In Your Pants with Dr. Susie G - In Your Pants Podcast!

Episode Date: October 15, 2020

If you're looking for one physical cause to your pain, you'll never find it. Pain is influenced by how you feel about it, as much as it's influenced by biomechanical, physiological, or pathological factors. There's a lot of research on the mechanisms of pain, on rating pain, and strategies for treating pain, but research has widely ignored the impacts of persistent pain on a person's life. Why is this missing puzzle piece so important? Because Tom Astill's QoL study on pelvic pain connects the dots between how pelvic pain impacts your life and where you can begin to explore your attitudes, beliefs, and values to start feeling better. We're zooming out and taking a look at everything with a wide scope. It's all connected.

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Hey guys, it's Dr. Susie G here and welcome to another In Your Pants podcast. Thank you so much for being here with me today. On today's show, I have guest Tom Astell and he's a physiotherapist working in a private musculoskeletal practice in Australia. As part of his undergraduate studies, he conducted an honors project where he and a group of colleagues developed a questionnaire to assess the impact of chronic pelvic pain in men.

This project has sparked his passion for research, chronic pain, and men's health. Tom is currently looking at various PhD topics in this area and is working on expanding his clinical skills to support his future research. You guys, this is such an awesome episode. Tom has shared with us his amazing research on really the heart of the issue with men dealing with pelvic pain and what they really are going through as they seek help for their issues, validation for what's going on for them. We really talk about even Tom's own experience as a guy experiencing issues of his own. And he was so vulnerable with us, which is just amazing. And I can't thank him enough for doing that because it is not easy for us to talk about our most private

and intimate areas. We go into what anyone really should look for in a healthcare provider and what men who are experiencing pelvic pain really want from providers. And I think that's a really awesome conversation that we have around that. And then we talk about, in general, some of the barriers for men seeking healthcare for pelvic pain. And Tom has been generous to share with us his research and the pelvic pain impact questionnaire for men, which I'll also have linked in the podcast show notes. So without further ado, this is one that you definitely don't want to miss. I introduce to you, Tom Aistel. Tom, thank you so much for being here. No worries. Thanks for inviting me.

Well, let's get right into it. I always like to ask my guests, what interested you in getting into chronic pain research or pelvic pain research? I haven't experienced chronic pain myself other than as a child. And it wasn't me, it was my mum so my mum when i was very young i think around three uh she was in a car a car accident so it's a hit and run accident where she sustained a whiplash injury and so that then became uh very very chronic in lots of pain uh medication everything and i think the first time i really started to understand the impact of chronic pain and that's where my research is uh is focused at the moment is the impact of pain a lot of people doing a lot of work into the the

mechanisms and uh rating pain and treating pain but less so that the impact that it has and that's another area that i feel like we can we can do better with treating um and my experience with that is um my mom when i was very young my granddad was teaching me and my brother had to do a cartwheel and um I said mum you have a go and she said no I can't because my pain and that was the first time it struck me that um you know there's this pain not only you know it's not only mum uh just in pain at the end of a day and things like that is she's stopping doing things she can't do the things that she wants to do um and so yeah I guess that's why I've always had a bit of an interest in it um and then when this this project came along um it just seemed like it seemed like

a good fit that's awesome that's really great and so what because you transitioned from pain research to clinical work to treating people in pain but how did that all pan out for you it's tough yeah it's hard people are in pain the it's it's all well and good knowing uh all the science behind it and you can explain things 10 ways to sunday but you know you you have i think getting that the human side of it um is just as important as knowing all of the the research you have to be able to read people and um you know understand if the the talk that you're having with someone whether that's actually useful or not um and whether they're getting anything out of it and sometimes you see this you know this fog descend and then nothing else is going in

um and you might you might say the wrong thing and i've had someone say you can't say that to me and have to quickly very quickly backpedal um which isn't easy to hear as even a clinician right because there's a lot of you know oh my gosh am i doing am i helping or am i harming and and how do i kind of salvage that situation right oh absolutely and you've got to very quickly be able to identify those situations and as you say salvage it um and so i find if you if you lose someone, uh, for, for whatever reason, then it's, it's very, very difficult to come back from that. And so that was probably my biggest takeaway from transitioning from doing research to, uh, more of a clinical role, um, is that the people side, uh, is, is hard. It's very

hard. Most definitely. And so how did you get into, um, the, the topic of chronic pelvic pain in men? Um, so I was in my, in my undergrad and I knew I wanted to study. I, well, I wanted to teach. So, uh, in every job I've ever had, I've always ended up doing a bit of a teaching role and I love it. It's fantastic seeing that little light bulb go off and yeah, it's good. Um, and so I wanted to teach at a uni and in Australia, it's, um, very preferable to have a PhD to get a PhD You either have to have honors or a master's. So I wanted to do honors in my undergrad. I wanted to do something in pain, and I ended up speaking to the person

who ended up being my supervisor, Jane Chalmers, and she said, you know, there's this real niche in men's health physio, especially men in men's health physio because there aren't that many of us. um and so that's that became uh interesting for me i started to look into the literature a little bit more and realized that there's not very much it's all very very biomechanical and didn't fit with my understanding of pain pain science and uh sort of more of a biocircus social approach um and so i i felt like there was some work that i could do there and i felt like i could contribute um to to a field which needed it right no 100 and and i'm a huge advocate as you know for

you know being a voice um for for men who are experiencing pelvic pain because it is it is very different than experiencing pain elsewhere in your body uh it has much more meaning when we when we relate things to our genitals uh and our gender and our roles in society and what culturally is expected of us etc etc you know these conceptual constructs that are created um in our in our world and how we interact with them and so in your i guess in your research and your experience and maybe your own personal experience of you know how does chronic pelvic pain differ in men versus in in women and other kinds of chronic pain as well big question um packet we'll take we have all the time in the world

um so i think okay let's put it this way if we were to explain to an alien who who are you one of the first things we would say is probably i'm male and what makes me male i have a penis so it's one of those things that um most tightly ties to your identity and there's going to be a lot of generalization in this there's a lot of generalization whenever we're talking about anything gender it's not always going to apply to everybody it's a tricky messy area because humans are tricky and messy when something comes along that threatens that area as you said it feels very important it feels very dangerous to us um that combined with men are again broad generalization men are typically terrible at talking about this stuff we're not good at it

it's not something that we do we um you know whether that is something cultural whatever it is but we've been brought up that no big boys don't cry um we you know we have to grit and bear it be a strong tough man fan up which is just very silly everybody please stop it um it's okay to not be okay um and i think that that combined with um it's being a a problem in an area that is so tightly tied to that sense of being a man um it makes it hard to talk about which means that people delay going and speaking about it problem gets worse they start to feel worse and worse about it because it's a bigger problem feels more dangerous which starts this horrible vicious cycle of worsening mood psychological

symptoms and pain um so i think it's different from other kinds of chronic pain in men because it is tightly tied to your genitals and that is tightly tied to what makes you feel like you a lot of the time um and it's something that we don't talk about you know a lot of men we find that uh they don't they'll delay going and seeking medical support but they also won't tell their partner about it they won't tell their uh co-worker or their boss about it they can't explain why they need all this time off work they can't explain why their performance at work is declining because they can't concentrate because it's pain you know so they start to get all of these these knock-on effects from that cultural belief that we can't talk about it that men have

to be strong um so yeah i guess my personal thing into that and i don't think i've actually ever mentioned this to to anyone except my doctor um that i have actually you know i had uh and have continue to have um problems with chronic anal fissures which for anyone who doesn't know is a slight uh sort of uh tear um either the anterior posterior uh edge of your anus that is very painful on um on defecation it can be very itchy it's uh when you after you defecate it can hurt for a long time um sitting down which as a researcher primarily we sit down and do a lot to work that's that's an issue yeah it's a big issue um and so i've experienced it through that and you know i'm a clinician and a researcher in this area and you know this is the first time

i'm talking about it so it's that that shows the impact of this 100 and think can i just say thank you for being vulnerable with us here today that's not easy it's like it felt like the right time It felt like the right time. Of course, the In Your Pants podcast. We're talking about things in your pants. It's very fitting for that to happen right now. But no, 100% to have space, to feel safe, to have a space, to just feel vulnerable. And I think vulnerability is often overlooked. And as you're saying, the messages that are relayed to men and about men or male bodies is this this hegemonic masculinity of you know you should be a certain way dress a certain way act a certain way respond a certain way not show emotions and vulnerability that's not even

in my vocabulary absolutely yeah so i i have to i have to commend you and and just say you know thanks for for you know having vulnerability with us all because we all have that and we're humans as you're saying we're all humans and we're all in this together exactly and i think there's no better time than now for us to realize that we're all in this together oh gosh yeah yeah everyone is on lockdown i heard boris johnson has coronavirus you know it's the prince charles it's such a great equalizer at the moment yes i guess that's maybe one positive that can come out this awful situation that's happening right right there's no discrimination it's no we're all vulnerable to you know aging sickness death yeah sorry to be morbid i'm in your pants podcast but

it's true it's an appropriate conversation to have right now and it's a realization i think for all of us right now because it's so in our face exactly yeah so oh my gosh so tell tell me more about the the research that you've done so far in um chronic pelvic pain research for men let's talk about that okay happier topic i suppose um so the the main body of work that i've done at the moment is um through my through my honors honors degree um and in that we developed a questionnaire. I have a copy of it. And you can actually, if you go to my ResearchGate page, you can download a copy of that if you wanted to have a look at it or start using it. I'd love to hear what people think. That's great. I'll link it to the show notes, actually. Yeah. Okay, great.

Great. And so with that, what we did was we wanted, it's called the Male Pelvic Pain Impact questionnaire. And the idea of it is to assess the impacts of chronic pelvic pain, not how much pain they're in, not what symptoms they have, how does it impact your life? And is that important to know in terms of treating? And it might help to guide a subjective exam. It might help to guide treatment if nothing else is sort of working. So to do that, we try to think of looking at the literature and speaking to clinicians and things tried to think of as many different ways that it could that pelvic pain could impact someone's life as possible then we went and took that big list to um a lot of people a lot of men in who have pelvic pain so

big shout out to everyone who every any man who's listening to this who did participate in that research has made a huge difference so thank you um and so they helped we did sort of three or four rounds of surveys where we narrowed down, narrowed down, narrowed down until we got to a list of about 10, 10 or 15 top impacts, the way that cotton palette pen impacts someone's life. So they, if we want to list it. Absolutely. You read my mind. so the top 10 number one by far and away is mood and so i think in our first survey it was 98.5 percent of participants selected some impact within that mood category so to say that it impacts mood is a massive understatement and it's the first and biggest thing that it affects

so that's feelings of frustration it can be stress sadness fear helplessness as well then mental health was the next next category so feelings of anxiety and depression it affects libido and arousal if you imagine it's hurting down there you don't really feel like doing anything with it appropriate yeah which is completely a normal reaction right like 100 that's total that's absolutely normal that is your body doing the right thing you're in pain it doesn't it suppresses those functions um your ability to take part in physical activity so the things we've already talked about you know um you've got that constant nagging that's drawing your attention you don't want to do anything else and performance and anything else

you do start to suffer so that ties into the next one which is productivity at work at school home university i think the next one was a little bit surprising this is one that we didn't identify in our original list um and it's one that we actually got through feedback from patients in the first round and that is mistrust of health profession oh do tell more interesting right yes let's unpack that yeah so i i think where that's coming from actually can we come back to that i'll just go go through the others and then and then because i think we feel like we'll spend a lot of time on that we'll come back to that 100 um the next the next one is frequency of enjoyment of or ability to masturbate for the same reasons we've talked about um sexual satisfaction um so even men

that's suggesting to us that men are still trying to have sex but it's just not not working and it's not it's not the same um the next one is intimacy with a partner um again same sort of reasons and affecting their marriage and long-term relationships possibly to do with what i've already talked about in terms of communication and men feeling vulnerable and feeling like they're in a place where they can share what's what's happening um generally uh those those men that have told us that they've told their partner their partner has been really good about it so um which which makes sense absolutely okay so coming back to trust and health professionals so we had a list i think it was about 150 uh topics and so this wasn't one of them um

and we started getting a lot of comments um in our first survey so in our first survey we basically said does this apply to you yes or no uh is there anything that we've missed and so we would expect uh you know just just a couple of little words but people took that opportunity to tell their whole life story and so we ended up having to do a bit more of a sort of qualitative analysis on that um and it it turned out that something that people were saying a lot and were implying a lot was that they they didn't trust the medical community and the health community not i shouldn't say just medical but the health community in general a lot of people saying you know i've uh uh sorry my dog has just come to say hello um people people saying that

uh you know i've been put on antibiotics and i'm not sure why all my tests have come back negative and i'm on antibiotics and i'm getting all these horrible side effects do they even know what they're doing uh i'm getting got had people saying i'm going to pelvic floor physio it doesn't help doesn't do anything um and all it does is it's hurt i tried it for this this long and it doesn't help and people i think there was one quote where someone said this this disease is a joke and misunderstood people saying medical professionals gps urologists and physios should listen to us rather than just discounting us and referring us on to someone else.

And we found that I think we collected a lot of demographic data as well and we found that a lot of people were being diagnosed by physios and a lot of people were being diagnosed. So it was specialists and physios and then GPs. Those are the top three in that order. and so that tells us that specialists and physios a lot of the time people would have gone been referred to specialists and to physios they wouldn't have gone that presented there directly unless they happen to know a pelvic health physio or something like that you know there's not

something that's quite rare yeah exactly it's not at the front of people's minds it's not you know a lot of the time they don't know that we do right um and so you know you're having these situations where people are going and seeing many many health professionals and getting told the same thing i think whoever first said the phrase it's all in your head has a lot to answer for you know because that's how people feel whenever they're uh whenever they're they're being bounced around between between health professionals who can't find anything it's a they're being told to go away you're normal why why are you here and so i think that has bred a lot of mistrust because of the negative experiences they've had

and the amount of time they've spent with health professionals. That is huge. So as professionals, how do I unpack this? So the first thing when you started talking about when you left space for these men to share other comments, that was really important, it seemed like, for them to be able to tell their story. I just want to reiterate how important it is for us as humans, professionals, helping others

to really take the time to listen to someone's story, to genuinely be interested in what they have to say about the impacts of what they are going through in their life. I think that is huge. and that is so minimized well from my from my in my opinion i think that is minimized by a lot of professionals the power of just zipping your lip allowing the person to speak and that's therapy yeah be comfortable with that silence let let them you know a lot of the all of these guys i had a patient um who came in for shoulder pain and i've been seeing him for about six weeks and then he in one session he was saying i'm having a procedure on friday and then and just left it and then he kept on saying i'm having a procedure on friday so eventually i was like okay

what's the procedure what's happening talk to me he's clearly dying to tell me and he was ended up he was finding out that he was really scared because he was going in for a prostatectomy and he wanted to talk about it and wanted to know more, but it didn't want to, didn't want to bring it up. You know, even though he's already had that conversation is initiated care. It's still that reluctance to talk about it is so ingrained that even with someone he's been seeing for five weeks and I've had such a good rapport with him that it was still a tricky thing to tease out.

So I think, uh, I think you hit the nail on the head. We have to, uh, allow people the chance to talk. It's, it's validating for them aside from anything else. It makes our job easier. You know, we, we have all the information we, uh, that person knows that we have all the information. We have their buy-in speaking about, uh, being able to pump the brakes and backtrack. If something goes wrong, it's so much easier if that person trusts you and knows that you're on that slide and know that story. Right. Right. Yes. You're creating a safe container and you're allowing permission for the both of you to collaborate in this third space together and to navigate, right? I mean, right off the bat, you're creating that relationship of I'm here

to guide you. I'm here to coach you and to facilitate your journey. There's a sense of uncertainty as well. And I think as professionals, I think in general, humans are uncomfortable with uncertainty and leaning into uncertainty is challenging but that's the reality of it when we're working with like you said earlier being human is messy and tricky and that we need to transparency we need to put that on the table to say you know i know this is difficult for you i know that you're struggling with this and i'm here to to provide an offer and service to help you through this journey and we're going to help each other basically and and if we're not having that dialogue with our with the people in front of us then what are we doing

absolutely i mean if that's not on the forefront of everyone's mind treating these these kind of people um it should be let's say that it should be that should be you know you're almost your whole first session should just be zipping your lips and and listening right right well and i want to segue into something you said too that caught my attention which is i'm a huge uh this is a pet peeve of mine of i went to therapy and it was so it was painful why is why is that happening why are why are we treating pain with more pain can we have a discussion about that for a second why do we have to put a finger in the bum first of all like are we are we at all considering the person on the table that we're doing something to we this is not that's not a green light they

make an appointment to come in for us to do whatever we want absolutely we're violating that person's safety we're violating that consent to be like what do you what would you like to have happen? Are you comfortable with an internal examination? I mean, I'm speaking for, you know, the cisgendered male here who may or may not feel comfortable with certain procedures, right? I mean, we all know that the prostate exams, there's some reservations around that, right? Which have, you know, which now turns out after decades of doing it, it has very limited validity. right and so as therapists as physios i'm questioning what are we all doing in there when we're sticking a finger in the bump what are we looking for how are we what treat when we're

doing when we're helping someone what is it that we're doing and what is the outcome of that intervention like are we doing more harm than good and i think we really need to ask ourselves these questions yeah and we're trying to serve someone or help them through difficult situations because i feel like sometimes we might be taking steps in the back backward direction particularly if we're just creating more pain and discomfort and triggering those threat detection systems yeah do you know what i mean these people come in and you know they've reached a point where whatever is happening that they feel is happening to them right you know there's something happening to them and that has reached a point where that is more important than the social

standard of not going in and being vulnerable and talking to someone about your private parts yeah and so you need to the first thing that we need to be focusing on is de-escalate calm everything down um everything is is tight and sore and just is scary you you putting hands on is is is scary um and so we you're exactly right we need to be um making sure that you know if we need if we do need to do any sort of internal work i think this is where we just come back to the basics of our profession and inform consent you know the people need men me and women uh need to know what you're doing how it's going to help why it's important and what the alternatives are if they don't want to do that exactly and that can

be if they give permission that can be revoked at any time 100 you know that that is it's the basics of our profession. And that all comes back to communicating. We need to be able to have that rapport and say, look, I need to do something because I think this is going to give me a lot of information, which is going to help to take us that extra step that we haven't been able to get or something like that. Right. Absolutely. And I think just from your research, it sounds like as physios, and I know you're obviously doing this in your practice and I as well you know taking into consideration not just the biological but the psychological and social impacts that that has changed for that person because life as they

know it is different and if we're not addressing the emotional components in addition to that the the pain experience which is an inner world experience you know it's an inner problem it's it's a subjective experience. It's them, their experience that it's very hard to even just express, um, let alone, they're not even being validated for. So I think, you know, as a, as a physio, our roles should be more of how can we, how can we help this person find transformation within themselves? Uh, how can we give them back a sense of agency and autonomy and control a sense of control over the situation versus talking at them or doing things to them or blaming muscles and tissues or their trouble like trigger points don't get me started

said that word has a lot to answer for as well right right right exactly and and so again i think that that you know what can we as as clinicians do better when, when seeing this, when these men, and I think we touched upon some of this already, but I'd love to hear like, again, in your experience and you working in this field and doing research, um, you know, what can we do to help serve these men in a much better way? Cause we can always do things better. Yeah, absolutely. I think we have already touched on the first thing we need to do is is build rapport we need to have some level of trust where they're going to listen to what what you need to say um

and not only that but you know they come to a place where they can start they can start to talk about it and they can do some research and say hey what do you think about this susie um and you know have a person-to-person discussion and try and break down that therapist patient relationship so you're just two people working together to solve a problem you know in terms of i really like what you said about um they need to have control over it you know there's a lot of a lot of studies that show that when uh when someone feels like they can have some they can control their pain in some way whether that is do something immediately to make it better do something immediately to make it worse they have some agency over it then you know that the fear of

it decreased as well um and i think that just pause for a moment there was something really important that i was going to say i had something written down again I can't remember. Okay. So basically, to answer your question, what can we do be doing better as clinicians? I think the first thing that I think everyone does quite well is reassuring them. Actually, the thing that people do often, but not necessarily well, is reassuring them that, um, their pain is nothing dangerous. You know, so very often people are told there's nothing wrong. That's the wrong message. It's the right content, but it's the wrong way of

delivering it. You know, there, there is nothing, there are no serious pathologies. There's nothing underlying that everyone's missed. There is, uh, you know, there's, there's nothing that's going to, to necessarily get worse um i think that's that's an important message if it's followed up by here's what we think is happening so i think that second part of the explanation is something that is missing a lot of very valid point yeah not just leaving them you know high and dry of well there's nothing wrong so okay because they've been told that already exactly yeah you're no any better now there anything you want to do after this is going to be like and i think it's just if we we can do as much as we can to understand them um that that's the the main thing that that we can

be doing um and i think in terms of looking at today's current situation as as a equalizer again you know people are at home they're not being as productive uh they feel socially isolated and that's a great analog for what happening is happening with men with pelvic pain right imagine if that was just happening to you and nobody else believed you that that was happening to you that's how that's how these guys are feeling a lot of the time and so we need to break that down and say hey look i understand i get it i see what's happening this must be awful let's you know let's figure out why this is happening and try and work together for a solution. Um, and I think steering away from, uh, steering them away from their focus on the

symptoms and diagnosis and pathology, um, which is focused on, um, a lot, you know, in, in 90% of our, um, interactions with, with healthcare, there is a problem. Someone does some test and they find a problem and then they apply treatment and it works that breaks down in pelvic pain that does not happen you know because there are just there's too many structures all in the one place that may or may not be involved with the pain the pain you know it might be something else entirely it might be you know most of the time you find you find nothing wrong in in that place so we need to try shift focus away from symptoms and diagnosis and towards treatment. I think that's something that we can do a little bit better. And so what should, I think a plan or just generically,

and I know in an individual multimodal approach is typically best, but in general, what should, if a if a if a man is seeking help right because we know not every therapist has this knowledge or understanding or works in the way that we might right so what should that person be looking for when seeking help from health care professionals am i speaking to the men who are in pain here who haven't sought help yet yes or that have sought help that wasn't very helpful okay and there's you know they're just you know looking for something that's really going to to work with them to help make life bigger okay so i think the first thing isn't really answering your question but i think is an

important point the first thing that a lot of men do is go online and and look and look for help Um, all the actual medical information that's online so far is, uh, not great. It's very sort of biomedical focused on pathology, things like that. There aren't many great patient facing resources, which, which adequately explain what might be happening. Um, and so a lot of people then end up going to forums where a lot of men are experiencing the same thing. And these tend to be, uh, full of men who's, uh, typically, uh, quite far along down the

track, uh, have often understandably pretty negative viewpoints on this treatment didn't work. This treatment didn't work. Nothing has worked. Uh, I've been to this specialist, this kind of specialist, this pelvic floor physio, and it hasn't worked. Um, and then it's that kind of person combined with someone saying, I can cure your pelvic pain.com, um, who's then selling the, the chural treatment, um, and giving people false

hope a lot of the time. So I think that those forums are useful for a sense of connection, but I wouldn't be taking any medical advice from those forums because people who get better, don't go back to those forums. We never get our patients coming back once they're better. Once they're better, they stay away from us. Exactly. You don't hear from them and I'm checking in like, are you okay? Yeah, actually, I'm doing great. Okay, I'm just wondering. Exactly. And that's the same thing in these forums that a lot of guys turn to. So I think understanding that those forums typically represent the worst of the worst and are a

be all that helpful in the long run there are some good forums um i know carl monaghan uh it he runs some fantastic ones where it does it's very sort of evidence-based and it gets people who have recovered coming back and talking about their experience and that is generally a lot more helpful if you can find those sort of forms um and so what was the next what was the the question you asked me was which should men be looking for yeah when they're searching for a health professional to help them um navigate the situation i think finding one professional you feel like believes you even if they don't understand it if you have a good rapport with them and you can say something that and they will listen and they might go away and do some research

to find out more about it that's great that's you know that's half the battle right there if you're talking to a brick wall nobody's nobody's being helped and i think that don't write off an entire profession based on your experience with one person from that profession think about your daily life you know you have um good hairdressers and bad hairdressers you don't go to a hairdresser and have a bad experience and say don't go to a hairdresser it's awful right now it's the same thing with gps it's the same thing with specialists it's the same thing with pelvic floor physios the phrase pelvic floor physio doesn't work irks me a little bit and i get the frustration but um it's not the same you and me would treat

very differently and you're a patient who might be fantastic with you might fail uh i might fail them um and vice versa and vice versa yeah and so i think it's important that if you find something that doesn't work for you acknowledge that um early on um and especially if it's it's the person that doesn't work for you um this you know a lot of the time this pelvic pain develops over many months and years we had someone saying they've had pain for over 25 years um we have the majority of people in our in all our surveys have had pain for more than two years and i think it was about a third had pain for more than 10 years or something like that it's you know the amount of time these people are in pain is huge and i think that expecting that to

go to a clinician and that to disappear quickly is uh not not helpful so i think finding someone that you get along with that you feel comfortable being on a long journey with um is the most important thing even if they don't have all the facts and they don't know uh exactly what's happening they don't seem um to be you know as informed on the issue as you would like if it's someone you trust i think that is more much more important because that person is going to go and do that research and find someone who can help and put in good referrals and they're going to be you need someone to sort of be an advocate with you really i love that it's power with not power over i love it yeah that's really great well and i

if i wanted to kind of just circle it back around back to your own experience you know of what you've been going through um and this might be a personal question feel free not to to answer if you don't want to um but how how have you kind of worked with your own self with with during those difficult times or um you know when it is really uncomfortable like yeah you know what how how how yeah how have you worked with your own self i I have been a terrible patient why do I hear that from like every single health professional that I talk to I'm not I'm I'm a terrible patient I say that I say that as well so I'm gonna own it I'm gonna own

it okay but no we'll get we'll go into it now because I think it's important that people know that we have the same experience yes no we're not superhuman or anything right by any stretch um so my my experience um I had pain and and bleeding on on defecation for a long time I'm going to say more than a year um and to the point where my wife eventually said go get this looked at um and booked the appointment for me which again is a common thing that came up in our research you know it's the part of being the one driving it a lot of the time um and so i did and the i went to see my my gp who thought it was um probably anal fisher after doing a digital exam and then sent me to a specialist who did another digital exam came to

the same conclusion who then booked booked me in immediately for uh although there were no signs that it was anything sinister booked me in for um a colonoscopy uh plus or minus i forget what the term is but basically where they um they make an incision of the um external animal sphincter um, to loosen it. Uh, and this was, you know, it was, uh, a colonoscopy plus or minus this procedure as well. And I was like, hang on. No, no, no. I don't not, not okay with that. You know, we need to be, if, if you find something, I want to be consulted about it before we just go ahead and start cutting things down. Right. Going back to consent. yeah exactly yeah um and i actually didn't end up going and having it done

because i my symptoms started to subside with with just some advice um eat more fiber i think actually things like that and it started symptoms started to subside and it became not as important anymore and i think um a guy called craig allingham talks a lot about this um where you know if something men have these filters where how dangerous is something and how dangerous is it to me and although chronic anal fissures can be signs of of sinister pathologies as soon as symptoms started to subside it was no longer dangerous to me so back of my mind until it starts to reoccur and then i think oh i should really go do that again um and so it's you know i'm the classic male patient who's avoiding treatment based on

uh what i think is important to me and relevant to me at the time um so i should go and get it but in in terms of my my experience um i when i am having the flare-ups it is you know almost constant under most of the day there's either the itching or the pain and i don't want to walk for long distances if i sit and be completely still um usually it's okay um if i'm not completely still then if it's uh if it was niggling and it's very annoying um and yeah i guess that's that's my experience and i just start to eat more fiber again and wait for it to go away and yeah how do you work with that i think on a on a psychological level or mentally like because like i'm sure you know and i've had my experience as well you know speaking

vulnerability with um hemorrhoids and fissures as well and all that fun stuff that comes along with it and i'm just always curious to kind of tap into what goes on in someone's mind of like how do i work with that because it is uncomfortable and there's um figuratively and and um metaphorically speaking kind of sitting with it um you know as things change right because things do change but it's how do you work with that internally um and again i know this is a very deep question so feel free not to answer if you don't want and i'll completely omit it from here it's fine um look i think you know when you have it for a while and it's not going away and it's the

it is scary you know even though i know i've had it before what if this time's different and i start to look at those articles again start googling like crazy dr google it always tells you you have cancer right right um and uh it affects my productivity uh so i just in terms of working with it i just i do what i can and accept that it is going to make me a little less productive for a while but you know in the back of my mind i know that it's something that's going to go away but um every now and then i especially at the end of the day if i'm all alone less in the office i'll be googling um anal fissures and what to look for what are the signs and symptoms if it is something more sinister um and you find yourself doing that

you're aware of that you're mindful right of like our habits and our patterns that suck us in yeah that might not be helpful i mean short term might be helpful for sure because it's it's a it's a way of of doing something about it or taking action and having a behavior to support that uh but you know as you mentioned like if you're noticing you're going down a rabbit hole and and and and you have a shovel and that's all you got down there you're just gonna keep digging yeah you can't go out you can't get out anywhere that's a great analogy you just keep digging you know so um yeah and i think and and i'm and i'm so glad that you you shared that with all of us because we all have those experiences myself yours every human being has this is a normal thing

yes i'm normalizing these reactions and these feelings and the aversion to uncomfortable and unpleasant feelings and sensations and emotions these are all very normal things to be aware of and to experience because when you're aware of them you have choices at that point you're you're you have a choice what do i want to do with that right now it gives you control yes yeah yes full circle full circle yes i've never i mean i don't think that's ever happened on the in your pants podcast before so i'm super stoked that that happened um well on that note tom how can um listeners connect with you or health professionals for that matter i know we have some health professionals listening as well so what's the best way to reach you and connect with you

um you can either just email me thomas underscore astle at icloud.com um you can reach out to me on twitter i'm sure you can put my twitter handle in the in the show notes um i i post a lot of my my research uh on research gates and we are currently working on um another study we haven't published the the questionnaire yet because we're validating it so we're going through and making a lot of people fill it out um and uh we're going to look at you know if we think it does what we think it does um once we've got that data we're going to publish it but in the meantime we're putting a lot of preprints and things up on research gate so you can start to get a sneak peek at what's happening so i think right now there's the actual questionnaire up there on my

research research gate page and there's an abstract up on there as well so you can get a little bit of info about what we did in the study um awesome okay are you able to kind of sneak peek into what the new research is about or a topic uh we're still collecting still collecting data um and so it's on the same it's on the same survey um but we're just we're getting uh a lot of people to fill it out and we're looking at all the questions to see if um you know if questions are similar then we can remove one um and we're actually looking to it depends on how much data we get but we're i'm hoping to be able to see how it performs compared against um other questionnaires like the um chronic prostatitis symptom index which is used really commonly and things like

that so i think if we can get that data then we can say hey do these two things and it's going to give you this information that allows you to do this that's fantastic so i want to do stuff that people can can use there's a lot of research out there that um it's very cool and good knowledge um but isn't that applicable a lot of the time so i once you know i got into this because i found it's an area that i feel like some good work can be done that people can use and we can help people and that's what i want to do i want to do something that people can use right away oh that's so great and that's awesome thank you tom for all the work and that your team and all you guys are doing out there to help, you know, this patient population. And I mean, just really you're transforming

healthcare and you're really kind of transforming lives with all the work that you're doing. So thank you so much. Yes, no, a hundred percent. Thank you so much. And to all of our listeners out there, thank you for listening and supporting the podcast. As always in loving wellness for your pelvis this is dr suzy g signing off until next time my friends take care thanks for listening to today's episode be sure to head on over to drsuzyg.com where you can get more information show notes and related articles on today's topic also if you like what you're hearing head on over to itunes subscribe to the podcast and leave us a rating review we'd love to hear feedback thanks again