored. The moment when you go from believing the healthcare system will help you, to realising it won't. I call this a belief flip. In this short solo reflection on my conversation with Melissa Kramer and Dr Laura Katz on the subject of the role of thoughts and beliefs in bladder conditions, I want to sit with what that actually does to a person, and why it matters so much for how we then talk about the role of thoughts in bladder and pelvic conditions.

Because here's the thing. If your beliefs have been flipped, if you've gone from feeling safe and supported to feeling alone and dismissed, then someone exploring the psychological side of your symptoms is almost certainly going to feel like another version of being told it's all in your head. And that response makes complete sense. A threatened brain doesn't have much room for nuance.

What I wanted to unpack here is the nuance that I think is so worth having. Thoughts are not fluffy or incidental. They are biologically mediated. They have downstream effects on the nervous system, on pain processing, on how your body responds. That is not the same as saying you caused this, or that you're doing something wrong. You are not in control of the thousands of thoughts your brain generates every day.

But once you can see some of those patterns -the threat forecasting, the perfectionist tracking spiral, the self-blame that follows a flare -there is something you can do with that awareness.

I also reflect on what Laura said about validation -that you cannot ask someone to explore the psychological dimensions of their condition until they feel genuinely believed. Not just in words. In practice. That means biology and psychology together, not one instead of the other.

This one is a bit more thinking out loud than usual. I hope it adds something after episode 6.

This podcast is supported by Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. Find out more at www.howwereallyfeel.com/in-partnership-with-convatec

When your body changes, the system rarely changes with it. Here's what you can do about that.

This episode explores one of the most under-examined tensions in living with a health condition: the space between genuine acceptance and quiet resignation. Knowing the difference might be the most practical thing you can do for your own care.

Matthew Castelluccio is the interim CEO of United Spinal Association and has been a wheelchair user and paraplegic for over twenty-three years. He brings both lived experience and two decades of professional work in rehabilitation, peer mentoring, and patient advocacy to this conversation. Jane Werbicky is a nurse information specialist at United Spinal Association, with over thirty-five years of nursing experience focused on spinal cord injuries, bladder and continence care. Together, they field calls from people at every stage of navigating their condition,  from newly injured to decades in, recognising where the system helps and where it lets people down.

What we explore:

• Why acceptance and resignation can look identical from the outside and how peer connection is often the thing that starts to pull them apart
• The isolation that commonly follows a new diagnosis or injury, how bladder and continence concerns intensify it, and what small steps genuinely help
• What collaborative, curiosity-led care looks like in practice  and why the question "what's not working for you?" can open more than a full clinical assessment
• How to advocate for yourself in a medical appointment, including what to prepare, how to paint a full picture for your clinician, and when it is okay to change your doctor
• The systemic barriers -geographic, financial, architectural - that make this harder than it should be, and why collective voice has already shifted things
• What advocacy actually looks like for someone who is overwhelmed and exhausted and why showing up to listen counts

Whether you're navigating bladder or continence changes yourself, supporting someone who is, or working clinically with people who are, this conversation offers something grounding: the reminder that systems can and do shift, and that small, sustainable steps towards engagement are where it begins.

Show notes, resources and references: www.howwereallyfeel.com

This podcast is supported by Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. Find out more at www.howwereallyfeel.com/in-partnership-with-convatec

If you've ever been told there's nothing wrong with you and felt worse, not better, this episode is for you.

Dr Sula is joined by Dr Catriona Anderson, a GP with a special interest in recurrent and chronic UTI and founder of the Focus Medical Clinic, and Neha Visavadia, a women’s health coach and product consultant in health tech with an MSc in Health Psychology who draws on her own lived experience of long-term health conditions to articulate what so many people struggle to put into words.

Together, they unpick why chronic UTI still has no formal medical definition, why that gap leaves patients stuck in a tick-box system, and what it actually takes to be heard, believed and properly treated when your symptoms don't fit neatly into existing guidelines.

Here's some of what you'll take away:

• Why a negative test doesn't mean nothing is wrong. The real limitations of dipstick testing, and why recurrent and chronic UTI are so often missed, minimised or misdiagnosed as a result.
• The psychological cost of not being believed. How dismissal in healthcare can quietly fuel avoidance, and why that avoidance, while understandable, can make things worse.
• Medical misogyny, named plainly. Why women's symptoms are so often expected to be endured rather than investigated, and what's changing.
• How to prepare yourself to be heard. Practical, psychologically grounded ways to walk into an appointment ready to advocate for yourself, without needing to fight for it.

This podcast is supported by Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. Find out more at www.howwereallyfeel.com/in-partnership-with-convatec.

Whether you're navigating chronic UTI yourself, supporting someone who is, or working clinically with this patient group, this episode will help you feel less alone, better informed, and clearer on what to ask for next.

References and resources discussed in this episode, fact-checked and collated by our show researcher, are available at www.howwereallyfeel.com 

Sometimes the hardest part of a new way of managing your body isn't the technique. It's everything that happens in your head before you even get there.

This is my reflection following last week's conversation with Dr Angie Rantell, consultant nurse in urogynaecology at King's College Hospital, and Keira McGarrity, psychological wellbeing practitioner and intermittent catheter user. We talked about how long bladder symptoms can go unheard, what a negative test actually does to someone who knows something's wrong, and the moment everything shifted for Keira as she stopped trying to do it "right."

I keep coming back to that. How much of healing - physical, practical, everyday healing - depends on how we're relating to ourselves while we do it.

A few things I sit with in this episode:

Why self-blame so often fills the gap before a diagnosis arrives, and what that does to the nervous system over time.

What it really means when a test comes back clear but the symptoms don't.

Why easing up on perfectionism changed Keira's catheter use more than any equipment could, and what that tells us about the mind-body loop in chronic and intermittent health management.

This conversation connects closely with the work I'm doing with Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. Find out more at www.howwereallyfeel.com/in-partnership-with-convatec.

More resources and references for this episode are at www.howwereallyfeel.com

If you've ever been handed a medical device and sent home to figure it out alone, this episode is for you.

Dr Sula is joined by Angie Rantell, Consultant Nurse in Urogynaecology at King's College Hospital and Senior Lecturer in Pelvic Health at Brunel University, and Kiera, a psychological wellbeing practitioner, patient advocate with Convatec and catheter user herself. Two perspectives on the same experience -one clinical, one lived - sitting down together.

Kiera shares what it was like growing up with bladder symptoms from childhood, the years of being told tests were normal, and the long road to finally learning intermittent self-catheterisation, including the months of setbacks that nearly made her give up. Angie brings twenty years of teaching patients to catheterise, and how her own approach has changed dramatically over that time once she realised the skill isn't really about the technique at all.

Here's some of what you'll take away:

• Why help-seeking takes years for so many women with bladder issues, and what tends to be the tipping point that finally gets someone into a doctor's office
• The difference between teaching a procedure and teaching a life skill. Why where and how catheterisation is taught matters as much as what's taught
• How fear and tension physically interfere with catheterisation, and the small mindset shift that helped Kiera stop bracing against her own body
• What recurrent UTIs after starting catheter use actually mean, and the realistic, layered approach to managing and reducing them
  

Whether you're navigating bladder symptoms yourself, learning to use a catheter, or supporting someone who is, this episode will help you feel less alone, better informed, and clearer on what comes next.

This conversation connects closely with the work I'm doing with Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. Find out more at www.howwereallyfeel.com/in-partnership-with-convatec

You can access the Me+ free holistic programme here (UK) https://shorturl.at/TsOdG or here (USA) https://shorturl.at/Lh8XS 

You can access references and resources discussed in this episode, fact checked and collated by our show researcher and trainee health psychologist, here: www.howwereallyfeel.com

Acceptance gets treated like a dirty word in chronic illness. So does resignation, but for the opposite reason  we barely talk about it at all.

This is my reflection following the episode with Matt Castelluccio and Jane Werbicky from United Spinal Association, where we explored what it actually takes to keep going when the systems around you weren't built with you in mind.

I sit with the distinction between acceptance and resignation, why they can look identical from the outside, and why resignation isn't poor coping, it's a natural, protective response to feeling like control has been taken away. I also reflect on what Matt shared about the power of one question from his urologist, "what's not working for you?", and what that tells us about what collaborative care could look like, even within short appointment times.

If you haven't yet listened to the episode with Matt and Jane, you can find it in the show notes. I hope this reflection gives you something to sit with.

This conversation connects closely with the work I'm doing with Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources.

Find out more at: www.howwereallyfeel.com/in-partnership-with-convatec

Show notes, resources and references: https://www.howwereallyfeel.com/acceptance-advocacy-bladder-care

Most people who end up with chronic pelvic or bladder pain have seen a lot of clinicians. Often separately. Often with no one quite connecting the dots.

Dr Sula is joined by Shelli Burton and Katy Hansen, both nurse practitioners at Vanderbilt University Medical Center in Nashville. Shelli specialises in interstitial cystitis, bladder pain syndrome and pelvic health, working within Vanderbilt's multidisciplinary IC clinic. Katy works at the Osher Center for Integrative Health, bringing a whole-body lens shaped by her earlier years as a massage therapist.

Together, they unpick why treating pelvic and bladder symptoms in isolation so often stalls recovery, what changes when care is genuinely integrated, and why hormones, fascia, the nervous system and the mind are never really separate stories.

Here's some of what you'll take away:

• Why looking at one body part in isolation misses the picture. The cost of treating symptoms without asking about sleep, stress, hormones or other overlapping pain conditions.
• The difference between two types of pain, and why it matters. Understanding nociceptive versus central sensitisation pain changes which tools are actually likely to help.
• Why being seen by two clinicians together changes the experience of being believed. How integrated care quietly removes the "it's in your head" framing before it even starts.
• The fear and the evidence around vaginal hormone treatment. Why a localised, low-risk option is so often avoided, and what's actually true about it.
• A new way to think about control. Katy's idea of "baby birding": Holding on just tightly enough to make progress, without gripping so hard that nothing can move.

This podcast is supported by Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. Find out more at www.howwereallyfeel.com/in-partnership-with-convatec.

Whether you're navigating a complex pelvic or bladder condition yourself, supporting someone who is, or working clinically with this patient group, this episode will help you feel less alone, better informed, and clearer on what integrated, whole-person care can actually look like.

References and resources discussed in this episode, fact-checked and collated by our show researcher, are available at www.howwereallyfeel.com

This is one of my solo reflection episodes. Just me, sitting with what the conversation with Dr Catriona Anderson and Neha Visavadia stirred up.

We covered a lot of ground in that episode: chronic UTI, the gap in the medical definition, what it means to be dismissed by the healthcare system, and what you can actually do about it. This reflection picks up on three threads that I couldn't let go of afterwards.

The first is the psychological cost of not being believed - not just as a frustrating experience, but as something that actively changes your behaviour, closes down your options, and makes the next appointment feel harder before it's even happened. Neha described this so clearly, and I've seen it in clinical practice more times than I can count.

The second is medical misogyny - the expectation, embedded across centuries, that women will absorb a higher baseline of pain and difficulty without it being fully investigated. Dr Catriona named it plainly in the episode and I want to sit with it plainly here too, because naming it is part of shifting it.

And the third is what self-advocacy actually looks like in the room — not as a performance, but as a regulated, grounded way of communicating that actually changes how the person in front of you responds.

This reflection is for anyone who has ever left an appointment feeling smaller than when they walked in. And for anyone who works with patients and wants to understand why that happens.

This podcast is supported by Convatec Continence Care and their Me+ programme, which supports people using intermittent catheters with both practical guidance and emotional wellbeing resources. Find out more at www.howwereallyfeel.com/in-partnership-with-convatec.

Show notes and resources at https://www.howwereallyfeel.com/episode-10-when-youre-not-believed