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PELVIC, GYNAE & BLADDER ISSUES

Women's Health 

There are so many conditions falling under the umbrella of "women's health". Perhaps one of the top things that they have in common is the lack of priority they have in terms of research and healthcare funding. This has a heart-breaking effect on the women suffering with them. From delays in diagnoses, lack of clear diagnosis and multiple invasive tests, trial and error treatment routes, and dismissal from healthcare practitioners to deterioration in health.

There is a close connection between the bladder and pelvic region and the brain. The stress, anxiety and upset that these symptoms cause can create a vicious cycle whereby the bladder and pelvic regions become increasingly sensitised [1].  Whether you have recently started to experience symptoms and are unsure of how long may last or whether you have had ongoing bladder/pelvic symptoms for years, I tailor therapy to your unique experience and goals. 

I work with predominantly women with chronic/recurrent urinary tract infections (cUTI), interstitial cystitis (IC), overactive bladder (OAB), vulvodynia & pelvic pain in the context of, or separate to, endometriosis.

I use the latest evidence-based therapeutic methods to gradually interrupt this vicious cycle and support the de-amplification of these pain/sensation signals. Therapy involves information about the link between pelvis/bladder and brain, the conceptualisation of a holistic understanding of factors maintaining symptoms and management techniques for symptoms and associated distress. 

I am a passionate women's health advocate. I am currently focussing on research in this area and have a clinical caseload of women presenting with a range of health conditions. I am open about my own experiences with ongoing urogynae issues and how this motivated me to pursue my career in health psychology. 

Chronic Urinary Tract Infections (UTIs)/ Recurrent UTIs

Urinary tract infections occur when particular types of bacteria enter the urinary tract, causing inflammation. Symptoms include burning sensations when going to urinate, an inability to urinate, a frequent urge to urinate and a sense of incomplete urination. People experiencing UTIs may also experience more generalised pain in the urethra, bladder and/or kidneys. UTIs are the second most common infection after the common cold. Recurrent/chronic UTIs are symptomatic UTIs that follow the resolution of a previous UTI. To fulfil the criteria of cUTI, women will have experienced 2 or more UTIs within 6 months or 3 or more UTIs within a year.

The usual treatment path for women with cUTI includes multiple doses of antibiotics. Professor Peter Malone Lee's clinic advocates for long term low dose antibiotics, however, this is not the NICE recommended treatment and therefore not without its critics. 

Regardless of biomedical treatment approaches, women can continue to experience symptoms, causing substantial stress. Recent preliminary research suggests that stress and symptom-related concerns may sensitize pain pathways and increase/ maintain feelings of urgency through autonomic nervous system activity [2]. It is therefore really important to address the psychosocial aspects of having ongoing UTI, in order to heal from them. 

I currently use a formulation based approach drawing from neuroscience and psychoneuroimmunology research, as well as evidence-based therapeutic approaches for other long term conditions. I am currently working towards developing a formalised treatment protocol, that may be empirically assessed. 

Interstitial Cystitis 

Interstitial cystitis (IC) is a chronic bladder condition characterised by symptoms of increased bladder pressure, urinary frequency and/or urgency, and can be associated with pelvic pain. IC is increasingly understood to be a biopsychosocial condition akin to IBS [3]. This means that it is likely caused by a combination of physical (biological), psychological and social factors that all impact each other to produce ongoing symptoms. As with cUTI and other women's health issues, this is likely to be underpinned by central nervous system activity and potentially changes to immune system functioning. 

For the past 5 years, I've been collaborating with Professor Lindsey McKernan, based in Vanderbilt University in Nashville on research exploring the role of psychosocial factors in IC. Our paper published in 2020, collated the research establishing the significant relationship between psychological factors (including trauma and illness-related fears) and IC [4].  

Unfortunately, I am not able to take on any US-based clients, but I would recommend approaching Lindsey at the Osher Center to explore potential options if you are based in the US. 

Overactive Bladder (OAB)

Overactive bladder syndrome includes symptoms of urinary frequency, which may come with urgency and less of ability to control the bladder. The biomedical treatment options include medication and botox and this works sufficiently for many. For others who still have persistent symptoms, nurses-led bladder retraining may be recommended. Increasingly more emphasis is being placed on the other biopsychosocial aspects that may maintain OAB symptoms including symptom-related distress, sleep issues, isolation, mood and lifestyle issues. 

Endometriosis & Adenomyosis 

There is increasing awareness of the plight of women with endometriosis and adenomyosis. Endometriosis occurs when endometrium-like tissue grows outside of the uterus. Adenomyosis occurs when such tissue grows deeper into the womb. Some of the similarities in symptoms include painful periods, painful sex, chronic pelvic pain and fatigue. Women with these conditions may also have bowel issues.

For women with these conditions, getting a diagnosis and validation of their symptoms in the healthcare system can be a long and arduous journey. This journey in itself causes lots of problems and significantly impacts health outcomes. 

With increased awareness of these issues, there is a growing understanding that a biopsychosocial treatment approach is best. We know from chronic pain research that addressing thoughts about symptoms, emotions and bodily responses to symptoms is important for re-regulating the nervous system response to down-regulate sensations of pain that are produced [5]. This is where I can help women experiencing these conditions. In addition, I can also provide support for patient advocacy issues, preparing for appointments, navigating healthcare treatment decisions and processing medical traumas. 

[1] Quaghebeur, J., Petros, P., Wyndaele, J. J., & De Wachter, S. (2021). The innervation of the bladder, the pelvic floor, and emotion: A review. Autonomic Neuroscience, 235, 102868.

[2] Rosen, J.M. and Klumpp, D.J. (2014), UTI pain mechanisms. Int J Urol, 21: 26-32. https://doi.org/10.1111/iju.12309

[3] Dellis, A. E., Kostakopoulos, N., & Papatsoris, A. G. (2019). Is there an effective therapy of interstitial cystitis/bladder pain syndrome?. Expert opinion on pharmacotherapy, 20(12), 1417-1419

[4] Windgassen, S., & McKernan, L. (2020). Cognition, Emotion, and the Bladder: Psychosocial Factors in bladder pain syndrome and interstitial cystitis (BPS/IC). Current bladder dysfunction reports, 15(1), 9-14.

[5] McCarberg, B., & Peppin, J. (2019). Pain pathways and nervous system plasticity: learning and memory in pain. Pain Medicine, 20(12), 2421-2437.

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