#295 Pelvic Floor Help: Solutions for Incontinence, Prolapse, and Vaginal Health with Kim Vopni

The information provided in this podcast is educational and not intended to diagnose or treat medical conditions.

Dr. Donnie Wilson struggled for decades to solve her numerous health issues and heal her body. But with focused determination, she healed herself. And in doing so, she discovered the Dr. Donnie stress recovery protocol. On this show, you're going to hear from doctors, nutritionists, and Experts along with Dr. Donnie, who will give practical advice and wisdom to help heal your body. This is how humans heal.

Hi, and welcome to how humans heal. I'm Dr. Donni Wilson, and in today's episode, I'm really looking forward to introducing you to Kim Vapni. She's a certified fitness professional and menopause support practitioner. She's known as the vagina coach. So she helps women with their pelvic floor and pelvic health, vaginal health. And I'm so excited to get to talk about this with you, Kim. Thank you for coming.

I'm excited to be here. Thanks so much for having me.

Absolutely. What got you helping women in this way? Because you've been doing this for over 15 years, right?

Yeah, 21 years now. It's, you know, it's kind of crazy.

You're like, me. I mean, I've been helping women with their health for 25 years, and it's. It's a beautiful thing. Women need support with their health in general. Definitely with menopause and absolutely with the vagina. So as you and I do.

Yeah. And it's not something. I mean, I didn't grow up thinking, I want to be a vagina coach. Like, I want to specialize in the. I didn't even know the term pelvic floor. And so. But it stemmed from childbirth, indirectly. I saw a childbirth video when I was in sixth grade, and that really planted a seed of fear, but also a little bit of fascination. And so I was curious. I asked my mom. I look at her like, well, she gave birth to my brother and I and my aunts and my grandmas, you know, they've all done it and they're all still walking around, so it can't be that bad. But, boy, that. That video scare me. And so I kind of grew up with this, thinking that I would never have. And I made. I remember having a sticker album, and I had a sticker in there that proclaimed that I don't want a baby. Something like that. And that was. Everybody knew I wasn't gonna have kids. And then I grew up, met my now husband, was unsure if I was wanting to start a family or not with him, and he was aware of that. And but anyway, his, his brother in law or sorry, his brother and sister in law invited us, allowed us to witness their birth. And that was the first time I had seen anything that was different from what we typically see in the media, which is, you know, on your back and your knees, at your ears and somebody's count, having you hold your breath and count to 10 and screaming. Right? That's what you see.

What you see.

So, so that was very empowering for me. And I, I remember asking my sister in law, she didn't have any tearing and I was asking her the next day how she felt. And so it was a real turning point for me. And then the following year I was pregnant and I thought, okay, well I want to do everything that my sister in law did and even more so that I don't tear like my mom did or have an episode me, like my mom didn't have the issues that my mom had from postpartum. So that's kind of where it started. My midwives had recommended a product to me called the Epino, which Epino stands for no episiotomy. It's a product manufactured in Germany, inspired by women in Africa who use gourds of increasing size to prepare their pelvic floor for birth. And I thought, well, I'm a personal trainer, I'm a fitness professional. I embrace the philosophies of preparing for a physical event of which childbirth is definitely a very physical event. So I use this product. I had a great experience and I thought, well, why doesn't everybody use one of these? I asked if I could be a distributor in Canada, which is where I live. And my intention wasn't for it to be a business, to be honest. I just thought, I'll just have this as a little side thing and I'll sell it to my friends and other people and that will be that. Fast forward a couple years, I was doing this side thing. I was laid off from my full time job and I had started a bit of an E commerce like an online store for pelvic health as my side gig. And all of a sudden I was like, okay, well I guess I'm turning this into a business now. And as I said, that was like over 21 years ago. And originally I was working with pregnant women with the intention of educating them about the pelvic floor before they gave birth because we know that pregnancy and childbirth do quite a number on the pelvic floor. So that was my intention. And then I started to see that the postpartum recover aspect was very overlooked. So I was helping these people prepare, but then they were sprinting back to the gym. At a week or two weeks postpartum, there was no recovery that was even discussed. It just wasn't part of our culture discussed.

It's so unfortunate that women don't know that they can. They need to do pelvic floor recovery.

After they don't even think about it.

It's not part of our culture, baby. Yeah.

Yeah. So I started a second business called Belly Zinc. And we were wanting to take. We took inspiration from many other cultures around the world that really honor that postpartum recovery. The first 40 days, we manufactured our own postpartum wrap. We designed a postpartum recovery, very pelvic floor centric recovery exercise recovery program and juggled those two for a while. And then I started to go through my own perimenopause journey. So initially I was known as the fitness doula. I trained as a doula. I was a personal trainer, and I was working primarily with that population. Then I started to go through my own perimenopause and I started to have more people who had been following me over the years go through theirs. And this whole conversation around menopause was now starting to present itself. And I thought, well, holy, this is a whole other conversation, whole other part of life that we need to talk about the pelvic floor in. And so that's when I certified in menopause and learned more about that. And now really, the bulk of who I support is in that phase of life. I still have a few people in the prenatal postpartum phase, but most people have been pregnant at some point in their life. And usually that perimenopause post menopause phase is where if they've had any issues, they start to get worse, or if they haven't had any issues, they will start to show up during that time. It's a time where usually women are kind of fed up if they've been dealing with the, the symptoms. Now they're like, okay, it's time for me. My kids are grown. I've got more time. I have more money. Now. I'm going to prioritize myself. So I hope to kind flip that script a little bit, but that's, that's how it. And I, I was speaking to a group of women entrepreneurs one time and I, I joked it was all sort of. Every speaker was some sort of a business coach. And I joked that I was a vagina coach. And anyway, that's where that name came from. And that was about eight years ago.

It makes sense. And it's. It's so needed. I completely agree as a women's health expert and. And I was also a doula before I became a midwife. And it's so interesting to hear this, Kim, because I too, was so inspired by observing women in labor. It really led me to know that I wanted to help women as a midwife and through other phases of women's health. And so it is. It's a beautiful thing and to be able to support women in this way. And I love that. Your story and what you've shared. Thank you. To say, hey, this is, you know, it just very authentically was something you were drawn towards saying, hey, women need help with this, and there's not enough help out there. We can figure this out as women. We can figure out how to help women with pelvic floor and vaginal health. And you're so right that women like. We tend, first of all, not to talk about the vagina. We tend not to ask for help. Women, you know, women can go through a lot of pain and discomfort and not even know that there is someone to ask for help with the.

Exactly.

Vaginal health issues. And so I'm so glad that we're here saying, listen, if you're struggling, there's help. Right. What would you say when women contact you? What are some of the most common symptoms they're dealing with?

So they have. I would say the most common would be incontinence. So urinary issues. And that could be stress. Urinary incontinence, where they leak a little bit of urine with laugh, cough, sneeze, jump, exercise, that kind of thing. Urgency. So they feel sudden, overwhelming urges. They need to get to the bathroom, and they feel like they can't make it in time. They may lose a little bit of control of their bladder at that point, and that would be urge incontinence, feeling like they need to go to the bathroom all the time. So they feel like every 20 minutes they need to be in the bathroom. And then there's the anal or fecal incontinence side. So that's where gas or stool would leak out. Pelvic organ prolapse. This is statistically more common than incontinence, yet it's never, ever talked about. We typically hear a little bit of incontinence rhetoric in. In the media, usually saying it's just part of being a woman. But. But prolapse is something people have never heard about. Before. Yet it is more common than incontinence. 50% of women who've given birth will have some degree of prolapse. Prolapse is where the bladder, the uterus and or the rectum, sometimes the intestines shift out of their optimal anatomical position. They can start to bulge into or descend into the vagina. More common after pregnancy and childbirth. But there are many other contributing factors. And even somebody who's never been pregnant can experience incontinence or pelvic organ prolapse and or pelvic organ prolapse. So those are the two most common, incontinence and prolapse. And then there are also some people dealing with various types of pelvic pain. And that could be pain from very tight pelvic floor muscles, low back pain, pelvic girdle pain as well. Those would be the three most common. And to the point that you were saying earlier, women have this belief that suffering is just something that they need to deal with and they put up with a lot. Part of it. Because they think that's just the way that it is part of it because they don't even know that help exists. We just haven't been given appropriate information about our bodies to even know that what we're experiencing is common but also treatable and that we don't need to suffer with it.

Such a relief. Oh my gosh. Because women do they. And we, we suffer through menstrual cramps, usually. Women have. Sometimes they've been through menstrual cramps for years and heavy bleeding and then, then pregnancy and all the discomforts and postpartum and then into parent. There's a. That throughout women's lives there's all different factors that are going on with the pelvic floor. So I want to help people understand this term of the pelvic floor because like you're saying with a prolapse, I mean, if you think about it like the hip bones and the pelvic bones, it's almost like a bowl and the pelvic muscles are what's holding it together. But if, if they're weak, they're going to. It's going to fall through with gravity. Right. And pressure from above.

Right.

I want this. Have your explanation though, like, of what it tell us. What is that pelvic floor? And why is it so women can really visualize what, what is this? Because I think we also tend to like not even be looking at that part of our bodies or accepting that this is part of our bodies.

Right? Yeah. So I'm going to describe it. I'll also show for if any, if you have any video component to this. So this is a pelvis. This would be a female pelvis. Male, Female. You have a pelvic floor. A female pelvis is a little bit wider to accommodate childbirth. We have. So here's the pubic joint at the front. The two sit bones are the ischial tuberosities, which are on the side. So if you pull the flesh of your butt cheeks away, you'll feel a bit of a bone. Then at the base of our spine, we have our sacrum, the triangular bone, and it comes down to our coccyx or our tailbone. So the pubic joint, the coccyx, and the two sit bones form kind of like a diamond shape where the pelvic floor muscles attach. It's three different layers of muscle. There's multiple layers in the pelvic floor. It's not one muscle. And these muscles play a role in supporting the spine and pelvis. So because of the attachment points on the base of the spine and on our pelvis, they play a role in core stability, core control. The pelvic floor is the foundation of the core. The pelvic floor plays a role in managing the openings of. Sorry, have to point the right, right place. Urethra, vagina, anus. So the three openings, if you can see this, all the red here is all the, the multiple layers of the muscles. Here's the, the vulva, the pelvic floor. You mentioned the organ. So the pelvic floor also plays a role in supporting the organ. So here's how kind of like textbook the anatomy is the, the internal organ anatomy. Here's the bladder, here's the uterus, fallopian tubes, ovaries, vagina, rectum. There's the three openings that I pointed out, urethra, vagina, anus, and the pelvic floor is slung underneath. And when the organs are nestled into the pelvis, yes, the muscles play a role in support, but also our bony scaffolding. And so posturally, when we are in an optimal pelvic position from a posture like an optimal posture position, we also have support from the pubic joint here where the bladder rests. And then the uterus is on top when we have non optimal tucked pelvic position. Now we are relying on the muscles, ligaments, tendons, which, that's part of their job. But if we can utilize all the support mechanisms we have, we will fare better. And part of our ability to manage that pressure. You were Talking about from above, pressure from lifting, coughing, sneezing, laughing. We know from research the highest intra abdominal pressure actions. Coughing is one of the biggest. Coughing is really difficult for the pelvic floor to be able to manage that pressure. So we need an optimal pelvic position. We need muscles that people think we want tight muscles, but we want, I say supple. We want muscles that have a good range of motion, they can react quickly, they can react at the right time, generate enough force and also be at their optimal resting position so they're ready for that next increase in intra abdominal pressure. They need to be able to adapt to all the things that we're doing throughout the day. We have an interpretation that tight is strong and that we want a tight vagina because it's going to be better for our orgasm. It's going to be better for our partners to feel. It's going to mean that I don't leak or that I don't get prolapse. But tight muscles can't react at the right time, can't react quickly enough, can't generate enough force, don't have good blood flow. Circulation can create tension and pain. So strengthening the pelvic floor isn't about creating a tight pelvic floor or a tight vagina, which I think is a, is a really big myth that's out there. But typically the incontinence, prolapse, pelvic pain are the three more common buckets. And then understanding the anatomy that it's a group of muscles, that there's attachment points and bony scaffolding that we need to rely on as well. And that how we coordinate the pelvic floor with our diaphragm, our breathing muscle is really, really important from a core function perspective.

Amazing. Yeah. So realize, wow, if the now what do we know about like how over is it over time and as we age that the pelvic floor gets weaker and as the estrogen levels go down or why do you think that women are noticing it more and more as. As time goes by?

Yeah. Lots of different factors come into play there. The posture is one. So if we have spent a lot of time sitting, especially if we're sitting in a tucked position, if we spend a lot of time in shoes that have an elevated heel that contributes to shortening of the back sides of our legs, the hamstrings and the calves, which will pull our pelvis into more of a posterior tilt. If we have a chronic cough for some reason, emphysema, asthma, Covid, even short term coughing fits if we are a chronic heavy lifter. Now this doesn't mean that heavy lifting is bad for the pelvic floor. But if somebody had a heavy lifting occupation like carrying a big sack of mail, letter carriers, hospital workers, who for hours and hours, day on day, are lifting heavy, heavy loads, that can also be a contributing factor. Constipation is another one, having excess body fat. So obesity, higher bmi. I know there's, there's challenges with the bmi, but if there's excess weight on the pelvic floor that those muscles need to manage over time so that all can compound, then if you add a pregnancy or two or three, or however many pregnancies, potentially vaginal birth or cesarean birth, so cesareans can also interrupt or disrupt that core, that deep core system, then you also add on to that the fact that we are losing muscle mass as we age, we are losing bone mass as we age. I just showed you the model where we have the bony scaffolding, we have the group of muscles, skeletal muscle, just like the rest of our bodies. So we do face age related muscle loss called sarcopenia, in our pelvic floor as well. We also lose more. This is through the whole body, but important for the pelvic floor, we lose more type 2 muscle fibers. So type 2 muscle fibers are the ones that need to react quickly, kind of like the sprinter fibers. And when we think about incontinence, in particular, if we laugh, cough, sneeze, jump, and there's a quick sudden rise in intra abdominal pressure, we need the pelvic floor to be able to react quickly with enough force. And if we're losing more of those type 2 muscle fibers, we're losing our ability to react as quickly. We also are losing collagen, we're losing hyaluronic acid, and to top it all off, we're losing estrogen. So when we get to the phase of life, of perimenopause, menopause, we've had multiple years, multiple things. Maybe we've had car accidents in there, maybe we've had sexual trauma or any other type of trauma. Maybe we have fear and anxiety that's contributed or created tension. So many, many different factors. Then usually when we get to this phase of life, it's now compounding because of the muscle loss, the hyaluronic acid loss, the collagen and the estrogen loss.

And then it's like, no wonder there's going to be incontinence happening or discomfort happening. It's like, so please know it's nothing to be embarrassed about. Right. I think it's like, also something that women feel embarrassed is be like, oh, my go.

Oh, yeah, absolutely.

But it's nothing to be embarrassed about. This makes sense. This is a huge. This is like gravity. This is lots of different stress on your body in this one location. And this is something that most all. Would you say most women experience?

Yeah, most women have. Some. They will have experienced some sort of challenge with their pelvic floor. Some will experience all multiple things. Some will experience one. Some experience it from a younger age. Some don't experience it until maybe their 60s or 70s. But in my opinion, the majority of women will have some sort of challenge with their pelvic floor. And some are. Some of them are. I don't mean people. But some of the challenges are easier to kind of mask or just put up with. And there are others that can really halt women in their tracks. And it will hold them back from exercise, it will hold them back from intimacy. It will hold them back from committing to certain social outings. It'll hold them back from a lot of. And it's why I really believe the pelvic floor is so key to our longevity. To our. Our friend JJ version always says age powerfully. If the pelvic floor is not working optimally, we will not age as powerfully as we could if it was working optimally.

You're giving me goosebumps. Because it really is that. It's like the thing we're ignoring that's really is so important. And yes, I also, because as you know, I help so many women with high risk HPV and abnormal pap smears. And in that situation, we're thinking, oh, we're talking about a virus and how it can cause abnormal cells in the vaginal area, the cervix, and so on, even the vulva and the anal area. And as you're describing this, I can see how even when the structure is weakened and the blood flow is not as active, that that also can make women more susceptible to abnormal paps and activity from hpv. So I see that there's a crossover here that. That I'm looking forward to exploring more with you. You know, like, how. How is it that, you know, really when women are experiencing an abnormal pap smear? As a practitioner, we should. I should be asking, how is your pelvic floor? Do you have incontinence? Do you need some pelvic floor physical therapy that will also help you fend off hpv? Because it's got to be related.

Don't you think thousand percent, thousand percent. And I, I say that all the time, that pelvic health is a vital sign, or it should be. We should be, care providers should be asking about, are you pooping? Well, like, not just pooping daily because some people poop rabbit pellets, but are you having a good Bristol stool chart number four. Poop every day or multiple times a day? Do you strain at all? Are you experiencing any challenges with your bladder? Sometimes when you pose it that way it can be a little bit easier for somebody to hear. Some people, though, will hear that and go, oh no, no, I'm fine. They don't maybe associate leaking with their bladder or, or that they have something wrong with them. So it's important to ask questions very directly without hushing, without saying, sorry, this is going to be embarrassing. Just stand in the position of empowerment to say, do you leak when you laugh or cough or sneeze? Do you feel like you can't make it to the bathroom in time? Do you struggle with bowel movements? Do you have any painful sensations during sexual activity? With or without a partner? Are you able to achieve orgasm? Do you have low back pain? These are all questions that probably nobody has ever been asked before. And initially, depending on the relationship you have, some people may not initially feel comfortable asking those. But it's important for us to maybe even explain why I'm asking. I'm asking this because did you know 95% of women with low back pain have some form of pelvic floor assumption? Did you know that 50% of women have some degree of pelvic organ prolapse? And these are treatable conditions? Did you know that it's not normal to leak urine when you laugh, cough, sneeze, and if you say that and then they're like, really? I didn't know that. And then they may start to open up a little bit more. But I think that knowing from another study, 46% of women stop exercising because of their pelvic floor. And the vast majority of these people were younger, like 30ish. So if we think about how important it is, especially around that time of life, even earlier, to be building our bones, to be putting on muscle mass and they stop doing what is going to help them do that. Our risks are already increased. Risks of osteoporosis are going to be higher. Our already increased risks of heart disease, diabetes, cardiovascular disease are going to be higher. So we need to ensure that women are not holding themselves back from exercise or from other activities, sexual activities, social activity, because of their pelvic floor and know that most of what you're dealing with, if not all of what you're dealing with, is very, very, very treatable.

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Yeah, yeah. So I'll start with the pelvic floor physical therapy side. So this, these are people who have gone to school, they are trained, licensed physical therapists. Physiotherapy is. Is the nomenclature in Canada or, you know, in Australia. So it's physical therapy or physiotherapy. And they. Then some people will take additional training in the pelvic floor and they will then become licensed to do internal evaluations of the pelvic floor. So they really are taking the principles of pelvic. Sorry, of physical therapy applying to the pelvis. So you might search for a pelvic floor physical therapist or you might search for a women's health physical therapist. Or like those are the two most common that I would say. Or even just pelvic physical therapy. And these people you can Google, you can use the American Physical Therapy association website, you could use the Canadian Physiotherapy association website. You could go to pelvic guru.com. this has a listing of pelvic health professionals, not just pelvic pts, but personal trainers, doctors, nurse practitioners, people who have specialized training in the pelvic floor. So you can put in where you live in the world and see if anybody comes up, that list is a paid list, so not everybody will show up. I always recommend you start with Google and go see one. And I recommend women see a pelvic floor physical therapist once a year, even if they have no symptoms. Especially if they do. But even if you have no symptoms, go and see them for a checkup. Just like we go to the dentist for a checkup of our oral health, we need to do the same thing for our pelvic floor. And we just have not been taught that it's not been part of our culture. And the more we start talking about it, one day down the road, it will just be normal that we, from the time we're sexually active, we see a pelvic PT once a year for a checkup, just to keep things in check, to keep things functioning well. And part of then that's.

So I love this idea. Like, definitely. Right. Like I'm gonna telling women, you got to go in and just get checked.

Yeah. It's the most underused women's health resource we have, in my opinion. So what then? Like, when we go to the dentist, our home care, what helps us prevent cavities and gum recession and all that is our oral health care, which is brushing, flossing, you know, oral health care, using the appropriate toothbrush, what have you. So our home pelvic care is pelvic floor muscle training or pelvic floor exercise. And people probably have heard of the term Kegel exercises. Kegels are basically a voluntary contract, like activation of the pelvic floor and relaxation. The interpretation of what a kegel is is just a squeeze. So a lot of people squeeze their inner thighs. They squeeze their butt cheeks. Sometimes they hold their breath and bear down. So we know from research that most people do Kegels incorrectly, but it's not their fault. We've just never been taught. We might have been given a pamphlet or we've read online. It's the muscles that you use to stop the flow of urine. Okay. That can be helpful for some people, but it doesn't really ensure that you're doing a proper Kegel exercise.

And when the muscles are weak, you can't really feel them. So it's. When you're first starting off, it's hard to tell that you're using the right muscles.

Yeah. And I want to just add in weak. When we think of weak, we think lax, but really tight is also weak.

So if they're overly tight.

Exactly.

Either way.

Exactly. If you're already tight, there's not much room to squeeze. If you're really lax and there's not a lot of activation, it's going to be difficult as well. So if you don't feel it, it doesn't mean that you're really lax. Could mean that you're really tight, or it could mean that you're right. So you have to have somebody help you understand what's happening with your pelvic floor. And that's what the PTs do. They're in person. They look at your posture, they look at your breath, they look at how you move. With your consent, not always. On the first appointment, they will use a gloved finger to do an external check of your vulva. All the skin around, they will feel for touch if there's any pain. And with your consent, they will insert a finger potentially too, to feel tone, feel your ability to do a Kegel, feel the position of organs, see if there's any descent with bearing down. They will often assess you in standing as well, because being upright against gravity is different than lying on a treatment table. So it's a very, very comprehensive appointment. And people come out of that and they think, oh my gosh, how have I lived 30 years, 40, 60, however many years, and I've never known this about, about my body? So then that's what happens at the pt. That's like having the assessment of your mouth by your dentist or your dental hygienist. And then when we are at home, we need to do the pelvic floor. Muscle training and Kegel exercises are, in my opinion, a great start, but they are limited because we need to train the pelvic floor with fitness principles. We need to train the pelvic floor dynamically. And if you are doing Kegels, like if you have a Kegel practice and you're doing them correctly, usually it's like, oh, I do them at every red light, I do them when I brush my teeth, I do them when I'm lying on the floor watching TV at night. Okay, better than nothing. But if you're leaking at the gym, if you leak when you run across the street at a traffic light, if you, when you pick up your grandkids, notice you feel some heaviness or pressure sitting at every red light or sitting on the floor at night and doing some Kegels is not necessarily going to translate to you managing that, that pressure in that moment of a dynamic, quick reaction type activity. Does that make sense? So buff muff really is taking fitness principles and applying them to the pelvic floor, optimizing posture Coordinating the breath with the pelvic floor. Adding in different cues that allow people to connect with the part of the body we can't see. Because these muscles are inside, we can't flex them. Like we do our bicep in the mirror and then layer it into movements like squats, like lunges, like push ups, like bicep curls, like squat jumps. We need to train for strength, endurance, power. We need to stretch and release just like we do the rest of the muscles in our body. So that's kind of the foundation of what the buff muff method is.

That makes so much sense. That makes so much sense because it's like saying, okay, the Kegels are good, but that's like just the tip of the iceberg. We gotta like, if we really want to be going for longevity and, and health of the pelvic floor, then we need to be really getting our fitness. Just like you have a core workout or a leg workout or an arm workout, you need your pelvic floor workout, which is the buff method.

Yeah. And I want it to be, I don't want the buff muff method to be just another thing on our already really long to do list. So what my intention is and what I take people through is yes, you need an initial one to two weeks to kind of learn the philosophies, learn the foundation. But then I'm teaching you how to layer it into either the workouts that I do or your already existing Pilates or yoga or resistance training workouts so that it's just part of already what you're doing, or if you're not doing any exercise and it becomes your workout, that is also going to help you with your bones, it's also going to help you with your heart, that type of thing. So I don't want it to be an addition to what people are already doing because then they're not going to do it. They already, they're like, I've got too much on my list and I'm just, I can't do anything else. So I want it to be something that is education, it's informative, it's empowering. And it, when you put these principles into practice, people notice quick wins. Like within a week to two weeks, people can notice a drastic reduction in their symptoms. And then that's now going to be motivating. And I want people to like, if you think about from a menopause, the explosion of the menopause conversation has been extraordinary. So beneficial. Finally, we're, we're, we're getting the information we deserve and what's happened indirectly is pelvic health is being talked about because of genitourinary syndrome of menopause, which really a lot of everything we've talked about here, it falls under that bracket. But what we're told in if you're on social media, everyone's saying lift heavy, do high intensity resistance training, which I totally agree with those things. But there's a lot of women who either have, as we know from that study, they are not exercising because they have symptoms during the those exercises, or maybe they've been told don't do those exercises. Many care providers, uninformed care providers will say, oh, you can't jump or run if you have prolapse. Oh, it's if you're leaking that, stop doing that activity. Instead of saying, let's get your pelvic floor in check, apply the principles of fitness of progressive overload and get you to the point where you can. So heavy lifting and resistance training and impact, yeah, we need to do all those things, but we aren't going to start with the heaviest load. We're not going to start with the highest intensity activity. We have to establish that foundation first and then build upon it. And in my world, that foundation is the pelvic floor.

It makes so much sense. So if you've not been exercising and you've really been wanting to, then start with strengthening your pelvic floor and you can. And we're going to have the link to the buff muff method. So definitely look down in the podcast notes below and you can always go to vaginacoat coach.com to find Kim as well. But start there and then, then you, you've really literally built a foundation to then build on other workouts and.

Right.

Yeah, you mentioned. We both, I think, mentioned estrogen a little bit to me as I'm thinking about like especially the menopause situation, that that's such a key piece of this because. And again, like you said, the conversation is really changing. For over 20 years, women were told to not use estrogen. And as a naturopathic doctor and women's health expert, I was trained in bioidentical hormone replacement therapy in the 90s. So I've been helping women with bioidentical hormones and natural estrogens all these years, and now finally the researchers are saying, oh, we were wrong, it wasn't the estrogen was the problem. Actually, women really need vaginal estrogen. And so I want to take this chance to say yes. I mean, I talk about use of Vaginal estrogen to help prevent HPV and cervical cancer and vaginal cancer. But it's also huge. I would think that women postmenopausally, if we're trying to strengthen the pelvic floor, seems to me that estrogen is going to really help out.

Thousand percent. Yeah, it's going to help with the. So gsm, genitourinary syndrome and menopause. We have genital symptoms, signs and symptoms. So that could be dry thinning tissue, changes to our labia, the appearance, the clitoral hood can adhese over top of the clitoris. So we have visible changes. We also have sensory changes where we may experience things. Touching our skin may now be irritating. We may even have some bleeding with touch or intercourse. Sexual changes. So yes, potentially painful sex. And that could be because of tight pelvic floor muscles, it could be because of low estrogen, it could be because of scar tissue, it can be from many things. So we have to kind of get to the root there as well. And then we have the urinary piece as well. We've talked about urgency, frequency, stress, incontinence. So all of that is under this umbrella term of gsm, of which the hallmark of that is low estrogen. Now, it's not just, not just low estrogen, but usually that's the straw that kind of breaks the camel's back. And it's, as we said before, a culmination of many different things that have led us to that point. And now we have the estrogen that's kind of exacerbating things. But estrogen is also going to be what helps keep the PH of the vagina in the acidic phase, which we need. It's going to help with blood flow, it's going to help with the appropriate bacteria, it's going to help prevent UTIs and as you were mentioning, from an HPV perspective. So I recommend people, as soon as they reach their menopause, sooner if they have symptoms, but as soon as you reach your menopause again, don't wait until you have symptoms. We know that upwards of 80% of women are going to be dealing with GSM, usually in the 6 to 10 years post menopause is when it starts to really, really present itself. So don't wait, intervene early and just. And be proactive and be preventative. And the other piece of that too, just to bring in the exercise component again, there was a piece of research recently that looked at two groups dealing with. I have to. Actually, I've got three studies in my head and I need to make sure. I believe it was vulval vaginal atrophy. So, so kind of the GSM category of symptoms. And they looked at. Actually, no, I think this was an incontinence perspective, this study. Sorry, I'm kind of on the map. I, I'll, I'll provide the link so that people can read these, these pieces of research literature. But Kegel group and then a Kegel plus vaginal estrogen, in that case, they were using estriol as the form of estrogen. The group that used Kegels pelvic floor muscle training and estrogen fared better. And we can kind of make an assumption that the. Yes, we're getting the benefits of the estrogen, but we're also getting the benefits of the exercise that is helping deliver the estrogen with that blood flow and circulation. So it's, it's kind of like creatine. People are all being told not to take creatine. Well, you need the stimulus of the exercise to help get the creatine to where we need it to go. So the two really are so like peanut butter and jelly. Better, better together.

It makes so much sense to me. And I, and I really love that you're encouraging women too to say, hey, like when, if you're right at that, even if you're like just leading up to your last period, or as soon as you're like, oh my gosh, it's been six months since I had a period or if you started notice you got a bladder infection or vaginal infection. To me, those are some of the first things I hear from patients like, oh, I got a bladder infection out of nowhere. I'm like, oh, you probably need estrogen. And also women who are in their.

70S, 80s, like never too late, never too late.

It's never too late and it's never too early. Would you say with this? Basically, even if you're in your 70s and 80s, you can jump in and start now, thousand percent. And if you're in your 30s and you've just had a baby, like start now, like start anytime.

There's a, there's a newer term or coined term, genitourinary syndrome of lactation. So after people have given birth, they're in that breastfeeding lactation phase. We are in a low estrogen phase that is mimicking that post menopause phase. The difference is typically we come out of that in that post. In the lactation period, our hormones will regulate, go back to our kind of regular cycles. When we reach our menopause we now no longer are cycling and we will be in that low estrogen state unless we are using some sort of support with vaginal estrogen, potentially systemic estrogen as well, and another hormone therapy. I don't want to just say estrogen, but specific to the vagina gold standard would be estrogen, vaginal dhea. It could be an and or situation in there as well. So potentially somebody using both or just using DHA or just using estrogen, also potentially using two types of estrogen, estradiol and estriol, because we have both types of receptors in the, in the vagina. So there's lots of nuance in there. There's no exact prescription. The general protocol for vaginal estrogen is twice a week. I like a cream because a cream can go inside and outside. We need to make sure we care for the external tissues as well. And sometimes a tablet inserted in the vagina doesn't necessarily trickle down quite enough. Some people use a tablet inside and a cream outside. So there's lots of ways that we can individualize or personalize based on a person's unique needs. But as a kind of blanket, I think every woman would benefit from vaginal estrogen from the start of menopause for the rest of their life.

Yeah, I completely agree on it and there's a lot we could go into. So if you have questions, if this is new information for you, then definitely reach out because this is something that I help women with in my practice and help figure out what is the best solution for you. And we might start with estriol and we might then decide, do we need to add dhea, do we need to add hyaluronic acid, These are other things. And even add red light therapy. Have you worked also with red light therapy?

Oh yeah, I'm a huge fan. So back in the day, before red light was cool, like it probably when I had my E Commerce store, this is going to be, I don't know, 14, I can't remember exactly, but 14ish years ago, this company called Joy Lux approached me and said, hey, we have this, this red light therapy wand for the pelvic. Would you want to be a distributor in Canada? And I was like, I was very skeptical as I'm thinking, you know, this is something that people are going to insert in their vagina. I have to know all of the science before I say yes to this. So I did a deep dive. They were very generous with the research they provided and I became the Canadian distributor for Joylux. Back in the day, when I had my E Commerce store. So I've been a fan of red light therapy specific to the vagina for a long time and think it is. I love red light for many reasons in the body, but specific to the vulva and vagina. It's in addition to all the other things that we do and specific to the the two wands that I recommend, there's Joylex and there's one from a company called Fringe. They both have red light, they both have infrared heat, they both have vibration, all of which play a role in helping support the tissues, helping encourage blood flow and circulation, helping with with collagen, also helping with. You could do your pelvic floor muscle activation in the presence of vibration to heighten it. You could also have the vibration on but not do any pelvic floor muscle activation. And that can actually help elicit relaxation responses. So people who tend or kind of lean towards the tight or hypertonic pelvic floor may benefit from just having the vibration help relax the muscles. So they're so multipurpose. So many benefits. I don't recommend a ton of devices, but that one I love and will recommend to absolutely everybody.

Thank you for talking about that. And I do as well. We talk about it with helping with HPV and prevention of cancers caused by hpv. So I'll put a link for that below as well for anyone who's interested. And and I just wanted to just quickly clarify that when we talk about hormone replacement therapy there's I think this is a common, as you said, common myths or misconceptions is when we talk about hormone replacement therapy for your whole body, we talk about estrogen and progesterone like estradiol and oral progesterone, let's say. Or you can also use progesterone vaginally for the point of having what's called systemic or those hormones for your whole body. But we're specifically talking about the pelvic floor, so we're especially focused on especially the estrogen vaginally. So you really, for an optimal women's health hormone replacement plan would have both systemic hormones and vaginal hormones, not one or the other.

Right, Exactly. Yes. Yeah. Thank you for clarifying that. And the vaginal estrogens typically are. They're very low dose. The term is often used at local vaginal estrogen or local estrogen therapy, meaning it stays and acts locally. It's very little to any is traveling elsewhere in the body, which is why your vaginal estrogen is not going to play the role that does for say osteoporosis help or cardiovascular disease support? Whereas systemic like the transdermal patch or gel or the oral progesterone, those will be more whole body. But also then they have to go to all the parts of the body and there's not really that much left to get down to the vagina, which is, is why we benefit from both.

And I was going to also say that quite a lot of women that I hear from are not used to touching themselves. You know, they're like, whoa, this is like, this already feels like a big thing to just talk about the vagina, let alone to, for women to touch themselves. So what do you, how do you help women to just get through that part of like, let me get more comfortable with my own body. And, and, and because in order to help ourselves in this area, we're going to likely you can do some of it without touching, but. Yeah, yeah.

So people could use potentially if they really have an aversion from a self touch, they could use applicators. That's one. But I encourage people to get a mirror and there are, there are mirrors that actually are made specifically to kind of mold in between your legs to help you see. But you could do this with your pelvic floor. Physical therapist have them help you identify parts, help you with the mirror touch. So that because another person's touch may feel different than your own touch, one may feel safer than another. So potentially having a partner help you, potentially having a therapist help you with the delivery, it's not realistic necessarily for twice a week to have to have a practitioner go to a practitioner's office to apply your vaginal estrogen. But if you have a partner at home, that's a person that could potentially help you. But ideally we want to get. It's part of our body and hopefully we get to the point where we do develop a level of comfort and a relationship and a trust with ourselves and our body to be able to touch and look. It's important for us to see, to use the mirror to look for changes that happen in that area as well. Skin color, skin texture, loss of fullness, all of that will help identify as well. But again, you can also use. So there's like I have an applicator here that looks like a very skinny tampon that has the tablet inside, so you're technically not needing to touch per se. You can use an applicator for a cream. There's also the pessaries for vaginal estrogen distribution which could be inserted by a practitioner if you need or yourself one time, it stays in for three months. So there are options. Hopefully we can build some comfort and.

Trust with ourselves and with the buff muff method. Is there any aspect of it that has to do with touch or is it mostly you're doing that in without?

Yeah, I give some, like, from a teaching perspective at the beginning, where we're learning about the breath and the pelvic floor and what I call the core breath, I do have a lesson in there that talks like it's giving landmarks. Like, this is your pubic joint. Here's your two sit bones, not necessarily internal or external palpation right around the vulva. I invite people to explore with some touch about bony landmarks and muscle, but really the bulk of what we're doing is very movement or fitness focused, very breath, posture focused.

Wonderful. Thank you for clarifying. So then women just know, like, okay, here's what to expect and here's where you can, you know, it's all going to be your comfort level. And it's more a matter of like, let's just, just open up this conversation and say, hey, this is an important part of your body that needs attention and you deserve having support to learn how you, you know, what your options are at least. And you can, you can choose from there.

Yeah.

Is there anything else you'd like to share just to help women to understand what's possible once they, like, once people start working with you and paying attention. You said already that they sometimes see a difference even within a week or two. And what are some of the things that they can look forward to with. With making this effort to. To.

I'll share a couple. I'll share my own personal story. I will also share one, like a recent client story, just to give people a bit of. Of perspective, I guess so. Myself, I again, going back to. I thought, okay, if I don't tear, I won't. I won't have incontinence like my mom did. I didn't have any tearing, but I experienced stress during incontinence. And I thought this was after the birth of my second. About eight months or so after the birth of my second child. And I thought, well, wait a minute, how did that happen? I was doing Kegel exercises. I didn't tear. How is this happening to me? And that was kind of the start of me taking this additional level of training to understand function and then applying the fitness principles to it. So I had stress incontinence. It was honestly within about three weeks of me learning this information, which I now teach that was gone. It has stayed gone forever since then. That's like 20ish years ago. Well, 19 years ago. And then I also experienced prolapse. So I had a stage two uterine prolapse. I had a stage two rectocele where the rectum bulges in the back wall of the vagina. These became apparent to me during my perimenopause transition. Before I knew what perimenopause was, things were changing. One thing that had changed drastically for me was, was pooping. I, all of a sudden I was constipated and I hadn't changed anything, but all of a sudden I couldn't poop. And so I'd had straining and that led to the development of that. That wasn't just the only thing, but brought about these two types of prolapse. I was able to reverse the uterine prolapse with a technique called hypopressives. That's something that I teach not in the introductory buff muff method, but if somebody comes into the, excuse me, into the full membership, we dive deeper into hypopressives. You can also Google hypopressive or low pressure fitness. There's lots of resources online for that that helped me. It was about two to three months and I was able to reverse the stage two uterine prolapse, the rectocele. I chucked everything at it, I tried everything, and I lived with it for nine years and that nothing was changing with that. And I was really struggling with bowel movements and it was really starting to influence my quality of life. I was approaching menopause. I now knew perimenopause. I knew what was happening. I knew there was a thyroid component. So I'd done a lot of the work. And I just got to the point where I was like, nothing is going to change this. And I chose surgery. Anybody who is thinking of surgery, anybody who is thinking that's the only option, surgery is an option. It should never be your first line of defense. And everything that we talk about, that we've talked about here, everything I talk about in the buff MUFF program is all your prerequisite. It's all your prehab if you do it. Many people cancel their surgeries if you do it and it still doesn't move the needle, like for me with my rectocele surgery is there, but now you would have done your prehab. And everything after everything you've done is what you're going to do after for your rehab and your ongoing support, your Continued brushing and flossing.

Yeah, yeah. You were, like, getting ready and now you know how to help yourself recover from surgery, so. Exactly like, like, no. No harm in starting.

You might as well get started because you have to do it. I say it's even more important after surgery because now you have scar tissue. You've had to change to the landscape. So. So that's kind of my story. And I continue every single day, make sure I poop well, get my posture in check, do my buff muff exercises, my hypopresses, and. And I will continue to. I use my vaginal estrogen. I will do that for the rest of my life. I'm. I'm 54. Four years post menopause. The other one I'll share just quickly is I had a client who came to me 65, never had been pregnant before, obviously, then never given birth before postmenopause, 15 years, she was dealing with chronic back pain. She was dealing with urgency. She was dealing with stress, incontinence. She loved walking, she loved golf. But this was starting to now interfere with her golf game and her life. So she would pee before she left the house. She'd pee at the golf course. She'd pee at nine holes, she'd pee. So she was planning everything around bathroom visits and dealing with this pain. So after coming to me, we worked on the fundamentals of the bath muff method. So we looked at posture. I got her doing the core breath, the pelvic floor activation with the right cue for her layered into some movement. I recommended she see a pelvic floor pt. I recommend that to absolutely everybody. She started on vaginal estrogen within 3. So she went, she saw me once, went home for about a month and a half, did the exercises, came back, she said it was about a 60, 50, 60% reduction in her symptoms. And then at three months, so she came back and saw me a second time, went back, did her all the things she was doing at home. At three months, she sent me. It's one of the testimonials I have my website where she no longer was wearing pads. She no longer planned her life around the bathroom. She had no more back pain. She had this freedom and confidence back again that she had lost. And she didn't have this distraction of, is there going to be a bathroom, isn't it? You know, all the, all the little things, the little chatter that happens in our. In our brain. So that's just. I mean, I've had people cancel surgeries. I've had people now who sleep through the night because they've been waking up three, four, five times a night. People who had painful sex get back to pain free sex. People with constipation now poop. Well, all sorts of things. And, and it's really what, that's what keeps me going. I, I love those stories. And, and I just, I wanted, I want to change the world one pelvic floor at a time, but I want to Change it about 100 pelvic floors at a time.

Yes.

And in the buff muff community, we have hundreds of women just like you. And so we have coaching calls and you can come on and you see, oh my gosh, I'm not alone in this. And even if you are fly on the wall and you hear all the other questions being asked, you're going to learn something. And maybe the question you've had, somebody else has too. So it's a really nice way for people to feel supported, feel like they're not alone, and get answers to questions that they have.

It's so amazing. Thank you so much for creating that community for women to be able to, yeah, like you said, not feel alone and to get support and to not be ashamed. Be able to say, hey, this is just part of having a human body. Let's figure this out together. And yes, I, I'm completely with you on the mission of changing vaginal health for women. And, and to say, hey, wow, what a relief to be able to go through your life and not have to be constantly dealing with this in the background. That alone is reason to say, hey, I've got to start taking steps in this direction. So I'm so glad to get to cover this topic with you today. It's so important. Kim, thank you. And thank you everyone for listening in. Make sure to check out below. I'll put the link to Kim's website, which is vagina coach and also on social media. You're a vagina coach as well?

Yes, correct. Yeah.

So you can find her there. You can find the buff muff method, you can get to see your pelvic floor physical therapist. And let's start getting this on a priority list so that you can have freedom to do what you really want to be doing and not have to be in pain or dealing with these pelvic floor issues no matter what your age and no matter what your situation. Right?

Yes, exactly. Never too late. Thank you so much for helping me spread the message.

You're welcome. Thanks everyone for joining us today. And if you don't already subscribe, I welcome you to subscribe to How Humans Heal so you don't miss the next episode. Episode I'll see you all soon. Thanks Kim. Thank you.

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