Waking Up to Pee 6x a Night? (It's NOT Your Bladder)

When you sneeze and a little pee comes out, is that normal? And what about getting up a million times as it feels in the middle of the night because you feel like you have to go to the bathroom? Or what about when you're working out and you do that box jump? Or maybe you're just doing that squat and there's a little leakage and now you're thinking, do I always have to wear black? Is this a midlife problem that's not going to go away? Is this menopause? Perimenopause help? What do I do about it? Do I need a prescription today? I've got kids. Kim Bopny, here we are talking pelvic floor. And don't worry, we're not just getting into the standard. You got to do Kegels. That's not what we're going to be doing. We're going to be talking about why it happens, what we can do about it, and why we need to pay attention to this. Thank you so much for being here today, Kim.

You're welcome. Thanks so much for having me.

So let's back up a minute. What the heck is happening? Like, why does this even happen in the first place? I know we'll see a lot of memes on social media about the. If I sneeze, I have to, you know, cross my legs, or we kind of joke about it. It becomes this. This little, you know, annoyance that midlife women talk about. But what the heck is going on? Why? What's this coming from to begin with?

Yeah, a lot of it is we think of it as just being associated with, oh, that just happens now that you've had babies. Or that's just what happens because you're now reaching menopause. Or that's what happens because you get older and we have these just excuses and we are told to just accept them. That's just. That's just normal. But we don't understand all the mechanisms that have contributed, like, why. What are all the different reasons? And it's not just aging. That is a part of it. We're getting older. We have postural adaptations. We lose muscle mass as we age. In the pel. Like, the pelvic floor is a group of muscles. And we. We don't. We're not taught anything about the pelvic floor. So we have this. We have zero awareness, really, of what it is. We know our external genitalia, and that's pretty much it. But inside, there's a group of muscles, three different layers. They support our continents. They Support our internal organs. They, it's the foundation of our core. It provides core support and stability. So the ability of transferring loads from upper body, lower body, what have you sexual response. It acts like a sump pump with a diaphragm. So these are really important jobs that nobody's ever told us about. And when things go wrong, we usually wait on average six and a half to seven years before we go seek help. And when we finally do seek help, we usually go to our family doctor. They tell us it's cool, quote unquote normal. Part of aging, part of menopause. Go home and do your Kegels and, and that's kind of it. So, and then we see the pad company saying that's just part of being a woman. And this, just put this crinkly black underwear on and you'll be fine. And you can still ride on the back of a motorcycle with a handsome man. Right. So it's aging, it's loss of muscle mass. The type 1 and type 2 muscle fibers that we have all throughout our body are in the pelvic floor as well. We lose more type 2 muscle fibers as we are aging, especially post menopause. Type 2 muscle fibers are the quick contract, relax. That's what we need to come into play when we laugh, cough, sneeze, jump. We need that quick reaction time. And we also need the muscles to be able to generate enough force to close the openings off to prevent that urine from leaking out. So loss of type of muscle fibers, but loss of type 2, loss of estrogen, that's a big one. I would say loss of testosterone and progesterone as well, constipation, anything that's contributing to excess, like excess rounding in the upper back, loss of the lumbar curve. So how much people are sitting and in what position are they sitting all day long. The footwear that we have, chronic heavy lifting. And that's more from an occupational perspective. So every day for hours a day carrying heavy loads, say like a mail carrier or somebody who works in the healthcare industry, transferring people, chronic coughing, pregnancy and childbirth, those are well established as risk factors. So there's, there's many different things that contribute to the development of things like incontinence or organ prolapse. But we just simply are never told what they are and why it's happening and that's it.

I feel like we, it's very talked about, about after you have a baby. Right. So like in the 30 year old group, like before we were perimenopause and menopause I feel like it's talked about a lot, like just had a baby, this is what happens. And that's kind of like the only time it really is attributed to like, this is what it is, this is what you do. And that's when we first hear about Kegels. But then later in midlife, it becomes this like meme and this joke. And I mean, heck, you go down any shopping center, you see depends. There's so much stuff like to have help with this. But the only thing we literally hear to do about it is Kegels. And I don't even know what the heck a Kegel really is. So I'm going to ask you that in a few minutes. But before we even get into like, what should we be doing about it? Can we talk about if we do not fix it, Is it just a discomfort or is this going to create bigger issues in our life?

In my opinion, it absolutely is like a cascade of. It's the thing that stops a lot of other things from happening. So when we leak urine, I would say that's the one that is. It's an annoyance. People put a pad in, they carry on, they don't really pay too much attention. But it will not get better with time. It will continue to worsen. Urgency, I would say, is a bit more life altering. So that's the one where you're waking up to pee. That's the one where you're, you're planning your life around the bathroom. You're stopping doing certain activities because you think you're. There's not going to be a bathroom close by or you won't make it to the bathroom. You're going to stop sexual activity because you're afraid of leaking or you're afraid of what, you know, what if I have to have a go to the bathroom in the middle of things? So your life becomes a lot smaller with pelvic organ prolapse. That's where the bladder, the uterus and or the rectum start to shift out of their proper anatomical position and can descend into or bulge into the vagina. This is statistically more common than incontinence, yet we don't hear anything about it. And that's the one that really, really halts people in their tracks. The symptoms of heaviness and pressure, feeling very vulnerable, feeling like something's literally going to fall out of your body. Worrying if you know, any sort of impact activity is going to make things worse. So there was a recent study, it looked, it was close to 4,000 women 46% of women stop exercising because of their pelvic floor. And when we think about. I mean, you and I are. We've been in the fitness industry for years. We preach movement fitness, and it's very well established that that is important for our hearts, brains, metabolic health, so many things. So if we now are not exercising for our mental health, for our cardiovascular health, like all the things. So that's just going to be a cascade. Plus, again, our life is becoming very small because we're now afraid to leave the house. We are afraid to make commitments, especially later in the day, because what if I, you know, there's a certain type of prolapse where it's very hard to have a bowel movement. What if I haven't had a successful bowel movement that day? What if there's not gonna be any bathrooms close by? What if I don't have the right clothing? And what if I leak? What if you.

Wait a minute. Back up for a second. You said bowel movement because we're talking about urine, but you're saying. So when this is happening, is it also making you constipated or what's happening there?

Constipation is a major contributor to incontinence and to urgency.

Okay?

And also the straining to have a bowel movement is also putting pressure down on the pelvic floor. So not only is it going to increase that urgency and that feeling of needing to go more often and potentially leaking, you're going to feel like crap, literally, no pun intended, but also that when you're not getting the waste out, it's also recycling your hormones, not getting the toxins out. So your health is declining as well. And the straining to get that bowel movement out, finally, whenever it feels like you can, that is damaging to the pelvic floor as well. So hydration and constipation are always the two places I start with people, because what do people do if they think they're going to leak? What do people do if they're afraid there's not going to be a bathroom close by? They stop drinking. They stop drinking any type of liquid and especially water. And so now they're becoming dehydrated, but also that urine is becoming more concentrated. And that concentrated urine actually is more irritating to the bladder. So it's going to signal you more often and more frequently. And you're now going to be constipated because you don't have enough water on board. So you kind of get into this cycle. Right? And one thing is just contributing to the other. But long term, if left unaddressed, in my opinion, this is one of the biggest threats to our overall longevity. Okay.

Yeah. I mean, I'm, as I'm listening to you, I'm like, wow, this is like, affects every area of your life because it's going to affect your movement, it affects your sex life, it affects your confidence. Like, there's so many things that you just said. So the things that I. The two things I hear most, and I think all of these obviously are issues, but the two biggest things I hear is getting up in the middle of the night to go to the bathroom. So many times I. Last night, before this recording, I. Six times. I got up six times. And now that's the only symptom I've had. But I just connected the dots before we even hit recording, I'm like, okay, wow, that's not normal. Six times.

And think of how disruptive that is to your sleep and think of how important sleep is for the rest of your health. Yes.

And then I hear about women all the time sharing about the sneezing or the working out and the leakage. So this is, I think this is more common than women are talking about. I think there's probably a shame or an embarrassment around it too. So before we get into, like, what you do about it, like, I want to really get into what does, like traditional western medicine say? Like, if you were to go to your obgyn and say, I have this problem, what is their answer? Is this. Is that where that mesh thing comes in? Or the prescriptions are like, what are they doing?

Usually with. And with all due respect, their training is in pharmaceuticals and surgery. That's what they're trained. They. There's a problem. Here's the pharmaceutical, or here's a surgery that's going to fix it. And sometimes those are needed, and sometimes those are the best options. However very well established in the literature, that is not. Should not be our first line of defense. However, so often it is. So they would offer overactive bladder medication, which, you know, that has a increased risk of cognitive decline. Like, it's astounding really, when you, when you really look into things. But people just take them because they're desperate now. They're like, I just, I can't be controlled by my bladder anymore. Please help me. So they think they take this medication, which for some it might help a little, but usually if it is going to help, it only helps for a period of time because it still isn't addressing the root cause.

And Also, I believe UTIs with some people. I've heard it can.

Yep. It depends. Oral birth control, which is often offered to postmenopausal women, can create dryness and irritation and same conditions. So that's kind of so.

So a doctor. Well, meaning, might say, you need this overactive bladder prescription. But you have to understand, every time you take a prescription, it helps with the immediate problem, but what else does it create? So else is that doing so. And then. And I know, I know.

Gosh.

My mom, she. She was on medication. She also had that mesh surgery. What is that mesh thing? And when do they offer that and what does that.

They will. Sometimes that's what's offered first. So some people will say. Some doctors will say to people, exercise will not fix your problem. You have to have surgery. And if there's been an internal evaluation, and yes, if there is damage or overstretch to the ligamentous support structures, yes, exercise may not fix 100%, may not completely reverse a problem. But that does not negate the need for pelvic floor muscle training. It is absolutely. Still remains the first line of defense. And if you do have surgery now, you have a change to the landscape. You have scar tissue that is now in there, interfering with muscle function. So in my opinion, and this has been established in male research, but not for the females yet pelvic floor exercise is more important prehab and rehab. So prehab before your surgery, rehab after your surgery and for life. This is. Is like brushing your teeth. It's not a. Just do it for a period of time and then you're done.

So if they just. So we can all understand, though, if they're doing the surgery, I mean, obviously you're gonna have to still do exercises. But what is. Where do they put this mesh? Where is it actually going? What's it doing?

So there's many different types of pelvic surgeries specifically for incontinence. Usually they are. It's a mesh that's. It's like. If you can imagine, this is the urethra. It's like a. It's like a sling that's going around the urethra to. To kink, to basically.

What's it made of?

Synthetic mesh.

Okay.

Yeah. So we're not.

Now we're putting something else in our body. So we're also having. So there's also some stuff. And granted, look, I'm. I'm the queen of that stuff. I. I had implants for years that are now removed, and I've had. I have a disc replacement in My lower back. So I'm not saying some things aren't medical and necessary, but we have to always think about that. You put something in, what else does that create inside your body?

Yeah. And mesh, especially for sling surgeries. Very, very effective. Very few complications. There was several years ago, there was a big uproar against mesh, more so for prolapse repair. A different placement of the mesh and there were some serious complications. There were also many people that had great benefit from it. So it's not. I don't want to put all mesh in this category of mesh is bad. But we have to understand this is not a natural material. It will influence the capacity of things to move. We should. We need things to move within our pelvis, including the muscles. And if we have a more fixed fixture in there, it's going to influence the muscles to move. So we need to make sure that we have that managed with internal therapy. We have to make sure we're managing our constipation, hydration, pelvic floor muscle, like all the other things to mitigate that now increased risk that we have. People think surgery is like, well, they fix the problem. I'm cured. I don't, I don't have to do. And often, sometimes doctors even say, well, now you don't need to do your pelvic floor muscle training anymore. And I think 100 the opposite is true. You need it even more.

Makes sense. So when it gets to the point of the prolapse, which is more advanced. So like now we have got that. Is surgery an only option for then or also we can repair that through.

Exercise and things early stage prolapse, especially bladder and uterine prolapse. If you're on like a stage one or two, I know, myself included, you can reverse that. Many people can reverse. Not every single person. But there are things you can do to reverse that or improve it if you are more advanced. So if you have a bulge that's now at the opening visible, or you can palpate it at the opening of the vagina, or that it is actually now bulging out that stage three or four, you are not going to reverse that. But many of my clients at a stage three have gone to a stage one. They've greatly improved it through exercise, through avoiding constipation, through posture, through breath. There's also something called a pessary, which is like, if you think about people who wear orthotics in their shoes, a pessary is like an orthotic for the pelvic floor. It's a device different shapes and sizes. They are inserted into the vagina. You sort of fold them up, insert. When it opens, it now is providing support 360 degrees to the walls of the vagina. And where any of those bulges from the organs are starting to, to press down, it will help lift those up. Great for alleviating symptoms, great for providing additional support. Surgery is absolutely not mandatory. Very like even advanced prolapse is not physically life altering. Sorry, life threatening. It's very life altering. Some people can argue very advanced prolapse can be life threatening because people just stop living because this is holding them back from so many things. So definitely quality of life threatening. But accessories are a great. Another sort of first line of defense. That's not always after offer when you go see your family doctor.

So if we're healthy and we are doing the proper things, which we're going to talk about, if we're healthy and we're doing the proper things, does life actually look like you should be able to sleep eight hours through the night? Like you should be able to do be on a whole flight without getting like, tell us what is actually normal for urine and pro.

And that happening normal voiding would be every two and a half to four hours. So between five and nine times a day and not at night. It is, you know, if you, you could make arguments against or for this, but after age 65, it's considered normal if you wake up once a night. But I don't want that to be like, oh great, I'll just wake up because it's normal for me now we should be able to sleep through the night. The reason we wake up is so often not our bladder. It is for some other reason. And yet we, when we wake up, usually there's some sort of a sympathetic nervous response that could be what woke us up. A hot flash, for instance. Or we wake up and now we're like, why did I wake up again? And now. So we're getting anxious and that's now going to signal the bladder because it's thinking that there's something we need to worry about. We now think that's why I woke up. I go to the bathroom, I empty, I come back. And then we just get into this vicious cycle. We train the bladder to signal us when it's actually not empty. And that also can stem from what we do during the day as well. If we are peeing, just in case I've got my exercise class, I don't want to leak. I'm going to pee before I start my Class, actually, I'm going to pee halfway through my class, too, just in case. I'm going to. I have to go grocery shopping. I don't want to have. There's no bathroom there. I'm going to pee just before I leave the house. Like, we start. Yeah. Doing these mental games where we're training the bladder and it becomes a Pavlov's dog response. So every time I put the key in the front door when I come home, my bladder starts signaling. Every time I see the fitness class, my bladder starts to signal me. And then the same thing is happening at night, too. The bladder is like, well, she usually wakes up every two and a half hours. Okay, I'm just going to wake her up. And it's not actually full. We can go through that whole night. The more we keep responding, the more we are just stuck in this pattern. And now our sleep is just disruptive. And disrupted sleep will interfere with our ability for protein synthesis. So build the. The taking the fuel that we need to build muscle. So all the pelvic floor muscle training we're doing is not going to be effective, but it also will exacerbate symptoms of urgency and frequency and prolapse when we are sleep deprived. So a lot of sleep is. First of all, we have to decide what's waking us up. Is it the room temperature? Is it a hot flash? Is it a snoring partner? Is it sleep apnea that we have? Is it blood sugar dysregulation? What is it? Or did I drink a huge volume of liquid before I went to bed? And is it truly my bladder waking me up?

No, it makes sense. You're waking up from something else, and now you're hyperfocused on things, and then you feel that, and then you. They. Now you're. You're training that. So it becomes a process. So.

And just like it got trained to do it, it can get trained to not do it.

That makes sense. Okay, so when we look at what do we do about all this? Why are Kegels the first thing that we always keep hearing about? And what the heck is a Kegel?

So Dr. Arnold Kel was well intentioned. He saw his patients, specifically post childbirth, having difficulty contracting and relaxing their pelvic floor. He used a biofeedback device called a perineometer that allowed people to see when they were contracting and relaxing their pelvic floor. And that then became the Kegel exercise. It's a voluntary contract, lift, and release of the pelvic floor muscles. The challenge, again, nobody's ever. We've never learned this. Nobody's ever taught us. Maybe somebody gave us a brochure. Maybe we've gone to the Internet and it says it's the muscles that you use to stop the flow of urine. Some people will then start to practice their Kegels on the toilet, which is not what you want to do. So we have loads of evidence that Kegels work when they're done correctly, when they're done consistently. But we also have evidence to show the majority of people do them incorrectly because they've never been taught. And so then people do them incorrectly, nothing changes, or things get worse, and they're like, kegels don't work. And so I'm just doomed. I'll just. Just have to sit here. So.

Because when you say correctly, does that mean, like, you wouldn't like training your biceps? Like, you'd have to be consistent, Consistent every day, like a few days a week, or what does that even mean, consistent for Kegels?

So people will do like people. Again, it's a. It's a group of muscles we don't see. We see our external. We see our labia majora, our labia minora. Like, we can see the external genitalia. We can't see the layers of muscles that are on the inside. So we need some imagery, some guidance, maybe even some physical palpation or biofeedback to help us connect with that group of muscles and understand its relationship with the breath as well. So people's interpretation of what a Kegel is is squeeze. And so they will often squeeze their inner thighs, or they squeeze their glutes, or sometimes they'll even bear down and hold their breath, thinking they think they're activating their pelvic floor, but they're not. So then, of course, when it's not done correctly, then nothing will change. But what should happen if this is the. If this is the vagina? So make a little circle with your. Your thumb in your four fingers and take the finger of your other hand, put it through there. You know, the classic intercourse signal or symptom sign. What should happen in a Kegel is there should be a hug of the finger, a drawing up, and then a let go. So it should be a squeeze, lift and release. But again, people think of as a Kegel as just squeeze. And so they squeeze and they hold their breath. They often squeeze and bear down. They squeeze using other muscle groups, not the pelvic floor. So, of course it's not going to work. So having somebody assess Your pelvic floor correctly. And this is, in my opinion, not done successfully with. When you're having your pap exam, when you have like seven minutes with a doctor, go to a pelvic floor physical therapist. Okay. I believe this is the most underused women's health resource we have. I recommend every single woman see one every single year, once a year, for a checkup. Just like we go to the dentist. We go to the dentist because we've been conditioned to do so. We brush, we floss, we see the dentist once or twice a year for a checkup. And we go, even if there's nothing wrong, even if we don't have bleeding gums or pain, we go. And if we did the same thing with a pelvic floor, I literally think it would change the world.

And how does that, like a pelvic floor physical therapist, they. They do a test with you or what. How does that.

What happens? So they're. They are trained as a physical therapy. Okay, a physical therapist. They then take additional training in the pelvic floor. There are three different main courses they take for different types of evaluation. That involves an external and internal evaluation. Using a gloved finger potentially too. Happens with your consent. It doesn't always happen within the first appointment, but they will take a detailed health history. They look at things a lot of what I talk about. Posture, breath, movement. Then they do a screen of the external tissues. Are there any external tissue changes that they could highlight? For instance, postmenopause, the dry thin, the. The can be the loss of the labia. The clitoral hood can adhere over top of the clitoris. So visible changes. Or is there skin like autoimmune conditions like lichen sclerosis that they can screen for? Then they would see if touch is painful anywhere. They would, with your consent, insert a finger to see. Can you allow something to be inserted? Some people, insertion is not possible. So can you accommodate one or two fingers? Then they assess for tone. Is it balanced on both sides? They look at the position of the organs. They would ask you to cough or bear down gently to see if there's any descent of the organs. They ask you to do a Kegel. Can you contract and lift and let go? They would ideally assess you also in standing off the table. Because when we're lying down, there's a different presentation of things and muscles work differently compared to when we are upright against gravity. So again, not all of that would necessarily happen on that first appointment. But to me, it is. People come away and they're like, how have I lived 50 years, 60 years, 40 years in this body and I've never known this about, about me, about myself. I, I didn't. And some very small lifestyle posture, breath changes can make a huge difference in symptoms and muscle function. People who get scheduled for surgery avoid surgery because they're like, well, all I had to do was fix this thing. And so it, it to me again it's, it's life changing.

And so it's boggling to me that ob, GYN or GYN offices don't offer this. Like they don't have a physical therapist that does this in their office. Like they, that should be an add.

On to some degree. There are some who are having a bit more of a collaborative approach. But I still hear daily from people whose doctors, they don't believe in pelvic floor physical therapy, even though it is very well established in the literature. That is the always the first line of defense.

Yeah, but the same doctors don't believe in gut health either. Or don't believe.

Yeah, I was just at a conference here in Vancouver. The Canadian Society of Pelvic Medicine and the American Urogynecological association were doing a combined conference here in Vancouver. And I was pleasantly surprised that the majority of sessions were highlighting the importance of pelvic floor physical therapy. First, very well established. So hopefully it is starting to happen that there are more collaborative approaches happening, there is more referral out. But right now a lot of people have to advocate or potentially pay out of pocket on their own because either their insurance provider doesn't or their doctor won't make the referral. There's so many barriers to it, but if you can manage to get at least that one session in, it really can be such a life changer. Hey there.

If you're finding value in this episode of Midlife Conversations, I would really appreciate it if you would hit that like button and subscribe. And when that little bell pops up, you want to hit that. That way you are notified of all, all new episodes so you don't miss a beat. Also, you subscribing and liking helps others find this content. And this allows me to keep growing, keep getting amazing new guests for you and to keep sharing. Okay, so what we need to do to be aware of this, prevent it, even fix it. Let's kind of go down the list. Like obviously you said number one. I mean it doesn't have to be the starting point, but you should get a physical, a pelvic floor physical therapist appointment.

It's.

If I'm hearing you Correctly.

Yep. I recommend every single person do that. Even if you have no symptoms, do it once a year for the rest of your life.

Okay. What else do we need to be doing?

Drink 2 to 3 liters of water a day, so make sure you are hydrated. Okay.

And then the first thing that comes up when you say that, I know people listening are like, but then I'm gonna have to just go more.

Yeah. A lot of it is cuz you're dehydrated and water's just running through, you're not absorbing that water. So potentially adding electrolytes in or figuring out why you're not absorbing.

Is it true that you can train your bladder there? Like so if you're gonna add water, so you just kind of like make yourself hold it in longer? Like, is that what you wanna do?

Yep. Yeah. And that's just as I said. We've trained it to signal us more frequently because. So the bladder can hold about a cup. Well, it can hold more than this, but usually when it's telling you it's time to go, you've got about a cup and a half of urine in there.

Okay.

And when we are peeing, just in case, when we're peeing, when we don't really actually have a true signal to go, we're no reason. It's usually signaling us at like a quarter cup, maybe half a cup. So if we consistently do that, the bladder reaches that point and then it will start sending you signals and get trained there. But if we start to intervene with intervention, like curling your toes, doing calf raises, doing some pelvic floor muscle training, doing some breath work, something that is going to interrupt that messaging and calm that signal and then we just carry on. We don't actually go in empty, so we have to use that. We also use a bladder diary to identify bladder irritants like caffeine, alcohol, artificial sweeteners, chocolate, spicy food, carbonated beverages. Those are all known irritants. Doesn't mean everybody will be irritated by them. But when you start to look at, oh, every time I have my green tea, I have to go to the bathroom more urgently or more frequently or you know, so when people remove things, make sure they're drinking enough water, that in and of itself can be life changing for somebody. Then we have to say, okay, are you. Next thing is poop. Are you pooping at least once a day? Bristol stool chart number four. Poop well formed. You're not straining, it comes out magically, you know. Dr. Marisol. So like the queen of the Thrones like this should be an effortless sit down. Within seconds it comes out, it's, we have a poogasm and we carry on for the rest of the day. If that's not happening, you're constipated. And that is going to be increasing symptoms and contributing to pelvic floor.

Okay, let me go back to the water for a second here. So I want to make sure we're hearing this correctly. So a lot of times when we think we have to go, we've just trained ourselves. I think we have to go. We're now like, it was almost like we're hypersensitive to it. So we're, we're just aware. So that's the first thing. We don't necessarily have to go. So we have to almost get a little bit uncomfortable holding it. You're not saying hold it in all day. You're just saying, can you stretch it longer? Do you really have to go looking at the triggers, having a diary. So like, so for example, like someone like me, I said, I got up six, you know, five, six times, you know, in the middle of the night some nights, would you say, don't let yourself get up?

Like, what.

How do you. So you would say, just. You're going to say, no, you're going.

To wake up and you're going to say, all right, I've woken up for some reason, but it's not my bladder. I know that you are not full. I know you're not the reason that I woke up. And you do this little self talk. You can do it in your mind or inside, outside voice. And then you're going to use like, you can scrunch your toes, point and flex your feet, do some pelvic floor activation and relaxation. Counter pressure against your pelvic floor. Deep breaths. So calming the nervous system, calming that sympathetic nervous response. And doing the self talk. To be like, this is not the reason I woke up. There's no reason. I'm in control. We don't have to void. And you don't get out of bed. You lie there, okay, and you wait. It can be 15, 30 seconds, ish. And then you go back to sleep. And the more you do that, then now you're interrupting the pattern. And it can happen. I mean, it's happened overnight. Literally. People, once they're, they learn that and then they just say, okay, I'm putting my foot down, I'm not getting up. Then it, they have interrupted that pattern. They don't do it anymore. Some people, it takes, you know, A week or so.

What about airplanes? I. I notice. I mean, this is me definitely too, but I've heard other people say, like, on an airplane, you feel like you have to go constantly. Is that a dehydration thing? Is that an altitude thing or dehydration?

Yep, yep, very much so. And a lot of times. So again, if we're not sure we're going to be able to, because sometimes there's turbulence, you can't get up. So people are often then now restricting their fluids or maybe they've had coffee or they might have had something that is somewhat of an irritant. But dehydration plays a big role. And also just the. We're worried. What if I'm in a window seat? What if I don't want to disrupt my partner? What if there's turbulence? Like, it's the anxious thoughts. Anxiety contributes to tension in the pelvic floor. A major reason why we have constipation, why we have pelvic pain, why we have incontinence, why we have pelvic organ prolapse is tight muscles. And that is so counterintuitive to people. They're like, well, if I'm leaking urine and if my organs feel like they're falling out, how can my muscles be too tight? They must just be like. Like lax. And I need to really squeeze. But tight muscles can't. They can't squeeze anymore. They can't react at the right time. So if we laugh, cough, sneeze, jump, or have this urge, they're already like, I can't generate any more force here. And they get tired and they get weakened as a result. So tight muscles are weak muscles. And a lot of people are told, you can't do Kegels if you have tight muscles. While I wouldn't start there, we still need to take the muscles through their range of motion, remind them of what it feels like. And so what the release feels like, what the lift feels like. And we have to do specific things, like changes to our posture, working on our breath, do specific release exercises to let go of that tension. That's also going to help you sleep through the night. It's also going to help with the urges throughout the day. Okay.

So I want to make sure we're all good students here. So pelvic floor physical therapist, Drink a lot more water. Make sure you are pooping daily. I'm also hearing. Train your brain to say, like, I don't have to go is like, I'm going to at least try, like, go a Little bit longer. Can you do that? What else do we need to be doing?

So we've got the. Yeah, the pt, the water, the constipation. Pay attention to your posture. So we know that hyperkyphosis, meaning excess rounding in the upper spine, loss of the lumbar spine. So if we're sitting with a tucked or standing with a tucked tailbone, that also increases the likelihood of dealing with pelvic floor dysfunction. Any chronic coughing, any chronic bearing down, if you are have a heavy lifting occupation, making sure that you get the pelvic floor in check and you are bringing that into your lifts so that we can protect the pelvic floor if we are close to or beyond menopause. Vaginal estrogen and or vaginal DHEA I consider to be, I call them essential nutrients even though it's not a nutrient. They're hormones. DHEA is not a hormone, but helps with the conversion of estrogen and testosterone. Those are like it. It astounds me how many people have suffered four years with recurrent UTIs, dryness, painful sex, irritation, bleeding, and nobody has offered them vaginal estrogen. Again, very well established in the literature that this is gold standard. But we have been living under the hangover of the Women's Health Initiative that that made everybody think that estrogen was going to give you cancer. There is no link to any cancers of any kind with local vaginal estrogen. There was a meeting recently at the FDA. A panel of doctors July 17th met with the FDA. It's a two hour video on YouTube where they all had five minutes to present various data on hormones with the intent of having the FDA remove the black box warning on vaginal estrogen because it is not medically accurate. So many people are prescribed vaginal estrogen and don't take it because they read the label and think, oh my God, I'm going to have a heart attack and have a stroke, I'm going to have a blood clot, I'm going to get cancer. And none of that is established in literature anywhere with vaginal.

If you're taking estrogen replacement already, and a lot of my listeners are so that maybe they're already doing the patch or they're doing injections or whatever, they're taking estradiol, they have estradiol on board. Do they still need to add separately vaginal estrogen or dhea if they're already taking that systemically?

In my opinion, yes. So this is a. Another kind of misnomer that, well, I already am taking hormone therapy and then some Doctors even say that's too much estrogen. Now, I'm not going to give you vaginal estrogen, but that, that systemic needs to go in a whole lot of places and work in to do a lot of different things in the body. And when it comes down, there's not really enough left specific to help with the tissues in the vagina around the bladder and especially the external tissues of the vulva. We need local therapy as well. So, yes, cream and. Well, some people will use the tablet inside and a cream outside. Some people use the cream inside, outside. Some people use the. There's a ring like a pessary for estrogen. It doesn't matter. It's what, what form is best for you.

And you put it everywhere. So like Dr. Anna Kabeca would say, I already can hear her clitoris to anus with the estrogen. And her. She would say with that without her jalva too. So, okay, so that's, that's a must to have that on board. And then talk exercise specifically, what should we be doing? Like, should we doing Kegels or is it something else?

So there is a place for Kegels. Yes, but the limiting factor there is Kegels are an isometric, like isolated. You know, people say, do them at every red light or do them while you brush your teeth. Sure, if you're doing them correctly, better than nothing. But as we talked about at the beginning, the pelvic floor is a group of muscles, type 1 muscle fibers, type 2 muscle fibers. We need to take the same principles. We use power, endurance, hypertrophy, strength, and apply it to the pelvic floor. And isolated isometric contractions are really not going to take us very far. And if we are forever doing that at a red light, brushing our teeth, lying in bed, that doesn't translate to, oh, I leak when I pick up my grocery bag, leak when I do push ups at the gym. I leak when I skip rope at the gym. We need to train the pelvic floor with the principle of specificity from fitness. What is it that we want to do? What? Where do we need the pelvic floor to respond and act appropriately? Let's train it to be able to do those things and especially so bringing. I call it the core breath. So the pelvic floor is the foundation of our core, where nobody's ever taught that in fitness. The top of the core canister is the diaphragm, and the two of them work together. Sit. They should be working together synergistically with every breath. Inhales the pelvic floor relaxes and lengthens, exhales, the pelvic floor contracts and lifts. So I use the term core breath to highlight. It's the foundation of the core and it works with the breath rather than Kegels that again people interpret as this squeeze exercise. So we bring the core breath into, we start to layer it into movement, starting out with like a bridge or a squat or a lunge. And then we start to then add load sets, reps, resistance. Then we start to train with power. So more explosive movement. Just like we go through progressive. Yeah, overload in fitness. We need to do the same thing with the pelvic floor, but we have to have that foundation established first. Okay. And the challenge I have right now is within the menopause space, it's you have to do impact. Vonda Wright's telling us to jump, Jocelyn Wittstein's telling us to do impact and Stacey Sims is telling us to do heavy loads and what's heavy. And I agree with all that. However, there's again this population here who have either been told not to do any of that or they have not been doing it because they've self removed themselves. Now they're like, oh, I guess I really should. Now they go and they start to try to lift heavy, but they have not. Yeah, they haven't got the foundation established first, nor are they applying that the principles of progressive overlord overload.

So what about the devices that people sell? Like I see people sell, selling things that you insert or hold, like what are your thoughts around all that?

So devices are, they can be a tool in the toolbox, but if you have the money to spend on those, which usually they're 150 to 250 bucks, take that money and spend it with a pelvic floor physical therapist first to decide if that is what is going to benefit you and your pelvic floor. Okay. So often again the message is you are weak, you need to tighten. This will help you do it. So we buy this device and we think, okay, now again, especially if we haven't been given any appropriate education about how to do Kegels, we're now just squeezing against a device and we might think we're doing the right thing. But as I said before, most people have excess tension in the pelvic floor. So if they're doing more squeezing to add more tension, things are going to worsen. So it's often learning to relax, learning to release, stretching, lengthening down, regulating the nervous system. There's a great practice I, I do called hypopressives, which is really, really great for all of those things. But so many people are like, I want the pill, I want the, I want the device, I want the product. And they spend a lot of money. There's, there's a chair. I won't name the, the brand, but there, there is a magic Kegel chair that people sit on fully clothed and it tells you it's going to do 11 to 13,000 kegels for you. Which sounds glorious. Great. I don't need to do this on my own. Well, you're going to pay thousands of dollars to do that. It is not a lifelong cure. You will have to do it multiple times.

And how in the world is it.

Doing it for you?

Is something going inside you?

It's just, it's, it's energy. Okay. But the majority I have yet to hear somebody in my community who's had any success. I never tell anybody to go to those. I don't want to say that there's like somebody who was maybe spinal cord injury, nerve damage, mobility challenge, maybe they can play a role. They're grateful for certain types of technology. But if you are able bodied and you can do the work. Yeah, you should do the work.

Okay, I've got it. This might be a little bit out of your scope, but let me, I'm going to ask it anyway because no matter who I interview, no matter what topic, we end up at the same place with one thing. You just said so I could be interviewing about gut health, I could be interviewing about thyroid, I can be interviewing about hormones. I can interview about no matter what I interview. And it's just funny that now I'm interviewing about pelvic floor and this just came up again. We always get to downregulate your nervous system. Downregulate your nervous system.

What?

No matter what I interview on. And I think it is one of the most underlooked places overlooked, maybe overlooked like places. The problem is however that the personality that wants to learn all these things like that's listening to my episodes. That's my personality.

Who want.

Who's curious minded tends to be a little bit more of the type A. Like we want to learn. So we hear down regulate your nervous system. There's nothing to do. To do that you have to almost like be what's your guidance there? Because that's. I feel like we hear that and then everyone, it just goes to the same place. Well, you just need to do breath work and meditate and that doesn't really Give people tools. So can you just elaborate a little bit on what you said about down regulate your nervous system and like how you put that into practice personally and how you help people put that into practice.

Yeah. So sleeping can help you down regulate your nervous system. The comments of meditation, that never works for me. I cannot sit there and think of nothing and try to be silent and still I have to stresses me out more.

Puts me more sympathetic.

Yes, exactly. Walking in nature is what helps me. So going for a walk, maybe even taking your shoes off, that is a way to do it. Hypopressive, as I mentioned. So hypopressive hypo means low pressive pressure, low pressure fitness. So a lot of people will experience experience like leaks or pressure in their pelvis sometimes from an increase in intra abdominal pressure. So laughing, coughing, sneezing, lifting, pushing all of that in me standing up from my chair will increase intra abdominal pressure. We all have it, we all need it. It's part of our core control mechanism. When we don't have the capacity to manage like so the pelvic floor not being able to manage those increases in intra abdominal pressure, that's when we have pressure heaviness leaks. Right. And so hypopressive is a postural practice that involves a series of different postures or poses that you then do a specific breathing pattern in. Okay. Also with something called an apnea. Apnea is a breath hold. And when you are in the breath hold, you expand the ribs as if you're taking a breath in, but you don't allow air to come into your body. And what that does is it creates. Creates. So you've probably seen because you've been in the fitness industry and bodybuilding, you've seen like Arnold Schwarzenegger do the stomach vacuum. It looks very similar to that or Udiana bandha in yoga. This, the hypopressive practice doesn't involve a voluntary root lock or voluntary drawing in of the the abdomen. It happens in an involuntary way. The practice itself, and especially after you that like the way you go into an apnea, you exhale all of your air, you hold your breath, you open your ribs, it creates this suction and then when you're ready to take a breath, there's a sharp inhale, sharp sniff which actually releases the pelvic floor. So practices of hypopressive one, the lengthening and the posture is beneficial and helps with again the posture plays a role in the relationship of the diaphragm and the pelvic floor. And that core Breath, but just the breath practice itself is downregulating of the nervous system. And the sharp inhales can release and relax the pelvic floor. So that's more of like people especially who need to do something. You're doing something, but you're not doing the voluntary like root lock or the voluntary pelvic floor activation. So the magic in there is about taking the thought of always needing to do something and just getting to a place where even though I can be doing something physically moving, but I'm allowing something to happen as a result. So it's a, it's a practice of allowing. So that's one. So walking hypopresses is something that I do. Red light therapy and sauna is something else that I do.

However, let me just kind of just throw something out with that because I want to, because. And I am the number one guilty person of introducing devices and biohacking and all that to my audience. So like, and I'm a huge fan of red light and sauna. But I did learn something recently and I just think it's important to share. And this was my own. I know. And the reason I focus in on downregulating nervous system is I believe my root of everything is nervous system system. Like I. I think that's like my next level of what I want to learn. I do think when we focus so much on all these things, like sauna, like red light, like all the things. And I do all the things, I do all of it. If your body has a overactive nervous system to begin with, you probably also have a detox issue. Like you're probably sluggish in other areas. So what happens is when you start forcing things like red light and sauna and you do it too much, your body has no way, it doesn't know how to eliminate all the stuff that, that stuff is mobilizing. So I just want to be really aware when I say that because I think like, because then I'm guilty of this. I'm like, tell everybody do these things. And I'm doing all these things. But what I'm also realizing is sometimes there's nothing better than just going in nature, just doing. Yeah, just doing, not doing all the things. Like have those things, do those things. But it's not an everyday. Like I have to do these things and be regimented, which just can make everything worse. It can actually. You can create other problems from that. So, so I'm. The more I'm learning, the more I'm unlearning too. And I'm really becoming a fan of like, where can we be more in nature? Like you said, you do really well with nature. Where can we get more natural sun? Where can we do more circadian rhythm? So I just wanted to bring that up because I. Look, I'm the first one talking about promoting and I love my sauna. I love all of it. And I'm doing it a little bit less because I'm realizing this.

Yep, yep. Yeah, totally. I agree. And. And yeah, so walking is so valuable. I like hypopressives, to me is my moving meditation. So I do my walk every day and then I do my hypopressive practice. Not necessarily in that order, but I always do hypopresses and a walk every single day. And I do like. Same with you. I like all the biohacking, all the gadgets, but it can be overwhelming. And then there's an anxiety, it's created that you're not doing enough of the biohacking and now so you can get into that stuff state. But they can also. Like there are red light therapy devices for. Specific to the vagina. That's great. And there's a vibration component to them that is a way to, you know.

Yeah. Do you recommend that? Because I've seen that. I've seen Dr. Anna talk about that before too. Like, do you do. Is there one you particularly recommend or do.

So there's. There's Joy, Lex and Fringe are the two main ones. The two main companies. I like them both. I was the Canadian distributor for joylex for many, many years until I closed my E commerce store. Store down The Fringe has come on the market recently. They both have red light, they both have infrared heat, they both have vibration. The benef. But they're set.

It sounds like they're set specifically for this. You're not just putting red light on you, hoping it's doing something. It's not just. It's like a specific setting to help with this.

It's inserted into the vagina. So I'm talking specific to helping release tension in the pelvic floor. Which whole body nervous system. Yes. But also working specifically in the pelvic floor. So the heat can be helpful. The red light is coming in and will help with things like collagen, elastin, lubrication. So sort of the moisture side of things. The heat is relaxing and helps penetrate into the tissues. The vibration. Vibration can kind of be looked at three ways. We can look at it as vibration helps elicit a relaxation response in the muscles. There was Some interesting research presented at the conference. I was just at looking at vibration even externally. Vibration on the clitoris, vibration around the vulva, helping with pain and helping with. With all sorts of different types of pelvic pain conditions. So not looking at this as vibration from a pleasure, although if it goes there, fine. But the. Just the act of vibration and how that can mobilize tissues and elicit a release of tension, so then you can have the release. So for people that are okay with some activation, they can activate in the presence of that vibration to help. Just like we go on vibration platforms, it helps get fiber recruitment. And then of course, you've got the pleasure aspect in there, which I would.

Imagine too, like good sex, orgasm. All that's going to help with the health of all this as well, I imagine. Yeah.

And there's a lot of people not having sex because it hurts. Yep. Because their organs are in the way. Because they're afraid their organs are in the way. And their partner might see because they. If their muscles are really tight, there's not a lot of blood flow and circulation, they have difficulty reaching orgasm. So there's less and less sex happening. Even though sex is very beneficial for me.

Why is it so hard being a woman? Why are all these things. We didn't learn all this in our 20s. We didn't get told, like, hey, you're gonna.

You're 40. When you think what the kids are learning at school, I'm like, how about we switch this? Like, they can come home and watch YouTube for the history lesson, but let's teach kids about, like, we should learn. We need like a PhD in our bodies. We really do.

We do. Because I feel like I'm 54 and I feel like in my 50s. I'm like, what? WTF? Every day, like, what? I didn't know about this thing. What do you mean? It's crazy.

It's bonkers. It's bonkers. And just the process of, you know, social media is a trigger for like every. So much is upregulating our nervous system and the messaging. Even though thankfully menopause is being talked about. But there's a lot of negativity around it. There's a lot of that. You're going to suffer. And there's. Oh, my God, 50 million symptoms. And oh my God. Yeah. That in and of itself is. Now is just an additional stressor. So we have to find ways to remove ourselves from this, whatever it is that's aggravating, creating this. This within us.

Like my number one mission in life I swear this next coming year is to figure out nervous system because I, I feel like I've. No matter what I ask people about it, we kind of get back to, I mean you've, you've expanded a little bit more and I love what you just shared, but I feel like I just keep getting back to like this nervous system dysregulation is the creation of sense. So much stuff. And I don't know that there's like a, there's not a cookie cutter answer for it at all. I mean it's more complicated than, than hormones and gut and everything combined.

So.

But I really. Because I feel like the person that Zen, they, they figured it out, right? But where's the type a person that figured it out? That's what I wanted. Like, I want to know, like, because I think that that is if we can master this and figure out nervous system, like really figure it out, we would really fix a lot of other problems too.

Thousand million percent. And there's a lot of hands on pelvic floor therapists who are now taking additional training in trauma informed response, trauma informed care, somatic healing, whole body work. One of my dear, dear friends who we teach retreats together, she is a pelvic floor physical therapist and she has just completed this, this new certification specific to a whole body approach. Yes, she has the training to help from pelvic floor, but it's not like that's the only place. It's the head, it's the feet, it's the. And it's very touch heavy, which we miss in this day and age. We, we don't have, we're talking on screen right now. We have in person connection. But Covid definitely changed the landscape there. And there's also. Now there's, there's a lot more fear around being able to touch. And is it acceptable to touch? For sure. That's a source of oxytocin and we benefit from that. So her practice has a heavy emphasis on whole body touch and awareness. Vibrant pelvic health is. It's Dr. Brianne Grogan. She's in Bend, Oregon. She's absolutely amazing. And I think we need more of that. I agree.

And to appeal to the person that's not, you know, doesn't want to meditate or doesn't want to go on a rich. Like there's sometimes it gets, it falls into like the two woo woo category. And not everyone wants to go to woo woo. You know, it's like so, so that's what think. Okay, how do we learn More about everything that you've shared. Like hypo oppressive. You said. Like, how do we learn more about where do we start? Like, if someone's listening, they're like, okay, I need, I need more. I need part of this. Like, how do people become part of your community where they learn more? Where, where are you?

I'm, I'm all over. Vagina Coach is my handle on Instagram, YouTube, Facebook. Like most of the time I'm on Instagram. That's where I hang out the most. You can find me on TikTok and YouTube, but YouTube's a good place to go and just kind of look at my channel, look at some things, get an understanding of some of the things that I talk about, some of the ways that I move, how I incorporate pelvic floor into movement, and that might be enough for somebody. I have a few different books. My most recent is called your pelvic floor. So that's again, if people like reading, they can read a book and find that on Amazon and all major bookstores. I have a podcast called between two lips. So again, that's free information for people to just learn from me, but also the amazing. And it's not just pelvic health practitioners. It's like I'm talking to somebody today about sleep apnea, because sleep apnea is directly correlated with why we wake up multiple times a night to pee. So all these things that we don't necessarily tie into the pelvic floor I want to highlight and talk about. Vaginacoach.com is my main website and then my main program. I have a membership community called the Buff Muff.

I love that. The Buff Muff. That is so great.

Yeah. And yeah, it's my joy every week to go, I do community coaching calls with everybody in a group format and I love the group because people think they want one on one. People think their situation is special, people think they need a specific set of exercises. We all need to do really the same fundamentals. We all need to be together as a community and recognize we're not alone in this journey and share our stories with one another so we recognize we're not alone. But also I can learn from what somebody else has just shared. So those to me are one of the most powerful ways for people to heal is to feel heard, to feel seen, to have resources, to have a shared place where they, they, they're not trying to rush through with only being able to ask one question in a seven minute visit, knowing that they're going to be dismissed or being given medication. So good. Yeah, I love what I do. I feel incredibly passionate. Thank you for the opportunity to share with your community as well.

Thanks, Kim.