The Power of the Pelvic Floor: A Guide to Women’s Health

Kim Bokney is a personal trainer who became passionate about spreading awareness about pelvic floor health after the birth of her first child. She is a published author, a woman's health educator, a menopause support practitioner, known as the vagina Coach. I am so excited to share this unique and empowering information with you all today. So if you enjoy this podcast today or in general, please go leave us a review. It helps other people know that it's worth their investment of their most valuable asset, their time. Let's dig in. So I am so grateful I got to meet you in person a few months ago at a conference and immediately I just knew I had to have you on the podcast. Thank you so much for all the work that you do in general that supports women, especially as we age. And thank you so much for being here today to share all this information and awareness that I think is so incredibly valuable for women.

Yeah, likewise. I think I kind of accosted you in the hallway and just said I really like your show. I'm a follower, I'm a fan. And it was sort of a quick interaction but. But yeah, it was really lovely to meet you in person and I really appreciate the opportunity to share. Thank you.

Absolutely. So let's dig in. Tell me a little bit about how you ended up the vagina coach. Like tell me a little bit about. Because that's a. It's a very niche niche. So take me through it. I'm honestly curious.

Yeah, I always get asked this question and I joke that it's not something that I grew up thinking I want to be a vagina coach when I get older. It but. But I can trace it back to seeing a childbirth video when I was younger and that planted a seed fear where I thought no, I don't want to do that. So really growing up I had a fascination with it, but also this fear. And I really was pretty convinced that I was not going to have babies because I was also. I saw that video. I also witnessed my mom who had struggles. She had chronic back pain. She stopped exercising because she had incontinence. She had surgery for incontinence. She had a tummy that wouldn't flatten. And so I had this picture painted that pregnancy and childbirth are big contributing factors to these challenges. And I was happy exercising and doing all the things. So that's. That was my growing up. And then when I did decide I wanted to start a family the year before, I had seen my. My sister in law had allowed us to witness her birth and that was A kind of a turning point as well, where I saw birth differently than that childbirth video and everything that we've seen in the media. And so it was a, it inspired me. And the next year I was pregnant, I was asking my midwives what can I do to prevent tearing. In my mind, if I could prevent tearing, that means that I would not have pelvic floor dysfunction. And so they recommended this biofeed, that biofeedback device called the epo. And EPO stands for no episiotomy. It's manufactured in Germany and it's a German physician who saw women in Africa using gourds of increasing size to prepare their pelvic floor for birth. And so he saw this and said, brilliant idea, but it's not necessarily going to transition to western culture, so let's make this a bit more mainstream. They, they, there was a team of midwives and doctors and physiotherapists who came up with this medical device called the Epino. And it's like a silicone balloon attached to a gauge that looks kind of like a blood pressure gauge. And you insert it into the vagina, you inflate it with a little bit of air and it provides feedback. So when you contract and relax your muscles, you can see on the gauge what's happening because the pelvic floor is part of the body. We can't see it's this elusive part of the body. So anyway, that's how it started. And then the EPI know also can, can help prevent tearing because you in a little bit, a little bit more and more in the final weeks of pregnancy to try to mimic the sensations of stretch and pressure and discomfort so that you learn how to relax your pelvic floor, which is a really key part for her. So that's, that's the. I used this, I had a great experience and I said why is it that not everybody's using one of these? And I contacted the company and said could I be a distributor in Canada? And, and I didn't intend for it to be a business at the time. I thought I would just sell it and have a little bit of extra side pocket money. So that's where it started and I then grew. It had an E commerce store. I had been working in HR at the time and I ended up getting laid off. And so I recertified my fitness. I'd been a personal trainer prior. Recertified, started focusing in pregnancy and postpartum. With the intention of selling the epo, I created a program called Prepare to Push to Help women prepare their bodies for birthday and introduce the concept of the pelvic floor, because that's a very well established risk factor for pelvic floor dysfunction. Then I was witnessing that postpartum recoveries were overlooked in North America and took inspiration from other cultures. And I formed a second business with two other women called belly zinc. And we wanted to optimize postpartum recoveries with pelvic floor muscle training, but also postpartum wrapping, so some people call it belly binding. Juggled those two for a while. Started to go through my own perimenopause transition, had thyroid issues and recognized this is influencing my pelvic floor as well. And this, this whole conversation of pelvic health is something that we deserve much more education about earlier in life because of all the contributing phases of life that influence the pelvic floor. And, and that. So now where I am now is most of my community is in the per menopause, post menopause space because that's when usually things are getting a little bit either showing up for the first time or getting worse. We've kind of been ignoring little symptoms along the way, but once we reach our menopause, things get a little bit more challenging. And so anyway, that's how it all started.

How fascinating. I wish that I knew about all this before I had my kids.

Like, I just hear that all the time.

Kick myself. Right? Yeah. I'm sure that's everyone's response. And there's a couple things that I thought of that I'll put a pin in. Definitely sparked curiosity and questions for me. So we'll go. Let's go back to the basics. Tell me what the pelvic floor is and why it's important.

The pelvic floor is a group of muscles that closes off the base of our pelvis. So if you're, wherever you are listening to this, if you put your fingers on what people refer to as the pubic bone, it's actually a joint at the front. So that's a pubic joint. That is one part where, where the pelvic floor muscles attach. Then if you're, wherever you're sitting, if you lift up one butt cheek and you kind of pull the flesh of your butt cheeks away, you'll feel the bone in there, the sits bones. We have one on either side, the ischial tuberosities, your pelvic floor muscles attached there. And then at the base of our spine, we have the triangular bone of the sacrum. The very base of the sacrum, we have our Coccyx, that's also an attachment point for the pelvic floor. So they, they make sort of a diamond shape. And again, we see our external genitalia, but we don't see the musculature that's on the inside. It's three different layers. The first layer is primarily responsible for sexual response. Second layer, primarily responsible for managing the openings of the vagina, the urethra, the anus. The third layer, primarily responsible for organ support, the bladder, the uterus, the rectum. Pelvic floor also plays a role in our pelvic and spinal stability. So because of the attachment points at the base of our spine and our pelvis, it's the foundation of our core. And we've all heard of core exercise or core workouts and very, I mean, maybe starting to now, but the, the pelvic floor has been left out of that conversation. And we think of low back and abs as kind of our core. And it also works in synergy with our diaphragm. So the pelvic floor and the diaphragm are very intimately related. And our breath acts also like a bit of a sump pump and helps the, with blood flow and circulation and moving lymph through our, our body as well. So these are really important jobs that we've never been told about and we don't even, even know we have a pelvic floor. We don't think about it when things are working well, when things are not working well because it influences so many parts of our lives. All of a sudden it becomes one of the only things that we think about, and it becomes one of the reasons why people stop exercising, one of the reasons why relationships break down, one of the reasons people quit their jobs. Like, it, it becomes very. This is a weird word to use, but invasive in the, in our quality of life. So when we could, if, if we could get this information much earlier in life, I feel like it would literally change the world.

Right? And when you can change. I say this about thyroid all the time too. I feel it is totally applicable here. When you can change the life or the health of a woman, you're. The work is generational at that point, right? Like it affects just how you said, relationships, marriages, family dynamics, relationships with kids, the ability to show up as a grandparent. I really. The ability to be the caregiver and the care driver of the rest of your family's health. So I totally agree. How would someone know. Give me some symptoms or signs that people might be able to tune into to know if they should look into pelvic floor dysfunction or get a workup, that sort of thing.

So if you were to, if anybody watches tv, which not as many people do nowadays, but still you would, you've probably at some point in your life seen an ad for the, the pad companies that tell us that light bladder leakage, which is incontinence, is just part of being a woman. So we, we get these messages that this is normal. We may even have been dismissed by care providers that that's just what happens as you get older. And so a lot of people are dealing with symptoms they have, they are just accepting as normal, which they may be common, but they're not, not knowing also that there are, that they're very treatable. So a big one is stress urinary incontinence. That's what the pad companies are marketing us to, thinking we need to wear these for the rest of our life because we leak a little bit of urine. Stress urinary incontinence is where there's some sort of exertion. Standing up from a chair could be that exertion. Laughing, coughing, sneezing, jumping, exercising, pushing a heavy door, lifting a bag of groceries. There's some sort of increase in our intra abdominal pressure that the pelvic floor is not able to withstand. So we can't, the, the openings don't close, a little bit of urine will leak out. Very, very treatable with exercise and lifestyle modification. There's also urgency where people, they're like, no, I don't leak, I'm fine. But whenever I get home at the end of the day and I put my key in the front door or if I hear running water or if I think of a bathroom, all of a sudden I have these alarm bells going off and I feel like I can't make it. It's very strong urge. Sometimes you might have a little bit of urine leak out. Sometimes you have a full release of the bladder. So that would be urge urgency incontinence or urge incontinence. And you can have a combination of the two which would be considered mixed. You can also have anal incontinence. So that's where gas or stool can leak out. And this is much less common but, but much more life altering. And you can also have frequency and, and a lot of people will self diagnose themselves as either they say I have a small bladder or they'll say I have an overactive bladder. And there is a medical condition called overactive bladder that requires some, some testing to decide if that's truly what that is. But what I see is so often people, finally, it's usually six and a half to seven years of suffering until women go and seek help. They see their primary care doctor, they explain their symptoms, and they get put on overactive bladder medication without doing a root cause investigation. Is it, is it really truly an overactive bladder and that overactive bladder medication can contribute to constipation, which is often one of the contributors of overactive bladder can contribute to vaginal dryness. People who are usually dealing with these symptoms are also dealing with menopause symptoms as well. So, so overactive bladder is often due to tight muscles, low estrogen, constipation, dehydration, bladder irritants, and without. We can address those and not have to go on medication. But so many people think that this is just part of what happens. And they also then pee just in case because they don't want to leak or they don't want to have urges. And that will also contribute to the bladder signaling more often and more frequently. So they kind of get into the chicken and the egg scenario. The other ones would be pelvic organ prolapse. This is statistically more common than incontinence. So incontinence is somewhere between 30, 40% prolapse. 50% of women who have given birth have some degree of pelvic organ prolapse. And early stage prolapse is often asymptomatic. And part of why I recommend people see a pelvic floor physical therapist once a year for a checkup, even if they have no symptoms, is to screen for gorgon prolapse. Because if we catch it early, we could definitely prevent it from getting worse, but we can also potentially even reverse it. And so organ prolapse is where the bladder, the uterus and or the rectum start to shift out of their proper anatomical position and they can bulge into or descend into the vagina. And this is the one that really halts women's women in their tracks. So once it becomes more advanced, they may see or feel a bulge at the, at the opening of their vagina and they often think it's a tumor. They get incredibly scared. And then it becomes, they, they freeze, they stop exercising, they stop being intimate, they're ashamed, they're embarrassed, they don't know what to do. They're, they're told they absolutely have to have surgery, nothing's going to fix it. And so it, it really can be, it's, it literally is life altering.

Right?

Yeah. So those are, I would say the most common. One other thing I'll say there's the category of pelvic pain, which has many different facets to it. And back pain. Back pain. 95% of women with low back pain have some form of pelvic floor dysfunction. And women chase the symptoms with massage therapy and chiropractic, which I don't want to take away from. They can absolutely play a role in, in our pelvic health and our overall health. But so often it's the pelvic floor that's missing as the, as the link. And if they saw a pelvic floor physical therapist, it would address a lot more than, than they thought was going on.

What about pain with intercourse? Is that one as well or not so much?

Absolutely. And so we also, again, want to look at why is there pain? Is it pain from dry tissue, like low estrogen state? Is it pain from tight muscles? So people who are dealing with leaking and urgency, so women who feel like, oh my gosh, I don't want to leak while I'm at the gym. I don't want to. What if there's no bathroom around? What if I don't want my partner to see or feel my prolapse bulge? They unconsciously start to guard because they're, they either feel vulnerable, like something's going to fall out, or they, they're trying to stop the link, the, the leaks. So they, they don't even necessarily know they're doing it. But all of a sudden now the pelvic floor is getting tighter and tighter and a tight muscle is a weak muscle. There's not a lot of blood flow, circulation. And that's also now going to become. We need the muscles to be able to kind of contract and relax and, and, and experience different ranges of motion during sexual activity, even without insertion. But insertion can become much more challenging if they're, if the muscles are not at their optimal resting length.

So, so informative, like, so insightful. I naturally I have like a couple thoughts. I'm curious about risks for pelvic floor dysfunction. Like maybe risks during pregnancy, childbirth, peri and menopause or thyroid. Can you take me through some information about those that creates risk for this? You had mentioned earlier an episiotomy, which really sparked my curiosity as a healthcare provider. I would not have known maybe that an episiotomy would put you at risk later for pelvic floor prolapse or dysfunction or Take me through some of that.

Yeah. Pregnancy and childbirth are very well established in the literature to increase our risk of pelvic floor dysfunction and that includes a cesarean birth. A lot of people who have a cesarean think, well, my pelvic floor is fine because I didn't, I didn't give birth vaginally. But I could argue that they sometimes are at even greater challenges with their core and pelvic floor because of they, they've had the same hormonal changes, they've had the same postural adaptations, the same load on the pelvic floor. Some of them have actually even gone into labor and then had a cesarean. But even if you haven't, you then have multiple layers of incisions to get down to take Babe out and multiple layers of adhesions. Then that result, which those scar tissue is a major contributor, it hinders muscle function. So when we have that many layers of adhesions, it can really disrupt core fun core function. And many people post caesarean have a lot of pelvic pain. There's a lot of overactivity that happens as a result. So when we have a disruption to how we manage our intra abdominal pressure and function, now all of a sudden other muscles are coming in to try to help basically so with good intention, but it ends up creating more challenges. So pregnancy and childbirth definitely established risk, chronic coughing and that could be from asthma or emphysema, smokers, posture. So we have some evidence that when there's a loss of lumbar lordosis in the low back where we, we lose that, that curve in our low back when we have excess kyphosis. So rounding of the shoulders, there's some links to especially increased risk for pelvic organ prolapse, chronic constipation. So when you think of your community with thyroid challenges, a lot of women are dealing with constipation. Very well established risk factor for the development of pelvic floor dysfunction, as I mentioned earlier. Also if you're not pooping, even if you don't yet have prolapse, that's going to irritate the bladder and it's going to make you feel like you need to go more often and you're not going to feel very sexy either. So you're not going to want to have sex, you're not going to want to do very much. Right. Scar tissue I mentioned. So previous surgeries, if somebody's had a previous pelvic surgery or some other surgery in and around the abdomen or pelvis for even not a pelvic floor challenge, that scar tissue episiotomy is also now again there's scar tissue hysterectomy. So over 600,000 hysterectomies are performed in the United States alone. The every year. The top three reasons for a hysterectomy are fibroids, heavy bleeding, and pelvic organ prolapse. So from a, a thyroid and hormone perspective, a lot of time deficiency in progesterone can be a contributing factor to the fibroids and the heavy bleeding. Yet women are offered a hysterectomy. And especially if that person is maybe choosing not to have kids or has already given birth and is no longer going to have more children, being offered a hysterectomy when you have heavy bleeding is like, yes, please, I don't need it. And they're often told, you don't need it anymore, let's just take it out. And it sounds like that's the best option. However, hysterectomy increases the risk of incontinence and pelvic organ prolapse. And people often think they only associate prolapse with the uterus. So if the uterus isn't there.

Right.

They're not going to experience prolapse. So you can experience bladder prolapse. And the rectum can bulge in the back wall of the vagina as well. So if people knew the increased risks from a pelvic floor perspective, I hear all the time, I wouldn't have chosen a hysterectomy had I known. Yeah. So, I mean, those are some of the fear trauma are some other reasons. So if we have a lot of tension, again in the pelvic floor, that can also be a contributing factor. And we think we associate tight as strong. Yeah, we think we want a tight vagina and we have to strengthen, strengthen, strengthen. But so often we actually need to let go of that guarding and release tension so that the muscle can move through its range of motion and do all of the jobs that it needs to.

Wow. And then tell me to the hormonal piece through like menopause perimenopause, obviously, I would assume that estrogen. Right. Is, is somewhat protective against this. Right. I'm curious too about testosterone, just from the muscle atrophy component of that. So I'd love to pick your brain. Give me your thoughts on that.

Yeah, the hormonal fluctuation of, of perimenopause is. And again, a lot of the thyroid challenges that come in that phase as well are big contributors. It's, it's usually even the 5 years post, 5 to 10 years post menopause is where a lot of the symptoms under this umbrella term of genitourinary syndrome of menopause come into play. And a lot of it is testosterone, progesterone play a role. It's, I would say estrogen is kind of the, the leading factor. So in that low, permanent, low estrogen state, we now know 50 to 80% of women will deal with one or more symptoms under the umbrella of GSM. Genitone urinary syndrome of menopause, which has genital symptoms, urinary symptoms and sexual symptoms. So on the genital side we have changes to the external genitalia. A lot of people left unattended will lose their inner labia. The, the clitoris, the hit the hood. The clitoral hood can adhese over top of the clitoris so we, we can lose sensation. The walls of the vagina can literally close in in extreme cases of atrophy. And GSM used to be called genital or vaginal atrophy, which was kind of thinning, drying tissue. But it's a lot more than just thinning, drying tissue. And so estrogen is, it's our juicy, supple hormone. It's what keeps, I always say we, we, we're trying to fight wrinkles on our face, but we actually want wrinkles in our vagina. So we have these folds in the walls of our vagina that, that we, we want. It helps us allow things to come in if we want. It keeps everything sort of comfortable and flowy and without it, the tissues become thinner and drier and irritated. Burning, peeing can be uncomfortable, definitely insertion and even just touch externally can be a challenge as well. So I mentioned sexual symptoms. So that could be painful intercourse, that could be post coital bleeding. Urinary symptoms, urgency frequency, overactive bladder, increased risk of UTIs. That's a big one. We estrogen helps us keep our acidic ph and that's what helps us fend off infection and it helps feed the lactobacillus. In terms of our vaginal microbiome, when we no longer have our estrogen, we are, our vaginal microbiome is disrupted. We are more prone to infection. And also as those tissues are thinning, the tip of the urethra is also now more exposed. So we are much more prone to infection. And UTIs can become life threatening. And so many women I hear every single day are put on multiple rounds of antibiotics.

They get stuck in that cycle and.

They get stuck in the cycle and it can, it can go septic and literally can end your life, which it sounds very dramatic. But vaginal estrogen I consider to be like an essential nutrient. And I know it's not a nutrient, but really from the start of our menopause, for the rest of our life, it is well established in the literature to be the gold standard to help with these symptoms of gsm. Don't wait for them to happen knowing that the majority of us will. So that's a big one. Estrogen for sure. The testosterone piece. There's obviously, as you probably know, there's not a lot of research with regards to testosterone for women, but we do know that testosterone can also play a role in. Especially through the vagina, helping with. With function. And so estrogen is essential for building muscle. We've got type one and type two muscles in our pelvic floor just like the rest of our body. And if we don't have estrogen, and we also are not nourishing our body with the. With the raw ingredients to build muscle, and knowing that we lose muscle loss as we're aging, then the pelvic floor is not immune to that.

Yeah, I mean, I couldn't agree more. And even when women come to me and they're like, well, I'm not really having a ton of low estrogen symptoms, but maybe a painful intercourse here and there, I'm like, listen, we need to do something about this, because you are, I mean, sometimes 46. Right. If they're post hysterectomy or something, I'm like, you cannot go with no estrogen forever. You are just way too young. One of the top reasons, truly, is just the atrophy of the entire genitourinary area that can just devastate women's lives.

Yeah.

So I love that. I know you touched on the thyroid piece, how thyroid can play a role. Is there anything else that you'd like to add to that? Any other sort of implication or connection between the two that you didn't already bring up? I just wanted to give you that opportunity.

Yeah. I mean, mainly it's the constipation, so the hypothyroid piece for sure. But there's also the. The poor sleep, the lack of energy, the lethargy, which at the end of the day, without, we need to move, we need to exercise, we need to load our bones, we need to load our joints or build our muscle. And if we don't have the energy to do that, our whole body, including the pelvic floor, will. Will suffer with that.

So tell me a little bit about what people can do at each sort of of those phases. Like, right during. You kind of touched on this in the intro. When they're pregnant, leading up to childbirth, even postpartum, what can moms or future moms or recent moms maybe do? And then also obviously in the peri and menopausal phases as well, or just generally speaking, I'd love for people to get empowered with some steps that they can take. I mean, I'd love to hear the exercise component, which that's kind of where our mind initially goes to. So. Yeah, get me through it.

Yeah. It's my hope that at some point in my life that we. We see this being taught in schools. When we're teaching kids about menstrual cycles and sexual health and their bodies. That's a perfect opportunity to plant the seed of this really important group of muscles called the pelvic floor. When you become sexually active, you see a pelvic floor physical therapist once a year. And here is. We can introduce Kegels. Most people have heard the term Kegels or Kegels, and it is. I want to. I want to honor Dr. Arnold Keegle, who was the one who invented the exercise. He was witnessing his patients postpartum having difficulties contracting and relaxing their pelvic floor. So he used a biofeedback device, kind of similar to the epo, but it was called the perineometer. That helped them see when they were contracting and relaxing, and that then ended up becoming the Keal exercise. But the interpretation has been a bit changed. People think of it as just this squeeze. And a lot of people are squeezing their butt or squeezing their inner thighs or even bearing down thinking that they're doing a Kegel. And then when they're. Because they're not doing it correctly. We have evidence to show the majority of women are not because they've never been taught. Then they think they don't work. So then they just kind of give up. So if we taught this earlier in life, taught people how to do pelvic floor exercise, had them see a pelvic floor physical therapist, I literally think it would change the world. And it would also plant the seed that if you are a person who's choosing to become pregnant at some point in your life, now we look at, okay, what do we need to do differently in pregnancy? We have to look at what are the postural adaptations. So as the belly grows out in front of us, our center of gravity is shifting. And unconsciously what happens is a lot of women start to lean back. They thrust their pelvis forward a little bit, and that messes with that optimal alignment of the diaphragm and the pelvic floor. So that's a contributing factor. We want to look at that. We can, the hormone piece is something that we're usually in a, in a higher estrogen phase, which is, which is nice for a lot of things. But then we have to look at, I look at it as if like we're training for a marathon or training for a triathlon or a big mountain climb. We, we want to look at the principles of specificity from fitness. What are the demands of childbirth? What are the most favorable birth positions and how can I train my body for strength and endurance and the ability to relax the pelvic floor in those different positions. So squats, side lying tall, kneeling, the more common birth positions, all fours. Let's build those into your fitness program while you are also incorporating the pelvic floor so you know what it feels like in those positions to contract and to relax. Because we need, during childbirth, it's an elimination. We need the pelvic floor to lengthen and expand to allow the babe to come out. So we want to train our pelvic floor in those positions. From a postpartum perspective, we're in a low estrogen state, so that's like a glimpse into post menopause. So vaginal estrogen is also something that can benefit the postpartum mom. Pelvic floor physical therapy. I always recommend that you see them during your pregnancy and you pre book an appointment for around six to eight weeks postpartum because most pelvic physios currently are, they usually have a six to eight week wait list. So pre book that appointment while you're still pregnant. You can go to that appointment at your six to eight week mark. They are going to check for scar tissue, they're going to look at how it's healing, they're going to assess the position of the organs. A great pelvic PT will assess you in standing because what it looks like standing is different from what it looks like lying down. Assess your ability to contract and relax and they should be the ones to give you the, the quote unquote green light to go back to more intense activity. And I look at most people right now, they get a green light at six weeks and they're back at the gym. Some people are back at the gym even sooner. They're not paying any regard to the need to recover and retrain the pelvic floor.

And checking like the reality is, is no one's actually checking.

They're just and even at the checkbox.

Of four to six weeks.

Yeah, even at, even at the six week mark, they may go, but how you doing? How you feeling? Good.

Great.

And they're and they. And nothing. And I think, oh my gosh, like it's just, it's mind boggling to me. So we, we in North America and that was part of our. When we were creating Bellies Inc. That was part of our mission was to bring in these, like get people honoring the need to recover and looking at what other cultures around the world do. The first 40 days, that is revered and the mom is supported so that she can better help her babe. If the mom is depleted, that's not going to favor the babe either. And we need to retrain that, that whole system. So seeing your pelvic floor physical therapist, they give you the green light. But usually it's around four to six months postpartum before you are back to the heavier lifting. Now of course you're exercising a lot, you are carrying a babe. Your car seats, strollers, you're moving in a lot of different ways. And ideally you would have worked with somebody during your pregnancy to train you for motherhood as well. Train for birth, train for the demands of motherhood. Make sure the pelvic floor can manage all of those loads. Potentially postpartum wrapping as well. In, in those initial. Usually around four to eight weeks. Sorry, up to four to eight weeks postpartum. And then that's, that's kind of the postpartum phase. But we're postpartum for the rest of our life. Sometimes there may be permanent injuries. About 30% of births have something called a levator ani evulsion. Levator ani is one part of the pelvic floor and evulsion is literally a pulling away from the bone, which they're changing the wording a little bit because it's not completely accurate in some cases. But some people can have complete evulsion on both sides. Complete on one side, partial on both, partial on one. And that historically has been a non repairable injury and does increase your risk of pelvic organ prolapse and incontinence. So knowing that again it's not screened for, but knowing to even ask to be screened for that is important because that might change some of the decisions you make going forward with regards to your movement and, and what have you. Then as we're getting into kind of the perimenopause post menopause, we've touched on a little bit the, the lowest estrogen state. Yeah, but we Also look at, not everybody has given birth, but most still nowadays most people do. Around 80ish percent of women do. So we need to factor all of those. If they haven't addressed their posture or their lifestyle, if they have been chronically constipated, if they have participated, if they have maybe a heavy lifting occupation like a mail carrier or something like that, that is also an increased risk. So looking at all the different risk factors that somebody has now, as we are approaching menopause, we know that low estrogen state is now going to be permanent. Jumping in and supplementing if we can, but carrying on with seeing your pelvic floor PT once a year, even if you have no symptoms, but especially if you do just like our dentist do it as our, as our checkup. And then so Kegel exercises are evidence based. They work when they're done correctly. When they're done consistently, we have lots of evidence to show that most women are doing them incorrectly. They're not doing them consistently because they think they don't work, also because they're boring. And the other limiting factor is they don't train the pelvic floor dynamically. So they are, most people think, oh, I'll do them at every red light, I do them while I'm brushing my teeth. And really when we are at the gym or when we're playing with our grandkids, that's when we're upright against gravity and moving when we have these symptoms. So we need to train the pelvic floor to manage those loads. So incorporating keels, I call it the core breath into whole body movement is one of the first ways that we start addressing the problem.

How would women know if they're not doing Keals correctly if they don't notice?

So the, the gold standard for Kegels is three sets of ten, ten second holds three times a day. And I don't know about you, but I don't know many people that are going to, to, to commit to that. If they do and if within a couple of weeks they don't notice any change or they notice a worsening of their symptoms, that's a good indication of not doing them correctly. Seeing your pelvic floor physical therapist is the gold standard. They are the ones who are going to help you understand if you are doing them correctly or not. But a lot of people are also marketed to with devices such as I, I don't want to name them but there are other biofeedback devices which can absolutely be helpful. The challenge with them though is they can't distinguish necessarily between a contraction versus an inner thigh squeeze or potentially even a bearing down. So any pressure against those devices could potentially register as an increase, which would give us the impression that we are doing it correctly. But if they aren't actually using the pelvic floor to generate that increase in, In. In the reading, then they may not be doing. Does that make sense?

It does. What about the ones that are passive? Like I, I've seen in like med spa clinics, the chairs that you sit in, or even ones that end, like you insert into the vaginal area, but you don't have to necessarily bear down or anything like that. Tell me your thoughts on those. I'm so curious.

Yeah, those are that I get asked every single day, what about those Kegel chairs? So, yes, there's a few devices. There's electrical stimulation, which is a device that would be inserted. And they are. It's attached to a machine that it essentially stimulates the muscle to do the contractions and relaxation without you. So you don't have your voluntary activation. It's doing it for you. I. Those can help with somebody who may have nerve damage, who may have dissociation, who may have some scar tissue in interrupting function. They. They can absolutely play a role and can be beneficial. But again, they are not going to train the pelvic floor in its full capacity or build a lot of resilience for other things. It's not going to translate. So it's kind of a starting point for some people. Then we see the ones where you, you're promised that you, if you sit on this chair fully clothed, 20 minutes, 11 to 13,000 kegels are done for you. And again, I think it's amazing that we have these, these technologies that are available for certain populations. And I think spinal cord injury, nerve damage, mobility challenges. I think they could potentially. We have evidence that they can play a role for sure. However, they're expensive. They are not a lifelong cure. They require maintenance, and they still don't train the pelvic floor dynamically. And if somebody has the issues like incontinence or organ prolapse because of tight muscles, okay. And they haven't seen a pelvic floor pt they don't know that they then go sit on this chair. That adds more activation. They could potentially be creating more of an issue. So I don't believe in outsourcing unless you functionally do not have the capacity to move your own body.

Darn. I was like, could I just do that preventatively for the next every.

So Often.

And then in between, do my key goals. But wow, three, like 10 seconds, three times a day, three round. Like, that's just a lot.

So. And that's kind of where, like, my whole bias is. Yeah, we shouldn't need necessarily a pelvic floor muscle training program. And then our workout, we can combine the two together. And when we do, we actually even have research now that supports my bias. There was one piece of research that looked at elderly women with urinary incontinence, and they looked at, if we do Kegels before they do resistance training, they would get better quicker. Then there was another piece of research that looked. This is more confirming my bias, which is Kegels incorporated into resistance training would. Was more favorable than Kegels alone. So that's how we functionally train our pelvic floor, is we connect with it. We layer it into some movement, and then we start to progressively load it, just like we do to get stronger arms or stronger legs. But when we incorporate our pelvic floor into our whole body movement, sometimes that means that we are actually lifting heavier. We can last longer throughout our workouts as well. And I don't want to give the impression that we always have to add our Kegels or our core breath to every single activity that we're doing. We want to train the pelvic floor to be able to manage the loads that we deal with. But every once in a while, like, during my workouts, I make sure that a couple of them incorporate voluntary pelvic floor activation and relaxation. So I'm killing two birds with one stone and making sure I've checked off my pelvic floor box. Box is always a funny word when you're talking about pelvic floor. And I'm also doing my resistance training and. And all the other things that are going to help with my longevity.

I love that so much. Anything else you want? This has been so insightful for me. Like, I absolutely am inspired and enamored to, like, go on this journey myself. So I know so many of my listeners will be too. But anything else, Any other last pieces of advice or thoughts that you want to share? And then, of course, I'd love for you to tell people a little bit more about where they can find you and your offerings and all of.

All of the things I always like to leave people with. It's a. It's never too late. I have women in my community. My oldest Known Member is 93, and I just love that. And I've had women in their 80s and 90s who are, have new romantic partners and they have been able to sleep through the night again, they've been able to have sex again, they've. They can play pickleball again. All these things that they had removed from their life because they were dealing with these pelvic floor challenges that they just thought were normal and they had to put up with. So it's never too early. Well, the too early is maybe a little bit. I, I think once you're sexually active. So for anybody with daughters, start talking to them about the pelvic floor when they're young and plant the seed of pelvic floor physical therapy when they're sexually active. So they know, so they're informed. But then also, if you are already post menopause and you're struggling, you can make a change. The body is amazing from an adaptation perspective. When we have the right information and when we do the right things. And it, this is like 10 minutes a day is, is really all that it takes. So I, I always like to leave people with that, that you can always make change and it's never too late. I love it.

And then tell us about your program where we can find you. I know Instagram is a place you certainly hang out, but share with our listeners a little bit more about how they can connect with you and keep up with your work and participate.

Thank you. Yeah, my, my website's vaginacoach.com I do spend a lot of time on Instagram and my social media handles are all at Vaginacoach. I do have a lot of free content on my YouTube channel, so people can get an understanding of kind of my philosophies and, and, and practices. And if they want more guidance and support, I have something called the Buff Muff method. And that is, that is where people can come and, and learn this whole body approach and also learn that it's not just about the exercise. It's also our posture, it's our breath, it's how we hydrate, it's how we eat, it's all the little pieces that ultimately is what's going to help us age powerfully when the pelvic floor is in check.

I couldn't agree more. And might I just add that being a woman is so complicated, there are a lot of moving parts that we have to keep up with. So thank you for creating a safe place, an empowered place, and just in an informed place that we can go for this particular topic that is not discussed enough, not sourced for information enough. So thank you so much and thank you for being here today and. And sharing your message.

You're welcome. I appreciate you having me.