Everyday Medicine with Dr Luke

About Everyday Medicine with Dr Luke

Conversations with colleagues exploring their special interests in medicine and bringing to you Insights, ideas and advice for your medical practice.

Publisher

Dr Luke Crantock

Category

health & fitness

Language

en

Explicit

No

First episode

28 Aug 2020

Latest episode

5 Oct 2026

Latest episodes

213 episodes in the feed.

1. 

   5 Oct 2026

   Episode 195 - Pelvic Floor Physiotherapy in the Management of Colonic Dyssynergia with Varsha Bhikha

   Constipation is a very common clinical problem in our community, characterised by infrequent bowel motions or difficulty passing stool. It affects an estimated 24% of adults, with up to 18% of adults regularly using laxatives. Constipation may be secondary to slow colonic transit, pelvic dyssynergia, pelvic floor disorders associated with organ prolapse, or all of the above. Slow transit constipation or colonic inertia reflects an abnormally long length of time for waste material to pass through the colon. This contrasts with pelvic dyssynergia, also referred to as anismus or obstructed defaecation, which is a functional defaecation disorder in which the muscles involved in defaecation fail to coordinate properly. In pelvic dyssynergia, the anal sphincter and puborectalis muscle paradoxically contract or fail to relax adequately, resulting in difficulty evacuating stool. This is seen in 25–50% of patients with chronic constipation, is more common in women, and may overlap with features of irritable bowel syndrome. Pelvic floor physiotherapy helps target the root causes of bowel dysfunction associated with pelvic dyssynergia by restoring the coordination, strength and relaxation of pelvic muscles. It treats conditions like faecal incontinence, dyssynergic defecation and incomplete colon emptying by using muscle re-training, biofeedback and postural adjustments. Importantly, pelvic floor physiotherapy helps to reduce reliance on medication or surgery and can be highly effective, with rehabilitation and biofeedback therapies showing significant symptom improvement in a large majority of patients. Additionally, simple but highly effective adjustments are suggested to toilet mechanics, such as using a footstool to elevate the knees above the hips and leaning forward or backwards, which helps align the rectum and relax the pelvic floor. Further, incorporating breathing techniques with central core coordination by learning deep, diaphragmatic breathing and avoiding breath-holding helps to minimise dangerous downward pressure (straining) and relaxes the pelvic floor naturally. In our gastroenterology practice, we see pelvic floor physiotherapy and rehabilitation as essential partners in the management of the conditions discussed above. To take a deeper dive into this subject, we are joined by physiotherapist Varsha Bhikha. Varsha completed her Bachelor of Physiotherapy at Monash University in 2013 and then went on to complete a Post-Graduate Certificate in Pelvic Floor Physiotherapy in 2016. She has gained extensive experience in both Musculoskeletal and Pelvic Health Physiotherapy and works in both the maternity ward at Saint John of God Hospital Berwick and within private practice settings. Varsha also has a broad-based experience in treating women prenatally and postnatally and has further expertise in Clinical Pilates. Please welcome Varsha to the podcast. References: Varsha Bhikha (https://www.vigourphysiotherapy.com.au,/) www.gihealth.com.au (http://www.gihealth.com.au/) PubMed Central (https://pmc.ncbi.nlm.nih.gov/) Park et al., (2026). Biofeedback therapy and pelvic floor physical therapy in the treatment of constipation and fecal incontinence are very different in real-world practice. Neurogastroenterology & Motility, 38(8), e70412. https://doi.org/10.1111/nmo.70412 (https://doi.org/10.1111/nmo.70412)

2. 

   14 Sept 2026

   Episode 194 - Introduction to Diverticular Disease with Dr Asiri Arachchi

   Diverticular disease is both very common and largely asymptomatic. It is increasingly prevalent with age. Less than 10% of 40-year-olds have diverticulosis; however, the figure increases to 30–40% by age 60 years and 50–70% by age 80 years. It is more common in industrialised countries and associated with low fibre diets, obesity, sedentary lifestyle and smoking. NSAID use and corticosteroids are quoted to increase complication risk, such as bleeding and perforation. The natural history includes 70–80% of patients with diverticulosis remaining asymptomatic lifelong. Approximately 15–20% of patients eventually become symptomatic, but with uncomplicated diverticulitis that may be managed as an outpatient with bowel rest, analgesia and antibiotics. Some 12–15% of diverticulitis cases, however, will eventually become complicated and require hospital care with administration of intravenous antibiotic therapy and potentially surgical review. That is, overall, about 4–5% of patients with diverticulosis will eventually experience complicated diverticulitis during their lifetime, and of these, 3–5% will experience a diverticular bleed. Diverticulitis has a tendency to recur, and the recurrence rate for acute diverticulitis ranges between 16% and 35%, with roughly 20% of patients experiencing another episode within 5 to 10 years following their initial attack. The risk of future attacks increases if the first episode was complicated or if it occurred in patients under the age of 50 years. The risk increases with each flare-up. After a second episode, the recurrence rate jumps to roughly 55% over a 10-year period. Younger patients (typically under 50) and those with more complicated presentations tend to experience higher recurrence rates. Pips, seeds and nuts are irrelevant to episodic diverticulitis, although they have grown to occupy myth status in this regard. Major complications requiring hospital admission include acute diverticulitis warranting intravenous antibiotic therapy, pain management and bowel rest, abscess development, perforation, fistula development, bowel obstruction and peritonitis. Some acute diverticulitis events may be secondary to micro-perforation, with inflammation developing in and around diverticula. Such cases typically present with left lower quadrant pain, fever, raised inflammatory markers and altered bowel habit. Diverticular bleeding occurs with a ~3–5% lifetime risk and is usually painless, large-volume haematochezia. This is the most common cause of lower GI bleeding in older adults and is confronting for patients. Often, bleeding stops spontaneously (~70–80%), but with a recurrence rate of ~20–40%, which may require radiologically targeted embolisation or surgical intervention. Abscess formation occurs in ~15% of acute diverticulitis cases. Both frank perforation and peritonitis are less common. Other diverticular complications include fistula formation, with a frequency of about ~2–4%. The most common fistula is colovesical, presenting with pneumaturia, recurrent UTIs and faecaluria. Whilst most cases of acute complicated diverticulitis can be managed conservatively without surgery, I like to involve surgeons early in the hospital management of patients. For a deeper dive into this subject, we are joined by colorectal surgeon Asiri Arachchi, who is frequently called for his expert advice and intervention and provides an excellent service for both emergency and elective care across all colorectal pathologies in Southeast Melbourne. Asiri trained in high-volume colorectal units at Monash Health Victoria, Austin Health, North Shore Hospital Auckland and Christchurch Hospital, and is proficient in laparoscopic, open and robotic surgery. Please welcome Asiri to the podcast. References: Dr Asiri Arachchi: caseysurgicalgroup.com.au (https://caseysurgicalgroup.com.au/) Colorectal Surgery Australia and New Zealand Charity (crsanz.org ) PubMed Central  (https://pmc.ncbi.nlm.nih.gov/) NIH – Diverticular Disease  (https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis)

3. 

   24 Aug 2026

   Episode 193 - Colon Surveillance in Inflammatory Bowel Disease (IBD) with Dr Ali Eqbal

   Patients with ulcerative colitis (UC) and Crohn's disease (CD) involving the colon are at an elevated risk of developing colorectal cancer (CRC), secondary to long-term chronic mucosal inflammation. The level of risk depends primarily on disease duration, the extent of colonic involvement, and the presence and grade of precancerous cell changes (dysplasia) present. While most IBD patients never develop CRC, the risk, compared to the general population, is significantly higher. For ulcerative colitis, the cumulative risk is generally estimated as 1% to 2% at 10 years from diagnosis, 3% to 8% at 20 years since diagnosis, and 7% to 18% at 30 years' duration. The risk also depends on the severity and extent of the colitis. For patients with Crohn's colitis, a level of CRC risk similar to those with UC is noted when comparable extents of large intestine inflammation are involved. During colonoscopic surveillance of patients with IBD, dysplasia is looked for histologically, reflecting abnormal, precancerous cellular changes, and is categorised into low-grade (LGD) and high-grade (HGD) forms. Patients with LGD are approximately 3.5 times more likely to develop advanced neoplasia compared to those without dysplasia, in the absence of intervention. HGD is very dangerous. Approximately 40% of IBD patients with initial HGD findings on endoscopy will progress to colorectal cancer over a 15-year period if untreated. Risk magnifiers include disease duration of 8 years or longer, colitis activity, and extent of disease involvement, including colitis that extends beyond the rectum into the left side of the colon or involves the entire colon (pancolitis). Due to these risks, guidelines recommend starting surveillance colonoscopies 8 to 10 years after symptom onset. The gold standard technique for dysplasia detection at endoscopy involves the engagement of high-definition chromoendoscopy, followed by targeted biopsies of visible lesions rather than relying solely on random biopsies. Routine surveillance every 2 years helps identify dysplasia early, enabling proactive management and preventing progression to cancer. If PSC is diagnosed, annual colonic surveillance is recommended. To discuss this subject in further detail, we are joined by Dr Ali Eqbal. Ali has expertise in advanced colonic interventional endoscopy and inflammatory bowel disease. He completed a two-year advanced endoscopy fellowship at King's College Hospital, London, where he developed expertise in the diagnosis and management of complex colonic polyps using techniques including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). He also undertook a clinical research fellowship in complex IBD at the Austin Hospital in Melbourne. He is widely respected and recognised for his advanced technical skills and commitment to minimally invasive treatment options. He has published and presented both nationally and internationally. Please welcome Ali to the podcast. References Ali Eqbal (https://dralieqbal.com.au,/):  https://www.gihealth.com.au (https://www.gihealth.com.au/) Gastroenterological Society of Australia (GESA) (https://www.gesa.org.au/) NIH (https://www.nih.gov/) PubMed Central (PMC). Primary sclerosing cholangitis as an independent risk factor for colorectal cancer in the context of inflammatory bowel disease: A review of the literature. https://pmc.ncbi.nlm.nih.gov/articles/PMC4112886/

Who has been a guest on Everyday Medicine with Dr Luke

Names identified in recent episode analyses. Showing up to five guests.

• Dr David Canty
• Dr Maria Brosnan
• Anders Sorman-Nilsson
• Dr Ming Yii
• Dr Kiryu Yap

Reach and audience

Public platform figures. Ratings count people who left a rating, not total listeners.

Spotify

5.0 / 5

10 ratings

Podcast Authority Score: 53 / 100

A composite of feed quality, social presence, YouTube performance and engagement. Read the methodology.

Quality

74

Social presence

0

YouTube

0

Engagement

81

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