The Truth About Your Pelvic Floor (What Every Woman Should Know)

Welcome to the Dr. Ashley Show. I'm Dr. Ashley, and today I have a guest who is doing work that every woman needs to hear about. Whether you think it applies to you right now or not, it does. So the guest is Kim Vopni. She is known as the vagina coach. She is a certified fitness professional, a menopause support practitioner, a sought-after speaker, and the author of 3 books to date. She has spent over 15 years helping thousands of women take back their pelvic health at every stage of life, and she created what is known as the Buff Muff Method and membership to do it. Her oldest known member is 93 years old, and she talks about that today. If that doesn't tell you everything you need to know about who this work is for, I don't know what will. Kim, thank you for coming on the show. I've been really excited about this.

Yeah, likewise. Thanks so much for having me.

So you have helped thousands of women over the last 15 years under a name that most people can't even feel comfortable saying out loud. So I would love for you to share how you came about your name as The Vagina Coach. And if there was a moment in your life where you said, you know, I'm going to own this unapologetically. Tell me about that.

Yes, I know the exact moment. So I didn't start with that name. I sort of came into this world of pelvic health for women because of my own fear/fascination with pregnancy and childbirth. My mom had issues. I witnessed these issues, and I grew up thinking I'm never having kids because I don't want to have those issues. And then when I met my now husband, we decided we wanted to start a family. I was determined to have a different story, so I thought, well, I'll just have a cesarean section and that will protect my pelvic floor.

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And so that sort of was the start of the journey. And my midwives had recommended a biofeedback device to me from Germany called the EpiNo, which is supposed to— the biofeedback helps you reduce the risk of tearing, reduce the risk of episiotomy, which is where the name Epineo came from. So I used this, I had a great experience, and I thought, why doesn't everybody know about this? And I ended up becoming the distributor, and that was sort of the catalyst into this world of pelvic health. I didn't even know the term pelvic floor, to be honest, at the start. And as I was working, I, I had previously, in a previous life, been a personal trainer, and I ended up now recertifying applying fitness principles to the pelvic floor, working primarily with pregnant women and new moms. And I, I had also trained as a doula. So my handle or my brand at the time was Fitness Doula. And that was several years prenatal, postpartum. I started another company focused on postpartum recovery, all designed to help reduce the risks of pelvic floor dysfunction associated with pregnancy, childbirth, and postpartum recovery. Then I started to go through my own perimenopause journey, and that was now highlighting that there's this other chapter now we have to pay attention to the pelvic floor. And, and oh, and also then menopause and oh, in our third age. And so it was this, it's not just do your Kegels in pregnancy or here's how you recover postpartum. It's really this journey through all the life stages that we have. And I was speaking to a group of women entrepreneurs. This is about 9 or so years ago. I knew I needed a bit of a brand shift because I had started to transition to working more with perimenopause, menopause, people in that phase of life, and doula wasn't resonating so much. And so at this talk I was giving to a group of women entrepreneurs, my talk was how optimizing your pelvic health can make you a better mompreneur. It was the Mompreneur Conference. And I joked when I came on stage that, you know, like the other coaches who've been speaking, a marketing coach, a strategy and operations coach, I was I was a vagina coach. I said, so now you have a vagina coach for your business. And it was this little introductory joke, kind of icebreaker. And that was the light bulb. And I said, that's it. I'm gonna step into this word that nobody likes to say. Everybody hush-hushes it. And, and I did. And I remember I put a post on Instagram and I said, you know, fitness doula versus vagina coach, which one? And it was hands down vagina, vagina, vagina coach. And, uh, and that was great. I got the handle. However, it took me several years for me to be able to say the word vagina on Instagram because because— or even Facebook. Yeah, I had posts taken down. It was inappropriate. It was against their guidelines. And so that was a battle, but that just highlighted to me the importance of using that word because it's part of what contributes to the silent suffering that so many women go through.

Yeah, I think a lot of what you do is surrounded by hush-hush and silence. I mean, you work with a lot of people who are dealing with incontinence and prolapse, and I believe that a lot of women suffer with that in total silence. I would love for you to talk about that. What is it about these issues specifically that makes women just accept it, feel like they can't talk about it, and how do you come out and, you know, help people start to feel comfortable to ask, ask for help, really?

Yeah, it takes on average 6.5 to 7 years for a woman to seek help for their pelvic floor dysfunction, and part of that is because we, first of all, there's, there's a lot of shame and embarrassment and taboo, as we've both highlighted. Nobody even likes to say the word vagina, or if you do, it's often inappropriate. And then we have the lack of education. We've never been told anything about the pelvic floor. We've been told about our menstrual cycle. We've been told about sexual health, and usually that's how to not become pregnant or how not to get STDs. And that's really it. And so then when these issues start to show up, we might have heard through generations of, oh yeah, I can't jump on trampolines anymore. Oh, that's just what happens after you have babies, or what have you. And even people may hear those comments from their care providers. Well, what did you expect after you have kids? That's what happens when you reach menopause. That's part of aging. Then we see the media that tells us it's also quote unquote just part of being a woman, where we see these pad companies and they're, they're highlighting that this is something that we just need to accept, that you can still ride on the back of a motorcycle with a handsome man with your black wrinkly pad underwear that are supposed to somehow make you feel confident, which they play a role, but ideally those should be a temporary role. And I, and the illusion or the messaging that is sent is that you just have to put up with this, and here are these pads that you're going to have to wear for the rest of your life. So we get into this acceptance mode, and especially if we have then been dismissed by a care provider, or we have heard that, oh, what happened to my mom, or, oh, it's happened to my aunts, then we just sort of think, well, I guess that's just the way that it is. And I do my best to— obviously I use the word vagina, but I also use fun terms. My program is called Buff Muff. My podcast is Between Two Lips. I like to have fun with it because it is a heavy topic and we need to make it a little bit more accessible and have a little giggle around it while we're, while we're learning these things that ideally we should have been taught a long time ago.

Yeah, you know, you, you shared with us we're taught about menstrual cycle. I think the— what we're taught is just— no, it's so superficial. There's a great book if you want to learn more about menstrual cycle and you're listening to this called Wild Power by Alexandra Pope. Have you read that?

Yeah, great.

Uh, yeah, I mean, when my daughter comes to that age, I want her to feel empowered by what's happening because it is a really miraculous thing. And, I think us as women, if we can get in touch with it, can know so much more about ourselves and have such stronger intuition and, I don't know, connection with self and feel more safe in our bodies. And, that's what you're helping women do as well is feel safe in their bodies, be able to speak to this. So, you talk a lot about kegels and that kegels aren't the answer. I've always been told, I've had 3 children, I wish I had the Epi-No or No Epi, is that what it's called?

Yeah.

Yeah, because I went through that with 3 kids. I think I had a very strong pelvic floor from dancing for, you know, coming from being a professional ballet dancer for years, and I really struggled during labor for that reason. So I wish I learned that, but I had been told that I just needed to do Kegels to get everything back in order. Will you talk a little bit about why Kegels aren't necessarily the answer and what we should look to do instead?

I don't want to throw Kegels completely under the bus because they, they are a pelvic floor exercise. We do have literature to support that they can work when they're done correctly, when they're done consistently, and when they're done for the appropriate condition. What, what has happened is Kegels is just sort of the blanket cure for everything that falls under this pelvic floor dysfunction umbrella, which is, is it's not, that's not, we don't have one cure for anything. We have multiple different things that could potentially apply, and maybe it's a combo approach. So Kegels can play a role, I would say, more so for early stage pelvic organ prolapse and definitely for stress urinary incontinence. That being said, even with those two populations, I still wouldn't only do that. The limitation with Kegels is They are an isometric contraction. Well, there's a, there's a, I guess you can say a concentric contraction. There's a shortening and a lift that happens and then a hold. But we do that. Usually we hear, oh, when, when you're at the red light or while you're brushing your teeth or while you're watching TV. And we need to train the pelvic floor dynamically. That's what I consider to be a really strong missing link. And so we want the understanding of what a Kegel is, which is a voluntary activation, like squeeze, lift, and then release of the pelvic floor. The interpretation of Kegels is that it is just a squeeze. So part of the breakdown in the Kegel messaging is we've been— we hear about Kegels, we think it's the magic exercise. We've never really been evaluated to see, are we even doing them correctly, and is it appropriate for my pelvic floor. So we know from studies that the majority of women do them incorrectly. And if you're doing them incorrectly or if it's not the right exercise for you, things could potentially not get better or may even get worse. And then they think, oh, well, they're— they didn't work for me, so then I guess that's— I guess I'm out of luck. And they don't carry on. So they can— they have a role, and they have a role in the early training phase. I, I changed the terminology a little, not to take away from the fact I, I appreciate the work that Dr. Arnold Kegel did, but the interpretation again is missed. And the pelvic floor is the foundation of the core. It also works in synergy with our breathing diaphragm. And so I use the term core breath. That's my first foundational exercise to help people because core gets people in the door. When they think that's going to strengthen their core, they'll do it. And also that the breath is an important component of it. And once they understand and can repeatedly do the core breath, now we need to add in movement. We need to coordinate that as part of this whole body system that we have because leaking doesn't happen when we are standing brushing our teeth or when we're sitting at a red light. The heaviness from prolapse, all of those things usually show up when we're up and active during the day, when we're at the gym, when we're playing with our kids, when we cough, when we run across the street to catch the traffic light, you know. So we need to train the pelvic floor in moments or in exercise that mimics that, or even in those activities, so that the pelvic floor can respond appropriately with the right time, generate the appropriate amount of force, which when we just do Kegels— lift, squeeze, hold, let go— it sort of misses that mark. So I don't want to, again, completely say they're not effective. They are, they are, they play a role for sure, usually as an early education, and then we expand on that add it to movement, and then apply the fitness principles of progressive overload like we would do with any other muscle group. We need to— the muscles need to experience load, and that could be more sets, more repetitions, more weight, explosive power. The pelvic floor is a group of skeletal muscle, so it's going to respond to, uh, methods that we use for other parts of our body as well.

So we're talking about strengthening it just like we would strengthen a bicep muscle. What, what else comes into play? You know, my, my work is focused on metabolic health. And I know there's a lot more going on here than just strengthening a muscle. How do hormones— how are they connected in? What about stress, cortisol? What is happening in a woman's body when they are struggling with prolapse and incontinence rather than just the muscular piece?

Yeah, so the pelvic floor is a group of muscles, multiple layers of muscles. There's also ligaments, there's tendons, there's nerves, there's huge blood supply. It's not just one muscle that we need to either strengthen or not strengthen. It's a group of muscles and they're all doing their, their jobs of managing our continence, supporting our organs, managing core control and stability. Sexual response, acting like a sump pump, again, that diaphragm pelvic floor relationship. And so that's— that is what the pelvic floor is. It's the group of muscles closes off the base of the pelvis and it really manages— it trans— manages the transfer of load through the body. So when we cough, sneeze, pick things up, you know, we— the pelvic floor is managing those loads or should be. Strengthening is a term that's applied and we think if we're leaking, that must mean I'm weak or I have lax if my organs are shifting out of position, that must mean I'm weak or have laxity. So, we have this interpretation that strength means tight or, you know, and strong. But we can have tight, quote-unquote, like tight muscles that are weak. And tight muscles lack good blood flow or hinder good blood flow circulation. They are often not as responsive because they're always kind of guarding and on. So when we— you asked about stress and anxiety. When we experience stress in the body for many different reasons, our muscles will guard. Our nervous system kind of goes on high alert. We don't necessarily know we're actively contracting the pelvic floor muscles, but they get on high alert. They're contracted. And then if we need to cough or sneeze or the pelvic floor needs to react to something, it often is hindered in that response because they're fatigued because they've been on kind of guarding and contracting all the time. So, the role of stress and anxiety is huge because it can exacerbate symptoms. It can contribute to the muscles not working as well as we want them to. So, we need to decipher or decide what is, you know, do the nervous system regulation, but also then potentially release tension in that group of muscles. There can be laxity. So yes, we would want to strengthen, but again, strengthen can sometimes be releasing tension to allow the muscles to go through their range of motion. So there's a balance there between the, the effort and the ease. The interpretation again of Kegels is just squeeze and tighten, and that is supposed to make things stronger. But sometimes we need to let go of that first and then bring in the range of motion movement. From a hormone perspective, the menstrual cycle, postpartum, the menopause transition are all, um, associated with— well, the menstrual cycle, like, just before it starts is a low estrogen state. Postpartum, a low estrogen state. Postmenopause, low estrogen state. The status of our estrogen levels will— I don't want to say for every single person, but for the majority of people, We know upwards of 80% of women will experience one or more of the signs under the umbrella term genitourinary syndrome of menopause. There's also a term genitourinary syndrome of lactation. So the two mirror or mimic one another. They are low estrogen states that contribute to signs and symptoms like changes in the genital system, the urinary system, and our sexual system. And knowing that the role of estrogen to help offset that, to help manage some of those symptoms, even prevent those symptoms from happening in the first place, is an important consideration. But the overall balance of our thyroid, our hormones, is going to be also what keeps other systems working well. Constipation is a major contributor to pelvic floor dysfunction. Sometimes pelvic floor dysfunction can also contribute to constipation. And that could be from autoimmune conditions, from thyroid challenges, from hormone irregularity or imbalances as well. So it, it's a, it's a whole system and this is part of that system.

Do you recommend vaginal estradiol cream? Do you think that's important?

Yeah. And I, I recommend, so, uh, if anybody's not familiar, there was a recent removal of the black box warning label Initially, it was intended for, to my knowledge anyway, to be removed on vaginal estrogen. It ended up being removed from all estrogen products. The vaginal estrogen component, the, the label was applied to all estrogen, and what was on there was not medically accurate in terms of vaginal estrogen. With the lifting of that removal, it now hopefully will start to allow us to recover from the hangover that's been this last 20-plus years from the Women's Health Initiative that created a lot of fear around estrogen and hormone therapy.

Yeah.

Vaginal estrogen is safe, is, I argue, essential for all women from the start of their menopause for the rest of their life, sooner if symptoms indicate, and used even if you don't have those signs and symptoms yet when you start your menopause. We know upwards of 80% of women do. We also know that urosepsis from UTIs is one of the biggest contributors— like, UTIs is one of the biggest contributors to sepsis. It can be life-threatening when you have a UTI, and we know the risks of UTIs go up post-menopause. Vaginal estrogen helps keep the tissues supple and moist, juicy, good blood flow. It helps keep the pH of the vagina more acidic, which helps offset and prevents infection. When we don't have estrogen on board, the tissues become thinner and drier, less resilient, may contribute to dryness, itchy, burning, painful sex, increased risk of UTIs, increased risk of overall infection because the pH will change. And estrogen is the food for the the bacteria. We, we want to have one sort of predominant form of bacteria in the vagina compared to our gut health. We want to have a whole diversity, a whole bunch of different bacteria in the vagina. We want one, and, and estrogen is the food for that lactobacillus.

What is the one?

Lactobacillus. Okay, well, and you can get even more particular in that, but, um, but lactobacillus is the main, the main bacteria that we want.

So if I repeat back and understand what you're saying, the main— I don't know, the main cause of prolapse and incontinence is a low estrogen state, and it's one of the contributing factors.

I wouldn't say it's the main cause. It, it is more common, like prolapse becomes more— and, and incontinence more commonly diagnosed in that post-menopause phase, like as we age. But there's age-related muscle loss that's also playing a role. There's collagen loss, hyaluronic acid loss? Uh, what's the person's lifestyle been? Have they had a heavy lifting occupation? Have they been predominantly sedentary? What's their posture been like? Have they had chronic emphysema, chronic coughing? Um, have they given birth? Have they given birth multiple times? Have— like, so there's a lot of contributing factors. I wouldn't say, like, I can't really say there's ever been just one thing that is the cause. And a lot of people want to find that one thing. What is the reason I got this? And they search and search and search, and they— there's often a lot of blame or guilt associated with that. This is so common. 50% of women who've given birth have some degree of prolapse. People who've never given birth, never even been pregnant, can experience prolapse. Younger and younger people are also experiencing prolapse and incontinence, and there's many contributing factors, and it's not our fault.

Just so— okay, that's great. So then when hormones start to shift, it just increases the susceptibility, creates the environment that allows it to begin to or continue to propagate. So then, at what age should people consider the estradiol cream?

I usually say from the start of their menopause. So we know average age of menopause is around 51, but there are some people who will reach menopause sooner for surgical reasons or, um, medication, like they've gone into, into, um, medically induced menopause, or they may just simply have some of those symptoms earlier on in the perimenopause phase. So it's not a It's not a hard and fast rule, but I say generally around the start of your menopause, sooner if symptoms indicate. And it's something that we stay on for the rest of our life. It's not something we use just for a period of time and then everything's fixed. And that's sort of a message I like to hit home with about pelvic floor muscle training as well. We think of pelvic floor muscle training as something we only do if we experience incontinence or if we have pelvic organ prolapse. But when you, when you understand the roles that the pelvic floor is responsible for, when you understand that it is skeletal muscle, when we know the benefits of exercise on our muscle and how this helps us age and age well, reduce our fall risk, improve our balance, all the things, our metabolic health, our cognitive, heart, yada yada, the pelvic floor is part of that. And we, it deserves and needs and benefits from exercise along the way. And we can look at this— if we can shift the mindset, we look at this as something that would help us prevent or reduce the risks of these things happening. We also know that 46% of women stop exercising because of their pelvic floor. And so when we think about metabolic health and aging and diabetes and osteoporosis, I think a big contributor to the fact that we face those risks— yes, we know hormones play a big role in there, but I think it's also because we haven't been loading our bodies appropriately because we've been afraid to jump or lift, or maybe we've been told not to jump or lift. And one last thing I'll say there is there was a recent study that looked at pelvic floor muscle training with vaginal estrogen. And this was looking at a population of women with mild, moderate, and severe. So 3 different categories of what they termed vulvovaginal atrophy. The new term is GSM, genitourinary syndrome of menopause. And they had one group do Kegels alone. Kegels can help increase blood flow and circulation, which could potentially improve symptoms. And one that did Kegels plus vaginal estriol was the form of estrogen that they used. And that group fared better, especially in the moderate to severe categories. So highlighting that ideally we start a pelvic floor muscle training earlier in life, but it's never too late. And also then the benefits of the exercise helps basically deliver and helps improve the efficacy of the estriol as well, or the estrogen.

Okay, great. I have quite a few questions from all this.

It's good.

So, uh, when we talk about exercise, and let's say you do have a woman come to you who says that they're embarrassed to work out or exercise because they've been leaking, what do you tell these women? And are there any exercises they should really avoid? Are there ones that are better? What, what are your suggestions around that?

The first thing is I let them know that it's very common. It's not normal. It's not something they should accept. It, it's a signal that the body is sending, asking for something to change, asking for some help, and that it is very, very treatable, especially stress urinary incontinence. And exercise is the way to do that. So we have to, the first step is, is getting that connection to the core breath. So understanding that relationship between the diaphragm and the pelvic floor. So I use visualization, different postures or poses for people to get into where they can ideally feel the movement. A lot of people don't— they've never even really paid attention to their pelvic floor in that way. So understanding the relationship, shrink— teaching them the core breath, then starting to coordinate it into movement, then progressively loading it. And specifically with— if you think of runners or people who are doing more explosive activity, HIIT, CrossFit, HIIT classes. Those we know there's a higher risk. Those high-intensity exercises, more likely to experience incontinence, sometimes anal incontinence as well. So we need to come back to the basics, do the core breath, layer it into some movement, and then also build up to resistance and explosive. So jump squats or, you know, swinging weights or that type of thing. With, with regards to, is there good or bad or safe or unsafe exercises. I don't like to create a safe and unsafe list. I don't like using the word safe. I don't want people to be afraid of movement. What we need to do is explore, retrain the pelvic floor, but also explore what was your strategy in that exercise. Was maybe the time of day that you were doing it? What— did you maybe not sleep well? Did you not poop well today? Were you really stressed? Did you hold your breath? Did you bear down? So looking at what are some of the contributing factors that are maybe the reason why you experienced a leak or heaviness or pressure in that exercise, and then what could we change so that your pelvic floor can better manage it, or maybe there is another exercise that would be achieving the same goals but that would feel better in your body. So I wanna help people rather than they're fearing an exercise or saying that that one is bad, understand that there's variables you can change, understand that there's other exercises you could do that could potentially achieve the same goals that are more favorable for your pelvic floor in this current phase of life or what have you.

Are there any specific tools that you recommend? I know, I think it was after I had my third baby, I had some kind of tool that I utilized, like squeezed around. There was an app that like I was gamified. Are there any tools like that? That— yeah, Perifit.

Exactly.

I think I have it somewhere. I wasn't very consistent with it, obviously.

I tried a lot. Yeah. Um, first thing I recommend people do, and I recommend that people do this once a year, even if they have no symptoms, starting today, is go see a pelvic floor physical therapist. So especially if you have money to put to a device, I would take that money first and go see a pelvic floor physical therapist for an in-person evaluation assessment. It's a whole body assessment. Dr. Ashley Lucas, there will be a component that is a pelvic floor assessment, may not be on that very first visit, doesn't even have to happen at all, but these are physical therapists who have additional training in the pelvic floor. They are licensed to evaluate and treat beyond the opening of the vagina. With your consent, there would be a gloved, um, finger evaluation looking externally, looking internally, assessing for the position of the organs, the ability of the muscles to contract and relax, Are they balanced? Is there scar tissue that's hindering? Ideally have the therapist assess you in standing, because now we're upright against gravity and things change. So that is one thing I recommend all women do. I recommend we do that every single year, just like we go see the dentist once or twice a year for a checkup for our teeth. Go for a checkup even if you have no symptoms. Then after that, we have to get the foundational principles in place. So you're— you talk a lot about metabolic health. Now before we go directly to a medication or to you know, intervention, so to speak. We need to get the fundamentals in place— sleep, hydration, diet, that type of thing. So that's like the pelvic floor as well. We want the foundations in place. Are you pooping well? Are you sleeping well? Are you eating— sorry, are you drinking enough water? Have you eliminated bladder irritants? Are you consistently doing a pelvic floor, ideally a whole body pelvic floor exercise or fitness routine? And then after that, if we still need some additional help, those— we do have devices like the Perifit, like the LV, um, there's loads and loads and loads of devices. And while I'm grateful for those devices and for the technology, and there's new ones coming out on the market all the time, I never would put that ahead of a pelvic PT assessment. Not everybody can see a pelvic PT. Not everybody may be able to afford a pelvic PT. So the content I put out online and many other pelvic PTs put out online is a way to help you kind of self-assess and understand what to do as well. So devices play a role, not the first line of defense ideally. If it's something that would keep you motivated and keeps you engaged and keeps you consistent, by all means. But it still doesn't train the pelvic floor dynamically. You're usually lying in bed. And I like the gamification aspect. Biofeedback can be helpful, but it can also, if somebody was to squeeze their inner thighs or squeeze their glutes, it could also register as if there's, that's, that was a Kegel when it actually isn't. So having somebody evaluate that you're doing it correctly will also make sure that if you're using a device that you're using that in a way that's going to help you. Hmm.

Why is it so important to get a PT to take a look? Like what, what are they going to find there? If there's weakness, starting, or why? Why?

Yeah, they can pre-screen. We know that, um, again, 50% of women who've given birth have some degree of prolapse. Statistics are 30 to 40% of women experience incontinence, and those risks go up as we are aging. And if we can catch especially prolapse earlier, because we know early stage prolapse is often asymptomatic, If we can catch it earlier, we're in a position to definitely prevent it from getting worse, potentially improve it, sometimes even reverse it. When we leave it, when we don't know about it, and all of a sudden then people say, I, I just, I had a coughing fit, or I just went to the gym today and all of a sudden I, I felt this bulge, or I saw this bulge in the shower, I felt it while I washing, and that is very, uh, it's more advanced. It's very scary for people. People, a lot of people will think they've got a tumor of some sort. So when we catch it, when we can be more proactive and prevent it, we have more opportunity to, to intervene and prevent these from delaying us from, or taking us away from exercise, or a lot of people then avoid social outings. They will avoid, avoid intimacy. It just— there's a lot of breakdown of a lot of what we enjoy in life because of our pelvic floor. So we want to catch those early, make sure they don't become major problems. They're easier to fix when we find them earlier, also easier to prevent than to, to have to overcome them.

Will you talk to the signs and symptoms that people should be looking out for?

Yeah, with incontinence, the obvious one with stress incontinence— so stress incontinence is where we laugh, cough, sneeze, jump, we exert some sort of movement or cough, there's some, an increase in intra-abdominal pressure that the pelvic floor is not able to respond to. We can't close the openings off in time or with enough force, so we leak a bit of urine. So leaking urine is a, is a big one. Also urgency, urge incontinence, where we are We can manage a cough or a sneeze, but if I see a bathroom or if I think about the toilet or if, as I'm coming home and I'm putting my key in my door, all of a sudden I have to like race and run to the bathroom and I feel like I can't make it. Sometimes I leak. Sometimes I lose complete control of my bladder. So that would be urgency or urge incontinence. Frequency is feeling like you have to go all the time. Well, I just went 20 minutes ago. Why do I have to go again? And so you're planning your whole life around your bathroom. Or bathroom visits anywhere. And you often will say, I can't go there because there aren't bathrooms. And that's the limiting aspect of that urgency and frequency can also be trained. Meaning if we are always peeing just before every exercise class, peeing before we leave the house, peeing just, you know, partway through my walk because I'm afraid there's not going to be a bathroom If I keep walking further, we, we're training the bladder to signal when it's not actually full. So we start to create those problems as well. Then we can have anal incontinence. So leaking gas or stool, same principles can apply. That's much more life-altering for people. With prolapse, it can be, as I mentioned, early stage can be asymptomatic, or we may have symptoms that we don't necessarily associate and many people have never even heard the term prolapse. So low back pain is one. 95% of women with low back pain have some form of pelvic floor dysfunction. Painful intercourse, pain in and around the pelvic girdle, so pubic joint pain, tailbone pain, pain in our hips, pain with touch, pain with insertion, uh, pain without anything touching or It's just like a constant type of pain. Uh, there's different types of pelvic pain categories. Um, but sorry, but I kind of got off track there with prolapse. It could also be a sense of heaviness or pressure. People will say they feel like there's something in their vagina, or when they sit down, they feel like they're sitting on a golf ball. They might see or feel a bulge. Insertion. So that could be inserting a tampon, finger, toy. Menstrual cup, penis, that feels like they hit a wall or there feels like there's something in the way, or you may feel a sense of discomfort or, or pressure, difficulty emptying the bladder, difficulty emptying the bowels. Usually pressure, heaviness gets worse throughout the day. You feel like you want to sit down. You feel like you want to have kind of counter pressure against your perineum. Those are, are the more common prolapse symptoms. And, um, yeah, that, that kind of covers most of the, most of the more common ones.

Lots of fun things.

Lots of fun things.

Can we talk a little bit about the connection around weight loss? You know, I help people, women, men, but we're focused on women here, drop 30, 40, 80, 100+ pounds. Can you talk to what happens during weight loss? And the pelvic floor. You know, should women be addressing pelvic floor health at the same time as they're dropping weight? Should they focus on it after? What's the connection between the two?

Mm-hmm. When we carry excess weight on the body, um, and excess fat, whatever terminology we want to use, the excess weight is also excess weight that the pelvic floor is carrying and needing to manage. We know that when people have weight to lose, that weight loss can help significantly improve symptoms of pelvic floor dysfunction. We also know that during weight loss, and it can be dependent on how they're doing it, how fast it happens, there can also be muscle loss. And that muscle loss, again, because the pelvic floor is skeletal muscle, it can influence the pelvic floor as well. So in terms of, um, actually one more thing I'll say before I go on is, is the pelvic floor dysfunction could also be the limiting factor in the people being able to move in ways that could support their weight loss. So my bias, of course, is we should do it. I don't want to say always has to be— you can't start a weight loss program before you have your pelvic floor in check, but you definitely want to have your pelvic floor involved in that conversation. Ideally, as I said, I hope some— at some point in my lifetime that this is being taught in schools or however— I don't know what future education is going to look like with the way AI is moving, but we need this information much earlier in life. And I argue when we are learning about menstrual health and sexual health and our bodies, we should be learning about the pelvic floor and we should be told about pelvic PT. We should start seeing pelvic PT when we become sexually active. So it's not— I want it to be this, not an exercise that we wait to do only because we have symptoms. It needs to be part of our overall health and longevity plan. If we get to a point where we have become— we sedentary, inactive, have weight to lose, then again, we don't have to wait, start your pelvic floor first, then do your weight loss. It can be done together, but I absolutely think it needs to be part of the scenario.

Kim, will you teach us the core breath that you've been talking about? Is that possible to walk us through how we can start with that? And then tell us a little bit about the Buff Muff method. I do love that name.

Yeah, for sure. So the core breath, it— I do teach it usually in either a seated position or a lying down or a wide leg child's where you and I are both sitting right now. Some of the listeners may be sitting, so I invite you wherever you are to sit on— could be a hard surface chair, ideally not a couch or a really sort of fluffy pluff, um, plump type couch or chair, and sit in a way that would be what I would consider to be a neutral pelvis. So we wanna sit with our sit bones. So if you rock back and forth or if you pull the flesh of your butt cheek away, you should feel those bony points in your bum. You want those on the surface of the chair and you want your vulva on the surface of the chair, the, the sort of more the back part of the vulva. So your pubic joint, if you take your fingers and put them on your pubic joint and on your hip bones, the, the pubic joint and the hip bones would be in the same plane if we were to put a, like a block or a book in front of us. And we want the vulva and the two sit bones on the surface of the chair. There should be a gentle curve in your low back. And now ideally in this position where we have the rib cage a little more aligned over top of the pelvis to facilitate that diaphragm pelvic floor relationship. When we take a breath in, the ribs should expand ideally kind of 360 degrees, but a lot of people like the image of lateral expansion, like an umbrella opening. You could think about breathing into your bra strap. There should also be an expansion in the belly. So we wanna make sure we're not holding on to tension, like, thinking we're strengthening our core by, by keeping our abs on all day. We want our, our belly to soften when we take a breath in. And the pelvic floor also lengthens and expands on an inhalation ideally. So people may put their hands on the side of their ribs. They could put one hand on their ribs, one hand on their belly, and then invite the breath Laterally, invite an overflow into the belly, and then bring your attention to the surface of the chair where your vulva is. And when you take a breath in, can you feel or sense or imagine like your vulva is blossoming? Like your labia are like lungs that are inflating with that air. So that's what should happen on an inhale. The diaphragm flattens, draws air into the body. The belly should expand and the pelvic floor should expand. Then the exhalation, the opposite will happen. The pelvic floor contracts and lifts, the belly naturally draws in, and the diaphragm goes back up. So this is an inhale, this is an exhale, this is the pelvic floor, this is the diaphragm. For those who aren't— I have a hand on top and a hand on bottom, and I'm mimicking kind of like a jellyfish. Jellyfish is also a good cue for people. So now on the exhalation, I invite people to purse the lips on their face and blow as if you're blowing out a birthday candle or blowing through a straw. And that helps change the pressure and can help change that sensation. And then after you've patterned that for a few breaths, then when you exhale and purse the lips on your face, you're also going to— you could argue purse the lips in your vulva— and you're gonna pick up a blueberry. Imagine picking up a blueberry with your vagina and your anus, and then inhale and let the blueberry go. Or you could imagine as you exhale sipping a smoothie through a straw with your vagina. Inhale, let that go. You could imagine a jellyfish, as I mentioned, softly floating. And then when we exhale, the jellyfish propels up to the surface of the ocean. Inhale, it softens. So inhale, expand. We expand the ribs, soften the belly, blossom the vulva. Then we exhale, purse our lips, and imagine picking up a blueberry or sipping a smoothie or acting like a jellyfish propelling up to the surface. So that is those are the fundamentals, or those are the steps. You can go to my YouTube channel and put in— go to YouTube and put in Kim Vopni core breath, and you'll, you'll find that. It's an educational video. I'll give you the link to have in the show notes as well. And that's a good starting point. And sometimes that is all people need to start to improve their symptoms. Of course, I want them to take the next steps of bringing it into starting with like a pelvic tilt and a bridge, but then eventually doing it with squats or push-ups even your bicep curls. We can turn so many exercises into a, you know, a core exercise just by incorporating that voluntary activation and relaxation of the pelvic floor using the core breath.

That's great. So if people want to learn more about the Buff Muff Method beyond just this core breath, where can people go? Where can they follow you?

Yeah, buffmuff.com. That's B-U-F-F-M-U-F-F.com. That has the introductory program. I usually promo it for $17, so it's a very accessible but really comprehensive introductory program that people will— you can keep it for life, and there's workouts and exercises in there. If people want more support, I do have a membership community where they can come, and I have coaching and meal plans and a lot more workouts. And some people love that and want to need the support. Some people are happy doing it on their own, and there's also a lot of free content on my YouTube channel. So Um, so try to meet people where they are. I've also written a book called Your Pelvic Floor that you can get on Amazon and most major bookstores, and that's another way for people who don't— some people don't like learning online, don't like videos, they, they want to read it. So there's another resource for people as well.

Great. An age range of folks who you help, what is that?

The majority of people in my community are usually kind of late 40s till I'd say mid-70s is the most common. Okay. My oldest, my oldest known member is 93, and we have a few people in kind of like their 30s, 40s as well, but the majority are kind of in that perimenopause-menopause transition.

Great. And you're speaking in New York City. Will you share about that with us?

Yeah, it's in New York State actually. It's out close to Woodstock at a location called Menla, which is a retreat location, and it's it's, uh, I'm, I'm part of a team. It's not my retreat. I'm part of a, a group. Um, Annemarie McQueen from Hot Flash Inc. is one of the speakers. Uh, Dr. Ashley Lucas, uh, also one of the speakers, and myself. And it's very focused on perimenopause. Um, most, you know, sort of the 45 to 55 year age ranges is who it's targeting. It's, uh, 3 days, June 4th to 7th, covering all aspects emotional, physical, spiritual. Of course, I'm bringing in the pelvic health there into the physical side of things. The overall theme is kind of emotional well-being, emotional fitness, and how all of these other layers come in, especially during this very arguably tumultuous, a lot of change happening time of our life. And it's nice to have more information and, and guidance about that. So that, uh, that will be a really amazing time to learn. But also you can do one-on-one work with with the speakers as well.

Oh, that's really great. Awesome. Thank you for sharing. Thank you, Kim, for coming on the show. Um, this is really great information, and I hope that all of you watching this and listening will go check out all of Kim's work. So thank you so much for coming on. All right, you guys, I hope that this conversation opened your eyes. Please, if you are listening to this on a podcast platform, leave a review. And if you are watching this on YouTube, do not be shy and drop your question, comments below. We are here. I can reach out to Kim to help answer your questions. You know, pelvic floor health is not just a postpartum issue. You now know that as a result of this episode today. It is not just an aging issue. It is a woman's health issue, and it is never too late to do something about it. If you want to learn more about Kim and her Buff Muff Method, go check her out. I'll make sure that all of the links will either be in the show notes or in the description here. I'll make sure to include the links. You guys, your body is not failing you. Just like with everything else, it is asking for your attention. It is giving you a signal, and what you need is the right information, the right support to be able to give your body truly what it needs. Remember, you've got to step up to make the change. Lead with your heart, train your mind, and do not negotiate with your body. I'll see you next time.