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/

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.

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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