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Incontinence and Bowel Management for Women, Men and Children.
Women’s Health Physiotherapist Brisbane, Australia.
Pelvic Floor Dysfunction Treatment.

Secret Women’s Business: The Big One

From time to time I have guest writers on my blog and someone (who is an actual writer but wishes to remain anonymous) has submitted this article to me.  I read it and found it interesting and decided to post it as it serves as a nice lead into a topic which I haven’t addressed with a blog and this topic certainly deserves one. It isn’t talked about very much and it may even sound rather uncomfortable. Some of you may squirm as you read this article and even not get to the end of the story, but I do encourage you all to see it through to the end.

To all my relatives – #embarrassmentalert.

Here is my guest bloggers article.

I guess it’s a particularly female thing. Maybe not often discussed. Somewhere along the line you realise you haven’t achieved this special physical feat. Let’s call it a goal. Well, at least you don’t think you have. You’re just not sure. Oh, you go through the motions. But no matter how experienced you are in the general ‘business’, no matter how much stamina or will you have, this goal seems tantalisingly unattainable. You just can’t get there.

Girlfriends who achieve one regularly assure you somewhat smugly that if you only ‘think’ you’ve reached this particular pinnacle, it’s a pretty sure bet you haven’t. As for ‘multiples’, gee, I’d be happy with just one.

I must admit it’s a little embarrassing to confess what I can’t help seeing as a failure at my age. It’s not like I haven’t been engaging in the activity for years. I just haven’t won the prize. I reckon I’ve come awfully close, but somehow am always left feeling dissatisfied. The build-up is intense, and then, and then …

In my case it’s not for want of trying. I reckon I try at least three times a week. I’m just not sure why I can’t actually make it happen. Perhaps it’s psychological. Do I feel too self-conscious about how I might look at the moment of success? I’m not the most physically coordinated person it’s true. And the whole thing is pretty undignified.

Still, apparently in this key moment, abandonment is the key. Give yourself over to the thing; just ride that wave – at least that’s what those in the know say.

It can be a dangerous business too. More than once I’ve bumped my head rather badly, which totally puts me off my game. I’ve strained my back too. On a couple of occasions, after much thrashing about, I’ve found myself facing the wall, completely disoriented and breathless.

Did I mention I’ve been trying this on my own? Could that be my problem? My technique must be missing something. Maybe there’s some kind of device I could plug in or strap on? Perhaps I should enlist the help of a partner – someone I can trust. Someone who can observe me as I strive and struggle and give feedback. Who knows? Maybe they could physically just tip me over at the crucial moment.

I’m fully aware that some women don’t stress – they simply fake it and lie about it to their girlfriends. But I’m afraid that’s not my style.

It occurs to me I may be overthinking the whole thing. After all I enjoy the overall experience leading up to this somewhat elusive end. The strokes, the physicality, the sheer feeling of exhilaration in my whole body and its movement.

Perhaps I should just be content with the pleasure I get from the rest of the exercise and give up on this heady release I’m seeking.

That’s the answer. Just stop trying so hard. I’ve decided finally, I’m not going to beat myself up about this anymore. Time to admit defeat and be satisfied with the status quo.

After all I’ve been swimming laps now on and off at my local pool for more years than I wish to admit. I’m an excellent, confident swimmer and I simply love the exercise.

So what’s the big deal about a tumble turn anyway?”

Now obviously my guest writer was having a bit of fun with us and that little article could have easily been about achieving an elusive orgasm. However the only difference is you can obviously openly chat about tumble turns, but unless you are at a Hen’s Night or in Grade 11 and have just read Dolly (I’m not sure what the equivalent mag is these days) and are asking your friends what is what, then women can’t easily find someone to discuss their orgasms with. But you can ask a Continence and Women’s and Men’s Health physio anything. We are used to discussing private matters related to pelvic floor dysfunction with care and professionalism and you can feel confident about privacy of any answers you give.

We do have to ask some difficult private questions – we have to ask about your voiding (weeing), frequency and your ease of passing a bowel motion, and it is important to ask women if they are sexually active; do they have pain with intercourse; do they lose urine with orgasm (coital incontinence) and if they are coming to see you with sexual dysfunction, asking about their ability to orgasm is a very important question.

Our role is also to educate about facts regarding orgasm. Many women discount a clitoral orgasm – like it doesn’t count if manual stimulation of the clitoris is involved. In fact only 30% of women are able to orgasm vaginally and 70% of women orgasm with clitoral stimulation only. (1) This article is quite comprehensive regarding the female orgasm if you would like to read more on it. Interestingly it was a female urologist Dr Helen O’Connor in Melbourne who made important anatomical discoveries about the size of the clitoris in 2005 completely turning Gray’s Anatomy description of the clitoris on its head! The article can be found in this link.

I also tell women that an important sex organ for women is their head (brain). There is a humorous YouTube clip on the difference between the male and the female brain and I think he pretty much sums it up accurately the cross wiring in women’s brains (that makes us able to multi-task so successfully). However, this cross wiring (metaphorically speaking), may contribute to the difficulties some women have in trying to achieve orgasm, in that many women find the busyness of their life and the anxieties and distractions of life diminishes their ability to orgasm. Financial worries, jobs unfinished, school reports, un-ironed clothes in the clothes basket – any or all of these things are liable to pop into a woman’s brain when she is having intimacy with her partner and in a second the intensity is lost and there’s no way she will achieve an orgasm. So clearing the head of distractions and setting the scene (minus the children in the house helps) enhances the prospect of achieving orgasm.

Learning that arousal is important, taking the necessary time with no rushing (which can be difficult with young children having daytime naps in the house) and using a good lubricant at any time can improve the enjoyment of intercourse and the potential for orgasm. If a woman is suffering with post-natal or post-menopausal vaginal dryness then discussing the use of a local oestrogen pessary or cream (twice a week) with your GP or specialist can significantly improve comfort and enjoyment.

Maintaining some libido can be an effort in itself and exhausted mothers and fathers can struggle to be bothered when some uninterrupted sleep holds far greater satisfaction than the prospect of sexual intimacy. But some time in the future, opportunities arise, the embers become low level flames and couples get back to enjoying sex as a part of their relationship, not as an obligation to be ticked off for the week. If there is ever any pain for the woman, it is important to ask a Continence and Women’s and Men’s Health Physio for assistance. With effective fear-reducing pain education and sensible advice depending on what has been found at assessment, dyspareunia can be significantly helped or cured. Dilators or a Therawand may be taught at the consultation by your Physio and used by the woman at home to help decrease any hypersensitivity and pelvic floor muscle soreness. As pain dissipates and pleasure and enjoyment returns, women can find significant help in achieving orgasm by experimenting with different sex toys such as vibrators. It can also help to venture into some romantic novels or light erotica,  -always sticking to your own comfort zone. Never do anything out of your comfort zone as it could make you have the opposite effect on your arousal.


Some tips:

  • Romance from the partners goes along way (even taking the rubbish out or vacuuming can amount to a significant romantic gesture in an exhausted woman’s eyes)
  • Offload the kiddies
  • Schedule intimacy just like you may schedule a pedicure- it is too easy to keep postponing it
  • Trial some different lubricants to see what is successful
  • Run away for a kid-free weekend to a romantic destination
  • Seek help sooner rather than later (here is the link to the APA’s Find a Physio website)
  • Keep your sense of humour with your partner around sex and keep communicating your needs and wants. Don’t assume they are mind readers.

International Women’s Day (IWD) 2017: #BeBoldForChange

As the title says- it’s International Women’s Day tomorrow on Wednesday 8th March and as the title instructs me to – I am going to #BeBoldForChange! That is the theme for this year’s International Women’s Day and being bold for change is a refreshingly demanding theme for us women.

Change is one of my favourite catch cries and in fact I wrote a blog about #change in 2011 when I first started writing blogs, because instituting lifetime change is what we Continence and Women’s and Men’s Health Physiotherapists have to inspire in women – we are obliged to encourage, cajole and nurture when we are educating women about managing problems with the pelvic floor. I liked my blog on #change so much (nothing like being a fan of your own writing) that I incorporated it into the conclusion of my books- because accepting and embracing change is how quality of life is maintained and improved in older age when there is increasing pelvic floor dysfunction.

But really I hear some (men) ask- why do we even have an International Women’s Day in this day and age? Is it still really necessary?

Well now in this digital age I have many virtual physio friends from the U.S. and if you read their posts in the lead up to the election and since the inauguration of Mr Trump (referred to from now on as DT), I feel they would say that the recognition and highlighting of IWD is more important than ever. Their dismay at the treatment and portrayal of women and girls during the past 8 months has been palpable because of the simply awful things that have been said and done to women. To the impressionable young girls in the US it must feel like a betrayal of their feminine being.

Not so far away, across the border in Canada of course is the complete antithesis of DT. And for all the women out there who love the other Justin (from hence known at TOJ) – here a reminder of Justin Trudeau extolling the virtue of the F word- feminism. What I find exhilarating when I listen to TOJ is his insistence that teaching young boys and men about feminism is as important as teaching young girls and women. #BeBoldForChange #Justin #swoon

Over the years, we in Australia have had our own awful disregard for the opinion and position of women in our political sphere and the workplace. Let me assure you, this meme below is not me being political. What is said in this meme may be something that many men may think to themselves – or not to themselves – they may actually articulate it at home, to their wives, or to their daughters, or in their workplace to their female employees or to their female friends.


But this was said by Tony Abbott when he was only 21. He was young and obviously silly.

Of course, he later went on to become our Prime Minister and the Minister for Women in a Government that only had five women at the Cabinet table and where a man was the Minister for Women…… (It is interesting to read this full Liz Jackson interview  during the 2010 election, where the quote was from, and realize it feels like we are living in a parallel universe). Of course I am sure, now that Mr Abbott is considerably older and wiser, he has a completely different idea about the value that women bring to the Cabinet or business table and how important a female perspective on anything is (such as world peace; such as diplomacy and words before guns and bombs; such as seeing people for what they are – people rather than a religion- remember I am following the theme for IWD #BeBoldForChange so am being deliberately provocative.) Well I hope he does anyway.

So the purpose of these musings?

It’s to reiterate for any women or men who think otherwise- acknowledging International Women’s Day is important.

It’s to encourage women to keep strong and resilient in the face of prejudice and unfairness in the workplace.

And it’s to say to women #BeBoldForChange in every aspect of your life from your bladder and bowel dysfunction to challenging inequity when you see it.

And to finish on a positive note -thank you to one of my lovely Women’s Health colleagues Meggan (developer of a great app called Clock Yourself to help with balance maintenance and improvement) for finding this quote from E.B. White:

I arise in the morning torn between desire to improve the world and a desire to enjoy the world. This makes it hard to plan the day.
Make sure you spend International Women’s Day both improving and enjoying the world.

#BeBoldForChange #IWD2017 #Feminism #Feminismisnotadirtyword



Knee replacements in the brain – the patient’s side

I have had plenty of family and friends undergoing joint replacements over the last couple of years and I wish I had had this great blog that I am re-blogging from NOIJam to refer them to and ask them to read. If you are undergoing a joint replacement in the future please add the suggestions in the blog to your pre-op routine. If you’ve just had one please still read it and it’s still a good way to view any post-op pain!

Thanks to BIM (Body in for this! The blog follows…..

John Barbis, aging Philadelphian PT had a bilateral knee replacement 4 months again. I have just watched him scurry though the snow like a squirrel and run up stairs like a five year old. He can si… Press the link to read the whole blog!

Source: Knee replacements in the brain – the patient’s side

Hypervigilance and some ideas to manage it.

yoga at EP3

Yoga is wonderful for decreasing anxiety and hypervigilance

Another of the Nuggets associated with our pain relaxation class.

Hypervigilance is an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviours whose purpose is to detect threats. Hypervigilance is also accompanied by a state of increased anxiety which can cause exhaustion.(1)

It is commonly associated with chronic or persistent pain conditions and anxiety conditions.

It is characterized by increased physical and psychological arousal. Physically, the person may sweat, their heart rate increases, their bladder spasms, they may have bowel cramps and breathing may become shallow and rapid. They may have delusional or paranoid thinking.

Numerous studies suggest that anxious individuals are more hypervigilant to threat in their environment than non-anxious individuals.  Anxious individuals are constantly looking out for signs of threat or harm in their environment and selectively attend to stimuli signalling possible danger, especially if the situation is new, or relatively unfamiliar, or potentially intimidating.

Telling people to simply stop worrying is not going to work.


A few things do seem to help reduce the intensity of hypervigilance.

(You know many of these but we will repeat them again to reinforce how important it is to do regular practice of these strategies.

  • Exercise, which helps to burn adrenaline and release feel-good hormones at the same time.
  • Dance – it needs its own category because it’s such a special exercise. The endorphins released from the rhythm of the movement and the music have a powerful effect on downgrading hypervigilance.
  • Relaxation
  • Yoga
  • Meditation
  • Mindfulness
  • Talking to someone who has a calming influence
  • Keep social contact (with positive friends and acquaintances)
  • Decrease the amount of screen time – Facebook and other social media (unless you have a group of friends on there that help you in a crisis)
  • Watching comedy shows
  • Stop watching or listening to the news, politics or talk-back shows
  • Breathing awareness
    • Be aware of upper chest breathing
    • Be aware of tummy breaths
    • Be aware of breathing in slowly and deeply, holding for four seconds then slowly breathing out as though expelling more air than was breathed in, may be helpful if anxiety builds as a result of perceived threats.
    • Be aware of relaxing your scalp, forehead, jaw, shoulders, tummy, pelvic floor and inner thighs as you breathe out and feel the warmth flowing into the palms of your hands as you let go of everything.

Take this information to assess whether you are overworking attention to threat and this may be increasing the stress hormones increasing your anxiety and or pain. Be proactive with some of the strategies to decrease the threat level and decrease pain and anxiety.

Part of this week’s Nugget is taken from a blog by Jerry Kennard

  1. Definition from Wikipedia

Mindfulness in Anxiety Management


Who isn’t feeling a bit anxious lately? Between the political landscape worldwide and the ever-distressing weather, amongst other things, there is plenty to be anxious about. (BTW if you live in Brisbane and are feeling a little whingy about our day-after-day unrelenting heat and humidity, then take a moment to check out Birdsville’s temperature- yes it is 9 pm at night and yes it is 39 degrees centigrade!!!)


We have learnt over many blogs that anxiety can ramp up chronic pain. The stress hormones that are released when you are anxious charge up the nervous system and intensify many negative sensations and feelings.

If you have chronic pain and have no strategies to help you manage and overcome it, the constancy of your situation and the gradual de-conditioning that comes with exercising less and socialising less, has many distressing effects on your mood and how good you are feeling. One of my deep desires when I established Studio194 at my old rooms, was to start a Pain Relaxation class to teach clients how to manage pain and anxiety, how to reduce muscle tension and most importantly provide them with a safe zone to allow them to escape from the hurley burley of life.

I took over from the wonderful Lori in May when she had to leave and took the class at 6.15pm every Monday night from May to December. Having attended Lori’s class since inception, mostly because I loved the ability to actively relax without feeling guilty for doing nothing for 45 minutes, I had felt I wanted to introduce a little bit of education at the beginning of the class. And as you all know, I am in love (figuratively speaking) with the fantastic Lorimer Moseley and Dave Butler, of Explain Pain fame so I decided to name these little snippets of education Nuggets (in their honour).

Every week I write a page or two on something to do with pain or anxiety management. It’s a wonderful way to keep discovering more about pain and anxiety management strategies and after rather a difficult year, there were many days when I was actually researching strategies for myself. In fact, my secretary Jose, who has taken the role of typing these nuggets up every week for me, commented the other day on how (ridiculously) quickly Mondays come around…“Really Sue it’s Monday Nuggets Day again?!?!?”

Luckily Martine now runs my Pain Relaxation class on a Monday night – she is a Physiotherapist and a Pilates instructor so is very skilled in teaching the stretches we use, many based on the wonderful work of Sandy Hilton, co-author of a great pain book called “Why Pain Hurts”. Much of what we do is down-training muscles, learning to let go, relax muscles rather than tightening them. My greatest joy when I took the class was when people commented on how beautifully they slept the night of the class and how great they felt when they woke up the next morning. Refreshed!

I have decided to put these as entries in my blog, because these days I hand these Nuggets out to many patients and it could save a few forests by having the information accessible online for my patients. The following one is on Mindfulness – a little explanation and the information was sourced from Linda Turner’s Mindfulness Based Stress Reduction as a Strategy in Reducing Pain which can be heard in it’s entirety on You Tube.

Mindfulness based stress reduction as a strategy in reducing pain

Mindfulness practice allows you to know what is right with you and your body, not what is wrong. A study in 2003 showed with 8 weeks of mindfulness training, participants saw an associated change in brain activity with:

  • A decrease in trait anxiety
  • An increase in positive affect (mood)
  • An enhancement of immune function (increased antibodies in the blood stream)

The participants had no previous experience with meditation or mindfulness, and in just 8 weeks had this positive response.

Mindfulness is about awareness.

The triangle of awareness:

  • Body sensations (hot, cold, breath awareness, discomfort/comfort, tension, muscles – are there tight areas that you are holding ?)
  • Thoughts
  • Emotion

We need to bring attention to our awareness, as much of the day we are on autopilot.  Attending to the body/breath brings us into the present moment – immediately.

Mindfulness begins with attention

Jon Kabat-Zinn defines mindfulness as attention that is:

  • Intentional
  • Moment-to-moment
  • Non-judgemental

Take home message

  • Just start noticing
  • Be present in the moment
  • Breath is always with us. Come back to your breath always.
  • Increase your power of concentration to being in the moment
  • And as one of my favourite things is to save memes on my phone when I come across them (and I am sure for many people memes can be one of the more annoying things about the internet) here are a couple to finish with. I hope you will pursue more information on mindfulness and use it to cope with anxiety (and pain) in these trying times.
  • breath-meme     happiness-meme
  • As these are memes saved in a microsecond on my phone over many years, unfortunately I am unable to reference them. I apologise to those who created them and thank you for your inventiveness!
  • (Bulletpoints have a mind of their own sometimes……..)

The latest on HADA – and how to get some ‘things’ out of your life.

I received an email today with an update from some heroes – Dr Barb Hall gave us an update on their latest trip to Uganda with Dr Hannah Krause and yet again their inspirational work makes me feel very inadequate.

Again I am just going to include the whole email, with some glorious photos of some very, very appreciative ladies, whose lives must have been truly miserable before Barb and Hannah performed their life-changing surgery and repaired their fistulas and restored their continence.

It beggars belief that the doctors performing the surgery have to pay to do it, but pay they do, and it is for this reason that they are heroes.

Barb’s email follows:


Some of the 151 patients waiting for screening.

Hello friends,

We have recently returned from Kagando, Uganda, having completed another successful surgical camp. This camp was fraught with uncertainty from the start. There was some violent, political unrest in the area not long before we were to go – so there was a period of uncertainty as to whether the camp would go ahead – however after reassurance from the local doctors we decided to go, as patients were already arriving at the hospital for treatment.

The “mobilisation” had been incredibly effective – nurses visiting mountain villages, radio announcements, church announcements and flyers in public places. We screened 151 patients and of these 123 required (or were suitable for) surgery. This included 52 fistulas, 67 prolapses and 4 minor procedures. The nurses and hospital facilities were stretched to the limit as we filled the fistula ward, the makeshift tent (erected over a concrete slab that will one day become another fixed ward) and the “overflow” paediatric ward with patients on every available bed (in some instances 2 to a bed) and then on mattresses on every spare centimetre of floor space. Morning ward rounds became increasingly long and tedious – as we spent considerable time crawling around the floor to examine patients! By the end of the camp, there were many, many happy faces and many women whose lives have been changed forever.

We spent approximately AUD$43,000 on the surgeries – US$300 per fistula and US$250 per prolapse. This has been possible because of your generosity – mainly with the huge success of our fundraiser event last year. We and the women of the Kasese region of Uganda thank you all for your contribution to our project.

I have included a photo above of women lining up to be screened on the day we arrived in Kagando, and another below of a group of women who are dressed up ready to go home – dry for the first time in years after successful surgery to close their vesico-vaginal fistulas. You can see the absolute delight on their faces!

We plan to return to Kagando later this year, so will need to once again call on your generosity to fund what promises to be another bumper camp! Our 2017 fund raiser is planned for June 10th.

Thank you for your generosity in helping us to cure these women,

Barbara Hall  – for the “team” of Hannah Krause, Judith Goh and John Taylor

PS On the plane on the way home we watched a movie  “The Queen of Katwe”. I would highly recommend this to anyone interested in seeing what life is like in rural Uganda. It is set mostly in Katwe, a town not too far from the Kagando region, and gives a true depiction of the life of the poorest people in Ugandan villages. It is a truly inspiring movie.

Thanks Barb for your email. In amongst the crazy goings-on today: Trump’s latest spin on continence; Nick Kyrgios behaving like a child undergoing toilet training and other dirty linen; it was a breath of fresh air to receive such an inspiring email! I have done the bolding within the email- to really emphasise some points – two women to a bed <aghast expression on face> Can you imagine if we were asked to not share a room but a BED with someone undergoing surgery??

As you read in my last blog, I chose to receive no presents last year, but instead asked that family and friends make a donation, regardless of how small to HADA and I also chose to give small donations to HADA on family and friends behalf, instead of buying them presents ie. more ‘things’.  Very quickly around $1000 was raised.

And people who donated on my behalf received a tax deduction for buying me a present!

And I received a tax deduction for donating to HADA instead of buying my family and friends more ‘things’!

A win-win situation – less ‘things’ and more money (100%) of which goes to the work that Professor Judith Goh, Dr Hannah Krause and Dr Barb Hall do in Uganda and other places.

SO I have decided to do the same again this year. I can’t go to Uganda and do anything useful, but I can give some small donations and I can spread the word about their marvellous work. Please – if you feel you would like to contribute to a life-changing cause – SHARE this blog far and wide and let’s try and help raise another $43,000 for HADA to do their thing!


Eight now dry Fistula patients about to go home HAPPY (one day’s discharges)!





It wasn’t HADA at all! An update.


fistula repair operations July 2016

Hannah Judith and patient

Last year as one of my New Year’s pledges I decided to ask my family and friends to give a donation to HADA -the organisation which fund-raises for the fistula and prolapse repair work that Professor Judith Goh and Dr Hannah Krause do in Africa – instead of giving me a present for my birthday and Mother’s day. I’ve written many blogs about the incredible life-changing surgery Judith and Hannah (and Neroli, Miriam and Barb) perform for the women, who suffer shocking birth injuries, which leaves them with constant urinary and faecal incontinence.  This incontinence often leads to ostracising of the woman from their family and even their community.

But early into the year it also occurred to me that I too could also give a donation to HADA in lieu of a present, to all the people I usually give presents to in a year – family, friends, staff – and most importantly all of them went along with it and thought it was a great idea! So for Mother’s Day and my birthday everyone complied and gave a donation to HADA and in the twelve months from January to December, I donated $844 (which is tax-deductible also!).

It wasn’t hard at all. In fact it was very satisfying. Can I suggest that if everyone thought about a $10 donation to their favourite charity and reduce the cost of the present you are buying for friends and relatives by $10 it would be a win for the charity such as HADA and a win for the ‘feel good factor’.

Just a thought for 2017.


Social anxiety in dogs and cats: Who would worry more about the speech they had to give?


My family are always very helpful when looking for “the” Xmas present for me. This year we had a different version of Secret Santa called Bad Santa – where you have a price limit (which almost nobody appeared to pay any attention to) and you buy a present that might suit quite a lot of different people, and either sex. Everyone’s names go in a hat and one by one names get drawn out. When the first person has chosen a wrapped parcel and opened it – it’s then on the open market for the next person to say ‘I like that’ and steal it! Each present can only be stolen twice and there has to be an agreement that if you very partial to a particular present and you didn’t get it, tanties and pouting are not allowed – the shops will be open the next day and you can go and buy yourself one.

Now there were a couple of presents that seemed to be targeted directly at me. I would have thought there wasn’t much more I needed to read about poo – studying many journal articles regularly, having read Giulia Enders book called Gut and changing Beau’s nappy quite regularly, but I got a facts book about poo called What’s your poo telling you? by Josh Richman and Anish Sheth. It’s really quite interesting with some funny facts and useful advice and anything that gets us all comfortable with discussing our bowels has to be a good thing. In fact here are two links to some bowel blogs I have written before.


It didn’t even register with me when Jimmy opened his present (the poo book amongst other things) – it took some prompting from a Croft child to say ‘I think that was meant for you, Mum’ and so some stealing occurred and it became mine! The next present opened, that was targeted at Bob and/or I, was a book (the thickest travel book I’ve ever seen) on Rough France. Word had got around that after our successful hiking holiday to the Swiss and Italian Alps, the French Alps are next on the bucket list. To say my travel appetite has been whet is an understatement. So plenty of reading happening on the (glorious) Sunshine Coast Beach.

Another book I have bought to help me understand anxiety and the brain with my patients is called The User’s Guide to the Human Mind: (Why our brains make us unhappy, anxious and neurotic and what we can do about it) by Shawn T. Smith.  It’s a great little book with practical advice and patient examples to clarify explanations. Anxiety plays a huge part when patients have overactive bladder symptoms (bladder urgency or urge leakage), faecal incontinence (gas or bowel motion incontinence) or persistent pain conditions (dyspareunia -painful sexual intercourse; vulvodynia; endometriosis; anal pain) and we know that the stress hormones released with anxiety may make all these conditions worse.

In the book, Smith talks about the mind giving us things we don’t want – thoughts, feelings, memories, anxieties, moods and even physical sensations like a pounding heart or sweaty armpits. Sometimes it happens out of the blue. I experienced this quite recently and it really brings home to me the potential drama the brain creates for us with perceived traumatic events. On Melbourne Cup Day, a car was pulled over by the police and the driver and his passenger (dressed in suits, appearing to have attended a Melbourne Cup function) got out of the car and had obviously over-indulged.

While the driver was being breathalysed, the passenger moved to the Studio driveway and in full view of myself was physically sick and lost control of his bladder. Now I had a very visceral response – I felt ill myself, I got the shakes because all the dance ladies were arriving and while I was cross with him, at the same time I felt his shame at this happening in front of everyone. We started the dance class and the first song was called Mambo No 5. We had been doing that song for weeks and I had it nailed. It’s a bit complex with leg and arm moves and that day I just couldn’t manage it.

I kept visualising what had just happened. I kept feeling angry it had happened and sick in the stomach. And I just couldn’t get the timing of the song right. Every time that we do that song, I get a flashback. As time goes on, the visceral response is less, and I am back to being coordinated with the dance but none the less it still is having an impact of some sort 7 weeks later. And that was just that innocuous episode. Imagine the response to a really traumatic event. The brain and the second brain (the gut) would have a field day.

Other times the mind throws a fit because we have dragged it into a situation it hoped to avoid (like a first date when rejection is a real possibility). He uses as an example a common fear among humans: public speaking. Other animals don’t posses this fear simply because they don’t make speeches. But he makes a funny observation (for all of you out there who are dog vs cat people….. and it is a very definite love hate thing this: ‘I love dogs, no I love cats’) that dogs being pack animals would probably suffer public-speaking anxiety because placing themselves in the spotlight might affect their standing in the pack. A poorly executed presentation on begging for table scraps could lead the other dogs to question the speaker’s competence. That could snowball into ostracism. Cats being more solitary could probably deliver a speech with the confidence that arises from a complete disregard for social acceptance. (page 14, 15)


He goes through examples of irrational thinking – while he uses the example of public speaking we could just as easily substitute some of the conditions I treat every day: bladder urgency and leakage or the overactive bladder (OAB), faecal incontinence (FI); painful intercourse. Let’s try and use his explanations for each of the categories.

All or none thinking – ‘If I fail (which I must not do) at retrying sexual intimacy, then I am not worthy of love or respect’ ;

Catastrophizing – ‘I had my first faecal incontinence episode at those shops, I can’t face going there again’;

Focusing on the negative – ‘Because it is unacceptable for my bladder to misbehave and it often misbehaves my life is no good;

Disqualifying the positive – ‘When he says I look beautiful he is only being kind, I am really overweight and ugly’;

Minimisation – (I’ll bring it back to the giving a speech example): ‘If the speech goes well, it’s due to luck, if it goes poorly it’s because I’m completely incompetent’ ;

Personalisation- ‘Everybody is looking at me, I must have soiled and there’s an odour’.

Once identified and put into words, evidence can shoot down irrational logic. If all goes well, the mind backs down, as we realise thoughts don’t match reality. But the problem is an anxious mind doesn’t calmly defer to logic. (p17)

Smith reminds us how busy the mind can be, buzzing along at 500 thoughts per hour. Many people with busy minds would agree that it would be nice to walk away from the mind’s chatter. Tibetan monks talk about monkey thoughts. When these thoughts and this chatter becomes overwhelming, breath awareness……the good old tummy breaths are good for calming things down. Anxiety can be useful though – if you are in a dangerous situation then the body responses from anxiety can cause you to avoid that situation. Athletes can benefit from moderate levels of anxiety to improve performance, but problems happen when the mind tries to save our lives, when our lives really aren’t at stake. In large doses, anxiety (and depression) can be debilitating.

Another important thing to remember is thoughts are not facts. Smith reminds us that thoughts are reasonably accurate representations of the world, but they can often be misleading and inaccurate. Even when the thoughts are accompanied by strong emotions, which can strengthen the illusion of credibility, the thought remains merely a thought.  Emotions do not turn thoughts into facts. (p40). Emotions tend to come with strong physical symptoms. Racing hearts, restless bladders, hair standing on end – we have no control over these experiences than the emotions that pawn them. (p44)

Psychologist Marsha Linehan suggests a useful exercise is to describe the emotional responses in words. For example someone experiencing fear before an exam might say: “I’m noticing my mouth is dry and my heart is beating fast” as opposed to “I’m going to fail my test, get kicked out of school and lose all my friends”. Applying this theory to say someone having repeatedly painful sex due to vulvodynia : “I feel my heart is racing, my legs and pelvic floor are gripping and I can’t breathe properly”.  This would allow them to identify the problem areas and concentrate on relaxing their adductor (inner thigh), abdominal and pelvic floor muscles and invoke some tummy breathing, while visualising a comforting scene such as the rolling waves at the beach.

This may stave off the wave of anxiety, the release of cortisol and adrenaline and enable them to recognise what is happening for what it is – a combination of memory – failed experiences at pain-free intercourse; getting more ‘practised’ at this anxious response to the same situation and a non-relaxing pelvic floor. In the book ‘Teach us to sit still’ by Tim Parks this sentence hit home powerfully with me when he said (p42) “It was true that my body and I weren’t the best of friends these days; we hardly communicated except through pain”. I think this is a common feature of persistent or chronic pain patients – assessing what is really going on with their body; what caused that violent response, that unpredictable response, is hard because the only time these patients listen to their body is when there is a pain response. Not only are they not communicating well with their body, their brain gets better and better at producing the pain.

What I related to with my patients and their pain issues, or their OAB issues or their FI issue is- the belief that they cannot move forward until their thoughts and emotions are in order. They tend to feel stuck until their minds are under control. With unruly, overprotective minds, patients can spend a lifetime waiting until they feel they are ready to act. (p49)

The book is full of gems of information and practical examples – I would recommend it to you as some reading, to better understand the grip anxiety can have over you.

And to finish on a great quote from another book on the holiday reading list called The Alchemist by Paul Coelho:

‘The secret of life is to fall seven times and get up eight times.’

So no matter how compelling the sense of failure, incompetence or rejection may be, dust yourself off and get up and have a sense of self-belief and get on with “living the shit out of life” (Rob Cook – he broke his neck in a helicopter accident in 2009 and is confined to a wheelchair ever since.)


Christmas thoughts

beach xmas

As I tend to do at times, I have realised……….quite late, that I have not done a Christmas blog. So as I decided to check out some Christmas quotes and see if there were some that may be useful advice for getting through another Christmas Day unscathed.  Now to say they were ordinary is an understatement…….this is the best I could muster up:

T’was the night before Christmas, when all through the house, not a creature was stirring, not even a mouse. Clement Clarke Moore

But then I just looked up the 60 selected best famous quotes of all time. ( and surprisingly there were some pretty appropriate ones to draw on, during the BIG DAY.

You can do anything, but not everything. David Allen

That’s for all the hostesses on the day. Delegate!!

Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away.Antoine de Saint-Exupéry

After last year, where everyone made a dish or three, we looked like at the end that we could feed another 50 people. So remember the company and the laughter is what is important not the quantity of food.

The richest man is not he who has the most, but he who needs the least. Unknown Author
So watch out all those who have second helpings of plum pud!
When hungry, eat your rice; when tired, close your eyes. Fools may laugh at me, but wise men will know what I mean. Lin-Chi
We all know who is going to take that advice seriously and just crash when overload takes control. Sleep to really enjoy Christmas Day!
 The person who reads too much and uses his brain too little will fall into lazy habits of thinking. Albert Einstein
And just because, as you know, I love Albert Einstein quotes, and this is a beauty.
And I can think of no better place to be thinking, than at the beach.
Dawn, Sunshine Beach, 24th December, 2016
Merry Christmas to everyone and may your Christmas Day go smoothly and with good cheer.
Sue xx

Steroids: Sinners or Saints?

Some elite netballers who train hard and long

At 9.55pm Friday night, I was in perfect health – quite stressed as I had finished work that day, had to pack for the holiday, gather the Xmas presents together etc etc. – you know the drill!- but felt physically fine. Come 10pm and  the awareness of a sore throat came rolling in and by morning I knew I was in trouble. We headed off to the beach and by the time the two-hour trip was over, I was incapable of helping Bob in any way to get everything up to the unit. (Now there are times when I’d wished I could feign illness to escape the torturous unloading of the car but I would never actually do it!)

I was moribund on the lounge, sore throat, glands up (Arnold Schwarzenegger like) and felt faint when I stood and attempted to be helpful.

By nightfall as it worsened, Bob suggested Noosa Hospital (probs at 9pm so it wouldn’t end up being 3am) and we fronted there and they were very helpful. Antibiotics, pain killers and a diagnosis of tonsillitis.

Monday arrives – things are worsening despite the antibiotics and it was the third day at the beach and we still hadn’t felt the slippery, white stuff between our toes. So back to the hospital and the magical Dr Ena takes control. She is the Emergency Director at Noosa Hospital and will soon be moving to the new University Hospital at Kawana – good for them, sad loss to Noosa. Blood tests (perfect) swab (“try not to vomit on me Sue”- Sue held it together) and then she orders two lots of IV antibiotics and IV steroids to help me swallow and get the swelling down.

As we said goodbye, even then I could feel the improvement. And here it is 12 hours later and the feeling of a complete turn around is truly spectacular! Now I hope I’m not jinxing this by writing about it (you know never mention the sleeping baby) but in the shower I had this thought – what if I was an elite athlete and out of the blue a couple of days out from the event I’d been training for – like for my whole life – I had an experience like I had – sudden catastrophic tonsillitis?

I mean the elite athlete possibly could have antibiotics but they definitely couldn’t have the steroids. And to me now that I have experienced their true wonder – that seems unfair. Steroids are used and abused. There is no doubt. But for the athlete who has trained his or her butt off for years and years a sudden dramatic illness IS catastrophic. Many have made huge sacrifices in their job, family life and social life for years and years. And to not be able to access the magic of steroids when an illness hits suddenly and ferociously – it seems unfair.

This is the second time in a very short while I have seen the magic of steroids. My gorgeous grandson got very unwell following a midge attack while hosing. Now you wouldn’t expect that midge bites could cause such a reaction but his rash and discomfort got worse and following three emergency department visits and a diagnosis of serum sickness, he finally experienced the magic of steroids. It’s like his rash melted and the swelling went down over just a few hours.

So the moral of this blog?

There are three.

1. It’s amazing how your body carries on until the second you finish work and then collapses.

2. Stress is a major provoker of body ailments and maintaining good control over your stress levels is important to sustaining good health. Examine toxic influences in your life and think about how you can change them.

3. Eat healthily, exercise regularly and safely and sleep well which may well mean less interaction on social media.

I’m going to really work hard on point number 3 for myself.

(Oh and point 4 could be – “Am I eligible for steroids Doc?”)

A rather imposing Santa 

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