00:00 – It’s just about bringing you into the here and now, grounding your body, moving you out of that sympathetic mode
00:06 – into the parasympathetic so that you can start to just slowly turn down that volume on the pain.
00:16 – [music]
00:22 – [music] How does the nervous system contribute to chronic bladder pain and
00:27 – inflammation? So nerves are what send pain signals. So that’s a really important point to start with. It’s not
00:34 – just pain that you’re feeling because there’s inflammation. If you cut your finger, your finger doesn’t actually
00:40 – have any pain in it. Your brain is sensing the pain via nerves that are leading to it.
00:45 – So it’s this body signaling that we’re talking about. There’s some really brilliant research uh on nerve sprouting
00:52 – with recurrent and chronic infections. And the longer the problem persists in the bladder, the bladder sprouts more
00:59 – and more nerves out into the lining creating more pain unfortunately turning
01:04 – up that volume dial for you. Um so we need to think about
01:10 – what is going on. Is there actually an infection there that is sending that pain signal? Is there a reason that pain
01:15 – signal is being sent or is it that these nerves are on hyper alert still and um
01:22 – over signaling to the brain that something is wrong? It’s really complicated. I just read
01:27 – some research recently about endometriosis lesions being able to grow their own nerves as well. So then we
01:33 – have these nerves sending signals for something that we may not necessarily need to know about and we certainly can’t do anything about it, but it is
01:41 – still a problem. It’s indicating that there’s a problem there. So, how do we then address this inflammation and the
01:47 – nerve signals? We can’t necessarily do anything about the bladder pain every time that we feel it. And so, how do we
01:53 – approach that problem of differentiating when we should get medical care as opposed to when we just need to take a
02:00 – different approach to address the pain signals themselves? So that’s a really tricky question
02:05 – because I think anytime that there is a problem that is amplified beyond what it
02:11 – has been before, we need to seek medical attention. So red flags are things like persistent
02:17 – pain or a new pain, any blood in urine, um or unexplained bleeding from the
02:23 – vagina or the rectum. Um, so I think all of these things need medical support, but we know quite well if you’ve got a
02:30 – recurrent or a chronic situation in your bladder and you go back to your doctor again and again and again. Unless you’ve
02:35 – got a really great one, quite often you are being dismissed because nothing’s coming up on the culture, nothing’s coming up on the dipstick.
02:42 – But these things should have medical intervention. There should be a medical assessment at least. You know, the red
02:48 – flags that I would send somebody to a doctor with are things like unexplained weight loss, that persistent uh or new
02:54 – or unexplained pain, um night sweats and recurrent fevers, um fatigue that’s
02:59 – ongoing, unexplained bleeding, as I said, lumps, masses, swelling, changes in bowel habits. I mean, how many people
03:05 – end up with diarrhea when they go on antibiotics, but they’re not going to the doctor about it? Um chest pain and shortness of breath
03:12 – and persistent nausea and various other things that aren’t necessarily connected to the bladder. But there’s quite a few of them that I say, you know, you’ve got
03:18 – to go and see your GP about this, but then they might be sent away again because the doctor says it’s nothing. So, it’s really hard to say when is this
03:26 – a medical problem and when is this just the the bladder oversignaling. But I think what we need to think about is um
03:32 – calming the nervous system and you know looking at it from that angle because the nervous system itself is what is
03:39 – driving this oversignaling of pain this turning up of that volume dial. So if we think about the nervous system as being
03:47 – um part of it, there’s lots of different parts of the nervous system, but one part of it is called the autonomic nervous system, and it has two
03:52 – components to that. There’s the parasympathetic and the sympathetic. Parasympathetic is your rest and digest.
03:58 – Sympathetic is your fight or flight. Now, here I am being interviewed, so I’m definitely in fight or flight at the moment, but I would calm down afterwards
04:05 – and go and be able to eat my lunch and be in a calm state. And that’s being able to flux between these two states
04:11 – without it being problematic. But when pain or something like that is ongoing,
04:16 – we can get shifted into the sympathetic and find it very hard to come back down into the parasympathetic because pain
04:23 – creates fear. But then if we add in these conditions that are underresearched and we have inadequate
04:29 – testing with no clear results on them and being told sometimes that it’s all in your head because there’s nothing on
04:34 – the test, this just bumps up this fear response, sticks you further and further into that sympathetic mode. And with
04:41 – that we become our brain becomes more and more hypervigilant. So it’s looking for any small little thing that to be
04:48 – fearful of. So rather than being sort of having a wide open vision and being able to take in the world as a whole, it
04:54 – becomes more blinkered and everything becomes a threat, a fear thing.
04:59 – So this hypervigilance is what we need to turn down. Um and that’s where we really need to sort of be thinking about
05:05 – how do we create a feeling of safety in the body? How do we um start shifting
05:12 – that brain back out of that um sympathetic mode sometimes into the
05:17 – parasympathetic? And there’s a few things that we can do for that. But it does take a little bit of time to rewire
05:22 – the brain. That’s an interesting topic though because I we do get the question a lot. How do you know if it’s still
05:28 – infection or if it is this amplification? And you’re just on this high alert always and you just said that
05:33 – you feel like you’re in fight or flight being interviewed. But when I talk about this topic with people, sometimes I
05:39 – start to think, do I feel bladder symptoms right now? Am I feeling a burning sensation? I don’t know if
05:44 – that’s real and whether it’s just this stress that I feel when we talk about
05:50 – these topics. And I hear these types of sentiments from the community all the time. They can’t tell if it is something
05:56 – stressful that is making them think about their bladder or if it’s the constant thinking about the bladder that is causing this. It’s a cycle. And
06:03 – obviously for a lot of people there is infection present but is it possible that for some people they have recovered
06:09 – from infection and they still have these feelings of pain or burning sensations in their bladder. So this rece research
06:16 – paper I think it was from last year um that I referred to earlier was talking
06:21 – about how yes once the infection is gone there is still all these nerve fibers that are out and are over signaling but
06:28 – there’s no way of really knowing unless you are repeatedly testing repeatedly bio um uh biopsying the bladder
06:34 – repeatedly looking in there um so I think we have to just take into account that this is something that anybody with
06:40 – a bladder condition should be doing you know as I say, “Yes, I may be in fight or flight right now, but that’s not a
06:46 – bad thing. That’s because that’s adrenaline pumping because I’m thinking and I’m being spoken to.” That’s not a negative. We’re meant to be
06:53 – able to go into fight or flight. It’s about being able to shift back out of it again afterwards. So, how do we create safety? How do we
07:00 – create a feeling of being okay and it’s not, unfortunately, about stopping the pain, which a lot of people obviously
07:06 – want that to happen. It’s about changing our perception of the pain. So the first
07:11 – thing is finding a place where you’re being listened to, where you feel like you’re being heard. And that might be with finding a decent doctor, working
07:18 – with a holistic specialist, but working within a community, whatever it is, that feeling of being understood and heard,
07:24 – that is one of the first steps of of starting to feel safe. Finding hope is incredibly important
07:31 – because without hope, you’re never going to heal. It’s a huge part of what I do in my clinic. Um, even when somebody
07:38 – just contacts me for a discovery call, I have a sequence of emails that go out and one of them is with testimonials in
07:44 – there of people who did recover because if you just start planting that seed of
07:49 – hope, it gives somebody that little thing to latch on to and that becomes safety as well. Um,
07:58 – you know, all the things like deep breathing, meditation, mindfulness, all of these things have been proven to uh
08:04 – slow the the response that’s happening in the brain down, calm everything back down and shift you back over into that
08:10 – parasympathetic a little bit. Um, there is no time frame on this how long it takes though. It can take a really long
08:16 – time and it’s about constant practice and you know each person will need to be
08:22 – sort of thinking about this in their own light because some might take a few weeks to start feeling safe, others
08:28 – might take months and some might never feel safe because there’s so much going on. Perhaps they have a trauma history, a trauma background where they’ve always
08:35 – felt unsafe as well that they’re always on high alert. So I think there’s a lot wrapped up in all of that.
08:41 – It is a tricky thing to ask someone to find hope when they’ve been dismissed by multiple conditions and they just
08:48 – haven’t found answers. And we acknowledge that too. And one of the things that we try to do is to share stories like you said, testimonials. We
08:54 – want people to know they’re not alone. Even if they’re still at the point in their journey where they haven’t found any answers, it’s really important to
09:00 – know that there are people out there with similar experiences and there are many people that want to help. And then
09:05 – it’s just trying to find what that next small step can be. And we have heard from a lot of people in the community
09:11 – who have started doing breathing exercises or mindfulness or neural rewiring training and have found that to
09:18 – be very beneficial even after decades of experiencing symptoms and it might not
09:23 – cure an underlying infection but it has helped them to manage their daily life and to give them back some quality of
09:29 – life which is really important. We had a few specific questions about the way the
09:34 – nervous system interacts with symptoms and whether if you experience fulvo
09:39 – vaginal pain or itching, it might be a nervous system issue, especially the
09:45 – itching one’s an interesting one because we think of nerves and pain but not necessarily itching. Do you have thoughts to share on that?
09:52 – Yeah. So, it’s a tricky one, isn’t it? Because um there may be a bacterial or fungal presentation causing that as
09:58 – well. And certainly with clients who have come to me saying they have ulvadenia and they’ve been given a vulvadenia diagnosis, we then go and use
10:06 – an extration sequencing testing and we find either a bacterial or fungal or both overgrowth going on in uh the
10:13 – vagina and once we resolve that the ulvadinia symptoms die down or go away completely. So is it nerve? Is it
10:20 – bacterial fungal? You know what’s going on there? It’s unpicking all of that and it’s never going to be a set thing for
10:26 – each person. Um but yes definitely I think you know going back to that nerve sprouting you know you mentioned about
10:32 – the endometriosis as well we’re understanding more and more and more where there can just be more additional
10:37 – nerve sprouting happening. So I think you know we need to think about is that something that’s going on
10:43 – and again that then comes back to the brain and how it’s perceiving that pain and the volume button that’s being
10:49 – turned up on it. Um so there are obviously other nerves in the area. Not
10:54 – going to go into like the pedendial nerve and things like that because I’m not a pelvic floor specialist and this isn’t quite my area. But there are
11:01 – specific nerves that run through our pelvic bowl and they can either get
11:06 – trapped or they can become over sensitive. I mean most of my clients I refer back out to see pelvic floor
11:12 – specialists because quite often even just when you’re in pain, you know, if you think about it when there’s pain
11:18 – you’re going to tighten up. You kind of everything gets a little bit tighter. Um, and that in itself can cause
11:26 – specific parts of the pelvic floor to tighten up. So, quite often some people might just have one part that is tight.
11:32 – Um, I had one client where her UTI symptoms um seemed a little bit she
11:39 – actually came very early on in her journey and her symptoms seemed a little bit kind of not unusual but they didn’t quite fit the mold as everybody’s don’t
11:47 – really but hers specifically didn’t. And I recommend because of other things that she had said as well like pain with sex
11:52 – and things like that. I referred her out to a pelvic floor specialist. She then also happened to have urethral uh assist
11:58 – and they did urethal dilation because they said it was too tight around there and then the pelvic floor specialist
12:04 – said that she did have a hypertonic pelvic floor and actually as she worked on all of that her UTI symptoms
12:10 – decreased. So maybe it was just urinary retention in the first place that was causing bacteria to stay pulled in the
12:17 – bladder that was causing the problem. Um there’s so much wrapped up in it. It’s such a complicated mass of things going
12:24 – on down there. It’s very complex for a lot of people and it’s one of the reasons it can be hard to figure it out on your own and
12:31 – sometimes you need input from specialists in different areas of health just to get that resolution of symptoms.
12:36 – Are there specific practices or supplements that you recommend to address this nervous system regulation?
12:43 – Yeah. So I think you know um breath work hugely. Absolutely. I love doing a body
12:50 – scan. So I imagine my breath swirling around my brain around my mouth up my nose and out into my throat and out my
12:56 – shoulders and out down my arms etc. passing the whole way through the body. That can be a really good one to do before bed.
13:03 – Don’t disassociate from your bladder. pull that breath into your bladder as well and imagine it being whole and
13:09 – healthy and well. And I think that can be really important having a nighttime routine where you’re calming yourself
13:15 – before bed because when we’re in that fight orflight response, cortisol is being pumped around our body. Adrenaline
13:21 – is being pumped around our body. We can’t sleep like that. We need to calm down before being able to sleep well. So
13:28 – having a nice calming routine before we get into bed can be useful with that. Looking for small winds in our day. So
13:34 – little glimmers of joy that happen. Maybe a smile from a child or a rainbow you see or even a sunset. Something like
13:41 – that where you’re focusing on the little bits of not joy is a big thing, isn’t it? But like little things that happen,
13:47 – the little glimmers of something nice that happened in the day. Trying to be present in the here and now rather than
13:53 – the past or the future. This is very difficult for somebody in pain. I totally get that. Being in your body
13:59 – right now is really important. and then not being stuck in support
14:04 – groups continuously and I know they are amazing places and they offer so much support out there but they are also
14:10 – places of despair as well you know it’s not not being in them at all but give
14:16 – yourself an allotted amount of time don’t make it just before you go to sleep at night maybe it’s 30 minutes in
14:21 – the morning where you have a look you look for specific questions or a specific word that you want to research
14:26 – rather than scrolling through and just seeing everybody who’s in an awful state and obviously there are wonderful
14:32 – stories that go out into them as well and I get a huge amount of my clients through these Facebook groups. So, I’m really not trying to disparage them, but
14:40 – they are places where you can get really sucked down into as well as I mentioned
14:45 – finding stories of hope as you said, not using Dr. Google too much. Again,
14:51 – everybody wants to support themselves and they’re not getting enough information out there. But for instance,
14:56 – your organization does a huge amount around this. So looking at somewhere like yourself at the live UTI free and
15:02 – looking what’s going on there rather than relying on Google for answers I think could be really helpful. A lot of
15:08 – people are now using chat GPT. You know it’s fantastic but it’s not looking at you as an individual. It is looking at
15:13 – whatever it can draw up off the internet. ChatGP is also a people pleaser and it will tell you whatever you want to hear sometimes as well.
15:21 – It’s also relying on the same misinformation in women’s health as everybody else is and it’s hard to get
15:26 – through that layer. But I think what you said about support groups is a really important point. People often find that
15:32 – they’re amazingly useful, especially for finding similar experiences or discussing certain topics. But there can
15:39 – be times when it’s just not good to be in those environments. And a lot of people have said that it’s helpful at certain parts of their journey.
15:45 – Sometimes they need to be outside these groups while they focus on their health and return to the groups when it’s
15:50 – useful. And the groups are amazing in that way. You can come and go as you need them. And probably like you said,
15:56 – just before bed is not the right time to be scrolling through groups. I found that personally too that it’s not
16:02 – something that I should focus on a lot. Absolutely. I think also a little bit of
16:07 – movement in the day, which can be so hard if you’re in pain. But even if it’s just getting outside your front door or
16:13 – your back door and getting some daylight onto your face. Um if you can walk around the block, do if you can make it
16:18 – to a park, even if you’re driving to the park, to walk short distance into the park and then to sit on a bench. Being
16:24 – in nature is so important. Our eyes need to see a different uh light and we don’t
16:31 – get that just through a window. The UV light is sort of blocked. um if we can watching the sun rise and the sunset we
16:37 – get a different light coming into our brain then as well which can affect our penal gland and really help us with our
16:42 – wake and sleep cycle grounding yourself doing things like walking with your feet in the grass I
16:47 – mean not particularly now it’s getting colder but it can be really helpful just to feel the earth underneath your feet
16:53 – and there’s huge amounts of research around how you know we are electric um electric beings and we have these atoms
17:00 – within us and actually the ground can sort of ground as well, which is really useful
17:05 – sometimes. And if you can move, something like shaking yourself or dancing, doing sematic dancing where you
17:12 – just kind of wiggle and move to the music can be really helpful for getting adrenaline out as well. If you can’t do
17:19 – that, just tapping up and down your arms, bringing yourself back into your body whilst you’re doing some breath work
17:25 – with that can be really useful as well. And as I said, none of this is going to magically stop your bladder pain,
17:30 – unfortunately. It’s just about bringing you into the here and now, grounding your body, moving you out of that
17:37 – sympathetic mode, into the parasympathetic so that you can start to just slowly turn down that volume on the
17:43 – pain. How long do you think you need for breath work for it to be effective? Does it have to be an hour before you go to
17:50 – sleep or can it be five minutes? No, literally like 5 10 minutes. Do a little bit. I always think doing a small
17:57 – amount of something is really important. If you like I couldn’t do an hour of breath work
18:03 – that in me but you know I always try every day to do maybe 10 minutes before I see my clients where I ground myself.
18:09 – I imagine roots coming down out of my feet into the ground and tapping into the earth and just doing some breathing
18:15 – maybe doing the body scan and that just starts my day. But it’s never more than 5 10 minutes of doing that. And same
18:21 – before bed just a few breaths just bringing yourself back in. a great breath work called um 478 which is
18:28 – there’s a TED talk by a guy called Max Strom I think it is and he explains it to you and gets the crowd to do it and
18:34 – you breathe in for four you hold for seven and you breathe out for eight and that holding of the breath and then the
18:39 – long slow breathing out helps to shift you out of that sympathetic back into parasympathetic and it can be really
18:45 – useful just doing something simple like that that’s good to hear because that’s the approach that I adopted after my
18:50 – surgery I decided I needed to do some breathing work just to heal from the endometriosis surgery. And the 478 is
18:57 – kind of where I landed as the one that feels the most comfortable as well. So, I’ve been trying to do that. It’s hard
19:02 – to incorporate into every day, but I do find that it is helpful for just calming everything down.
19:07 – Absolutely. You mentioned supplements, I think, didn’t you? To help nerve related symptoms. So, vitamin D is one of my
19:15 – most used supplements. I do tend to try and get clients to test first of all. It’s not just a case of everybody should
19:21 – be taking vitamin D, but most people are deficient in it. So, it helps to modulate the pain perception and it
19:28 – supports immune and nervous system balance as well in the body. I try and get my clients somewhere around about
19:34 – 100 nanomals per liter. In the USA, that would be 40 nanogs per liter. So,
19:39 – they’re different uh measurements that we use, which is higher than what your doctor is looking at, but not crazy
19:45 – high. And certainly there’s some research to back that up as being useful for the immune system. So that’s
19:50 – something that we can use. Magnesium is really useful for calming uh the nervous system um calming down overactive nerve
19:58 – firing, reducing muscle tension and pain sensitivity as well. So that can be
20:03 – really useful and it can be used orally or you can actually use it um on your skin as a transdermal or um with
20:10 – magnesium salt baths as well. Um omega-3 fatty acids. So we can get these from
20:16 – fish if we’re eating fish three times a week. Uh oily fish is a nice acronym of smash. So salmon, uh mackerel,
20:23 – anchovies, sardines, and herring. Tuna as well has good oily fats in it as well, but they don’t have that in the
20:30 – acronym. And then from the vegetarian side, things like chia seeds, hemp seeds, and walnuts all contain good
20:36 – amounts of omega-3 fatty acids, but we have to convert them. Whereas the fish have already converted um uh the various
20:42 – fats down to EPA and DHA which our cells want to use and we need zinc for conversion and so many people are
20:48 – deficient in zinc and the various B vitamins that are actually needed for this sort of uh five or six pathway
20:53 – conversion that needs to happen. You can obviously take it as a supplement as well but they have anti-inflammatory and
20:59 – they support the nerve membrane as well and the integrity of that which is really important. And then there’s some
21:04 – B vitamins as well. Um, I try not to use B vitamins as a as a singular rather
21:10 – than I always use them as a complex, but sometimes it is useful to go in with higher amounts of certain things, but
21:15 – um, B6, which I’m about to mention, doesn’t want to be too high because you can have toxicity with that. And I find
21:21 – that a lot of people with bladder issues say they have a B6 issue that it aggravates their bladder.
21:27 – Clinically, interestingly, I find not many actually do, but a lot of people say that they do and then we maybe try
21:33 – it and they don’t. Um it’s one of those things where you know people start talking about well this thing will
21:38 – aggravate your bladder and they go well that that’s going to aggravate my bladder so it becomes their story
21:43 – without actually trying it. Always useful to try. Um but B1, B6 and B12 all
21:50 – have u functions within the nervous system and can help support nerve repair and myelin sheath formation. So our
21:56 – nerves are wrapped um in this thing called myelin sheath which kind of if you imagine your um in your home your
22:02 – electrical cables they all have plastic around the outside and the myin sheath is basically that plastic wrapping
22:08 – around them. So we can use all of these in combination to support neuropathic um
22:13 – uh support in the body. Cumin is another one which is easy to get via food from
22:18 – turmeric a lovely spice that we can use. It’s anti-inflammatory and is also a little bit neuro um um calms down
22:26 – neuroinflammation as well. Um there’s a product called P that I can never pronounce the full name
22:32 – of um but it’s a natural fatty acid that we make in the body and um it can calm
22:37 – down nerves and quieten that pain signaling that’s going on and mass cells as well. Um there are some studies
22:44 – around it in vulvadenia and uh pelvic pain and a little bit in uh interstitial cyitis and bladder pain syndrome as
22:51 – well. So that’s quite a nice one to use for some people. I do find that it needs to be used over at least three to four
22:57 – weeks before some people will receive um any sort of benefit from it but but it
23:02 – can be used. Um alpha lipoic acid is another one which is a potent antioxidant. It can
23:08 – work really well in the body and there’s lots of research around that in diabetic neuropathy and things like that for
23:13 – reducing burning and tingling sensations. Whether that would cross over to the bladder as well or not is
23:19 – depends on the individual. Okay. Seems like there are quite a few things that you can potentially consider
23:24 – for nervous system regulation. What about on the side of prevention and treatment of UTI itself? Do you
23:30 – recommend certain supplements for that? So prevention is a hard one. I think,
23:36 – you know, we need to be again thinking about the body as a whole and it’s not just about throwing in supplements
23:41 – willy-nilly. But I think, yeah, there are definitely things that we can use to
23:47 – try and um if we know that somebody is more prone to getting UTI that we can
23:52 – think about things um beyond antibiotics. I do need to say though that antibiotics is always the number
23:58 – one approach that we should think of for a UTI. This is never one or the other. But for people who can no longer
24:04 – tolerate antibiotics or are looking for a different um approach to it, then
24:09 – there are definitely things that we can use. But we need to think about what the body needs rather than just throwing
24:15 – everything at it. The amount of times people come to me and they say, “Send me a list of all the supplements you’ve
24:20 – got.” And there’ll be sort of 30 different bottles of pills that they’ve bought. And are any of them working? They don’t know because it’s not
24:25 – targeted. So we do need to think about the individual. So you might want to think about are there any nutrient deficiencies? Is
24:32 – there anything that needs bumping up at all in terms of that the diet isn’t supporting enough? Antimicrobial herbs.
24:38 – Um probiotics as we’ve mentioned before supporting the vaginal microbiome. Um soothing the bladder lining. So deulsent
24:46 – teas are useful there. Slippery elm things like that. Supporting the immune system, supporting that nervous system,
24:52 – supporting any membrane health throughout the body. Um, and I think also hor hormonal support’s an
24:58 – interesting one because there’s so much research around estrogen and vaginal estrogen and UTI and you know we think
25:05 – about permenopause and menopause as being low estrogen states but also when
25:10 – people are postpartum sometimes they’re in a low estrogen state and I’ve certainly had clients that have come to me where they’re having recurrent or
25:16 – chronic UTI since giving birth to their child and sometimes in that case vaginal
25:21 – estrogen has helped there as well. Obviously, always discuss any medication like that with your doctor.
25:28 – There are a lot of things. The 30 supplement bottles I think is familiar to a lot of people in this community. My
25:33 – supplement cupboard also is a graveyard of things that I’ve tried and that haven’t worked. I think I’ve got a bit of a routine down now. We got a really
25:40 – specific question for people with long COVID who are experiencing bladder symptoms and they suspect a microbiome
25:47 – disruption. What preventative strategies would you recommend in that situation? So I am not a longco specialist. I have
25:54 – to put my hand up straight away and say that. Um I have had a couple of people come to me with longco but they have
26:00 – been working with a longco clinic at the same time. So in terms of specifics
26:06 – around that we’ve really just tried to look at what was going on in the bladder with the microbiome and support that
26:13 – looking at membrane health um and um mitochondrial health. So the energy
26:19 – production that’s being made in the cells and looking at things from that side, looking at zinc as well and trying
26:25 – to work on things from if if there’s a zinc deficiency for the immune system, but also in terms of how it um can
26:31 – affect the the process of of that co-actor of things kind of the chain event of things happening. Um and then
26:39 – yeah, thinking of the nervous system support, vitamin D is a huge one in that side of things as well, magnesium and
26:44 – the B vitamins. Um, but really it kind of comes back to looking at the microbiome. And so, yeah, like I say,
26:51 – I’m not a longco specialist, so that’s not my area of expertise, but I’ve worked with people where we’ve worked on
26:57 – the bladder and the vaginal microbiome and and sometimes the gut microbiome as well and seen improvements, but you
27:02 – know, long co is a long, unfortunately, as the name says, process to go through to get back onto their feet again, but
27:08 – certainly improvements have been made. Okay, that’s good to hear. Another area that we got a lot of questions on is UTI
27:15 – after sex and whether you have any prevention strategies for that. So yes, definitely I think we need to be
27:21 – thinking about what’s going on between the two individuals. Some people seem to be able to have sex without having any
27:27 – problem with their UTI and other people can’t go near anyone without having a UTI instantly. Um but there are some
27:34 – things we can do certainly. I think the first thing to be thinking about is what’s going on with your vaginal microbiome. That’s going to be perhaps
27:41 – the first point of call. Is it robust enough? Is it healthy enough? Are there problems there of itself? Does your
27:47 – partner have an issue that is being brought in to that space and causing a disruption for you? Or is it just the
27:53 – disruption of tissue that is causing the problem the movement of your own microbes? So before sex, you can both wash. And
28:00 – this can be for male to female partners or female to female because we know certainly with u BV there’s been a lot
28:07 – of research recently into how um male partners are passing on BV to um to
28:13 – female partners but we know from history there’s been quite a lot of research around this and and it’s the same with same-sex female relationships as well
28:20 – that they will share the microbiome. So um washing both of you for men if they
28:26 – can use an intimate soap on the penis u if they’re not circumcised underneath the foreskin there can be a lot of
28:32 – bacteria that’s held within that space but it’s like all of our skin everywhere on our body it’s going to contain bacteria.
28:38 – For women I suggest not washing the vulva with soap. It’s really important that we are not introducing anything
28:44 – that might disrupt the pH there. If you need to use a pH balance soap or an intimate soap then do but really water
28:50 – is enough. Never douching the vagina. Never washing it out is really important because it can shift the environment
28:56 – completely in there. And then something that’s really re really important is making sure you’re ready to receive.
29:02 – Take time over this. Don’t rush it. Don’t like just if we get it over and done with, you know, because it will please the partner. We need to make sure
29:09 – that we are open and receptive and feeling willing to go through this. It’s really important that part of it. You
29:15 – can start off just by massaging the pelvic floor and the vulva and actually allowing it to relax a little bit. That
29:21 – can also be beneficial because again if we’re fearful if we’re scared we’re going to tighten up a little bit so we need to relax with that. Um using pH
29:29 – balance lubes I think you know even if you feel like everything is wet enough and lubricated enough actually having a
29:36 – little bit of extra lubrication can be really helpful. Fragrance-free condoms. Don’t put anything that’s scented or anything that
29:43 – glitters or tingles. Nothing like that down there. I’m sure none of your audience would be doing that but just to
29:49 – double check. [laughter and gasps] Um, avoiding spermicidal lubes because they have a much higher pH,
29:55 – making sure your partner is using condoms, again, not ejaculating into you is really important. But also, when we
30:00 – think about the oral microbiome as well, if there’s oral sex, you may need to use a denture dam. Really unsexy, but
30:05 – basically it’s like a sort of rectangular piece of a of latex that you can put over u the clitoris to perform
30:11 – oral sex. You can even buy latex disposable pants as well to use for this part. So, that’s [clears throat]
30:17 – something that can be done. Um, and then urinating straight away afterwards, washing with warm water only. Avoiding
30:25 – douching as I mentioned. Um, if you can do a sits bath, that’s fantastic. So, actually bathing the vulva in a bowl if
30:31 – you can get it into a bowl. You can buy them on Amazon where they sit on the toilet. And bathing the urethra and the
30:36 – vulva in a warm u strong green tea or a sea salt water, whatever sort of works
30:43 – best for you. That can be really useful for stopping transllocation of bacteria from occurring.
30:48 – If there’s no cuts or tears afterwards, um a lactic acid pesery may be beneficial for bringing the vagina back
30:55 – to um that acidic space that we want it to be. And then um vaginal probiotics if
31:00 – you can get hold of them. There is a product that’s come over to this country recently called u V probiotic u which
31:07 – is a um they call it a suppository because it’s American. Um, but you can certainly get that in the states and
31:13 – that can be used after sex to try and bring back the vagina into a a robust
31:18 – lactobil bacillus environment unless you have too much of certain lacttopillus
31:24 – strains and then that can cause more problems. So there’s never this is never like [laughter] across the board everybody can do these kind of things.
31:30 – Um, but also teas might be helpful as well. So garlic, corn silk, um, bhu, nettle,
31:38 – ginger, parsley. Um I actually have a short webinar on my website that gives you information about teas of how you
31:45 – can use them for your bladder. But that can be really nice to drink after um having sex as well to help to flush
31:50 – anything through and then you’ll be urinating more as well. And try not to stress about it. So easy for me to stand
31:56 – here and say that. But you know breathing into the pelvic floor, relaxing and knowing that you’ve done
32:01 – everything you can to to help yourself and to support yourself. If you have the link to that video about
32:07 – the TE’s, we can also put it in the video description. so people can find it. You mentioned water-based lubricants. We did get a couple of
32:13 – questions about whether you can use other things like coconut oil as a lubricant or if that could actually cause more problems.
32:20 – Yeah. So, um if you’re using a condom, you can’t use an oil because it will u
32:25 – denature the surface of the condom and make it not protective and obviously we don’t want people getting pregnant and
32:31 – because that’s a massive life change. Um, so yeah, using water-based lubes, um, if if there’s condoms there, but if
32:37 – you’re not using a condom, if you’re postmenopausal, then yeah, you can use an oil. I think olive oil is better
32:42 – generally. I find, um, u, coconut oil can be a little bit drying for some people.
32:48 – But if it suits you and you like it, then that’s fine. That’s okay. I think um, there are some good water-based um,
32:55 – pH balance lubes out there like Yes. And Hanks do some. There’s more than that, but I think it’s just important to do a
33:01 – little bit of u investigating into that side of things. There’s a product called Olive and Bee that I use with a lot of
33:07 – my clients in terms of a sort of vulval vaginal moisturizer that can be used as an intimately as well because it’s
33:13 – allowed to go inside and that can it’s just olive oil and beeswax but just olive oil and a good quality coldressed
33:19 – olive oil can be useful. Um there was one research paper where it was shown to support the growth of lactobacillus
33:25 – crispartis but reduce the growth of lactobacillusiners u which can sometimes be a little bit problematic even though it is a
33:31 – lactobacilli and so olive oil is kind of one of my go-tos for for people definitely. Could oils like that also provide a
33:37 – protective barrier for swimming? Some people say that their UTI trig symptoms are triggered when they swim and they’ve
33:43 – asked about things like that. Yeah, it’s really difficult, isn’t it? Some people use like a petroleum based
33:48 – Vaseline on there. Um maybe you’d have to try it out and
33:54 – see. Um I think you need to wash straight after with the chlorine in the
33:59 – pool. It’s the high concentration of chlorine that I think is probably causing the issues and then u u that
34:05 – epithelial lining the skin inside the urethra or even on the vulva can be u disrupted by that chlorine presence. Um,
34:13 – I think that with swimming, you know, as soon as you get out the pool, swimsuits off, showering, particularly when people
34:18 – are on holiday as well, not sitting around in wet swimwear is really important. Shower change. Put on a
34:25 – different just take loads of bikini bottoms with you or loads of swimsuit changes and just keep on changing
34:30 – throughout the day. It’s boring, but if it reduces symptoms from occurring, then it’s really important.
34:35 – Yeah. The other thing that people ask about is for people who work long shifts and can’t use the bathroom a lot or who
34:41 – frequently travel on long flights. Do you have any tips about how to manage that and prevent UTI?
34:46 – That’s a really hard one because sometimes I think we have to assess like is my job actually impacting my health?
34:53 – And if you are prone to UTI and you aren’t able to use the bathroom very
34:58 – often, then that is a massive impact. And you know, I understand that not everybody can just change their job
35:04 – instantly, but it is something to maybe consider and to sit with and and to work through. So, you do need to empty your
35:11 – bladder fairly regularly. You know, at least every 2 to three hours. Um, and if it has to be longer than
35:17 – that, maybe that’s problematic for you and causing more problems. Stay hydrated. Don’t not drink. Um, you know,
35:24 – we need to keep flushing the bladder through. That is how the bladder is meant to function. And when we don’t drink enough, we do allow just the
35:32 – normal bacterial flora that’s in there to become more and for it to become more
35:38 – acidic as well, which can cause problems for lots of people. So, it doesn’t have to be huge amounts of water, like
35:43 – gugging it down, but just sipping, hydrating continuously through the day, and that can be herbal teas as well, as
35:49 – I mentioned earlier. Um, you know, you can sometimes if your shift is at certain times, you could hydrate earlier
35:55 – and then maybe not quite so much whilst you’re on your shift. But if you’re doing a 12-hour shift, for instance, you
36:00 – know, you do need to hydrate over that time. And maybe talking to your boss about being allowed more toilet breaks.
36:06 – You know, this I think probably comes under human rights somewhere. If it’s not, then as I say, maybe you need a
36:12 – different job. Um, don’t, you know, empty the bladder just in case though as
36:17 – well. So, you know, there’s a lot of my clients are if they’re leaving the house, they empty the bladder. When they arrive somewhere, they empty the
36:22 – bladder. Like, they do it whenever there’s a toilet, they empty the bladder. And you can actually change the signaling system of your bladder of
36:28 – understanding when it’s full if you’re emptying too often. And that sort of comes in with bladder retraining, which I’m not trained in, but I very gently
36:35 – will talk to my clients around just, you know, of course you should empty if you feel you need to, but if you have just
36:42 – emptied, do you really need to go? Can you hold on a little bit longer? Um, but if you are getting in a car and you know
36:48 – that 20 minutes down the road you’ll be able to urinate when you get somewhere. Do you really need to go before you
36:53 – before you leave the house? Um, avoid avoiding dehydrating drinks as
36:58 – well. So, coffee, fizzy drinks, alcohol. That’s not that you’d be out drinking alcohol whilst you’re at work hopefully,
37:04 – but you know, it’s still something to be considering. If you’re drinking alcohol the night before, you might be more
37:09 – dehydrated the next day. Um, long flights are really hard. Um, you do need
37:14 – to keep di dehydrated on a flight. You need to keep hydrated on a flight and empty your bladder regularly again then
37:21 – as well. So try and get a a seat in the aisle so that you you know maybe up closer to where the toilet is and avoid
37:28 – wearing tight trousers and get up and move around. Even if you’re just walking up and down the the cabin, sitting still for long
37:34 – periods can make things worse as well. All good tips and many of them I’ve implemented myself on long flights and
37:41 – this has been a really interesting chat. Uh what ways can people work with you if they’d like to get in touch about their
37:47 – own health journey? So I work onetoone with people. Um I work quite closely with them over three or six month
37:53 – programs which can be extended out longer if needed. For bladder stuff generally it is six months. It’s very
37:58 – rare that at 3 months we see resolution of of all symptoms unfortunately. I wish I could change that but I can’t. Um, I
38:06 – also run group programs as well. There’s a new one starting in January where I
38:11 – pass over the information that I give all of my bladder clients. I’m running one at the moment on candida and again
38:17 – that’s slightly different. It’s more about vaginal health that will be run again u next sort of September time.
38:23 – Um, so it’s the basics. It’s a way to get going with all of the basics. And there’s workshops where we come together
38:29 – to talk through everything that we’ve learned. So, it’s part education, part practical tips, and there’s a section on
38:36 – supplements and lifestyle advice and nervous system support and diet and nutrition and all that sort of thing as
38:42 – well. Okay, great. We can put the link to that in the description as well so people can learn more about it and we wanted to
38:48 – thank you again so much for sharing your time. It’s been really interesting. Thank you for having me.
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