Ep.60 The Vagina Coach

Incontinence and pelvic organ prolapse can come with sometimes uncomfortable or embarrassing consequences.  So often pharmaceutical or surgical intervention is suggested before addressing the core issue.  The great news is that there are highly trained and passionate professionals out there to help women get back to living life to the fullest.

Kim Vopni is an author, speaker, and pelvic health coach who helps women prevent and heal incontinence and prolapse as a leading authority in health and fitness coaching with pelvic floor dysfunction.

Also known as the Vagina Coach, Kim has a podcast called Between Two Lips, where she connects with other experts to share the latest in technology and information.  Her Buff Muff app, a training platform for women, offers a 28 day challenge to get clients' muffs buff and improve their quality of life. 

In this episode Kim Vopni and I discuss:
- How this fitness coach and entrepreneur entered the world of pelvic coaching
- The most common symptoms of incontinence and pelvic organ prolapse
- Why some of these issues later in life are from our earlier years of birthing babies
- The benefits of belly wrapping postpartum (and why our daughters may want to consider it)
- Kegels - you have to do them correctly to be effective.  What do you need to do  beyond kegels.
- Vaginal rejuvenation options - Votiva, Femlift, ThermiVa, Femtouch
- PRP injections like the O Shot
- Exciting, new innovations 
- The Buff Muff program

You can find Kim Vopni, The Vagina Coach at:
https://www.instagram.com/vaginacoach/
https://www.facebook.com/kim.vopni

Between Two Lips Podcast
https://podcasts.apple.com/us/podcast/between-two-lips/id1666065141

The Buff Muff app is available on for both Android and Apple

_________________________________________
Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling run-down. Faster Way, a transformative six-week group program, set me on the path to sustainable change. I'd love to work with you! Let me help you reach your health and fitness goals.
https://www.fasterwaycoach.com/?aid=MicheleFolan

Have questions about Faster Way? Please email me at:
mfolanfasterway@gmail.com

After trying countless products that overpromised and underdelivered, RIMAN skincare finally gave me real, visible results—restoring my glow, firmness, and confidence in my skin at 61. RIMAN Korea's #1 Skincare Line - https://michelefolan.riman.com

*Transcripts are done with AI and may not be perfectly accurate.

**This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such conditions.

Transcript

Asking for a Friend Podcast
The Vagina Coach
Michele Folan
Kim Vopni

SUMMARY KEYWORDS

pelvic floor, people, called, exercise, prolapse, pelvic floor physical, work, vagina, pelvic health, incontinence, muscles, pelvic organ prolapse, bladder, hysterectomy, kegel, women, birth, started, years, vaginal estrogen

Unknown Speaker  0:00  
In episode nine of the podcast, I interviewed Dr. Michael Karram, who is a thought leader in Urogynecology. As we spoke about incontinence, he highly endorsed the use of a pelvic floor coach as a first line before considering pharmaceuticals or surgery. Pelvic Floor health awareness is gaining great momentum with many more options for women to take control of their health in midlife.

Unknown Speaker  0:36  
Health, Wellness, career, relationships and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, Michele Folan, and this is asking for a friend.

Unknown Speaker  0:55  
Welcome to the show everyone. Our guest today is very busy to say the least. She is an author, speaker and pelvic health coach at Pelvin wellness Incorporated. Kim Hophni helps women prevent and heal incontinence and prolapse as a leading authority in health and fitness coaching with pelvic floor dysfunction. She has helped 1000s of women learn how to do pelvic exercises, ditch the incontinence pads, eliminate their prolapse symptoms and get back to living life to the fullest. Kim also has a podcast and the Buff Muff app, which I think that's such a great name, where she connects with others to share the latest in technology and information. Welcome to asking for a friend Kim Vajpayee, also known as the vagina Coach, thank you so much for the lovely introduction. Nice to be here. First of all, I want to just ask you, how do you do all this and keep your sanity?

Unknown Speaker  1:59  
Well, it has evolved over the years. It didn't happen overnight. My kids are older now. And I have a really supportive husband, I work from home. I have some more freedoms than I used to have. It was harder when my kids were younger. When I was first starting. I've got some people on my team that support me as well, which I'm really fortunate to have. Wonderful. I would like you to just tell us a little bit more about family where you're from school, all that good stuff. I'm a Canadian. I live in Vancouver, BC a little suburb of Vancouver called Port Moody. Growing up, I moved all over Canada. I was born in Winnipeg, and then I moved to Yellowknife and then I moved to Calgary and then I moved to Toronto and then I moved overseas. And I ended up back on the west coast where it was always where we would come growing up no matter where we lived. We would always come back to the west coast because it's where our family was. I have a husband, I have two kids who are ones almost 19. The other is 16. One of them's finished university, the other one just wrapped up his 10th year in high school. Aside from me having to drive my 16 year old doesn't have his full license yet. They're pretty independent kids, which I'm fortunate to have. That's a little bit about me. Well, good. One thing that I have found with doing the podcast is that everybody has a story. I would love to hear how you got into being a pelvic health coach in the first place. It's not a job title. They, you know, growing up thinking I want to be a vagina coach.

Unknown Speaker  3:26  
Again, it was an evolution. And I always say it was kind of accidentally on purpose. But really through growing up, my mom was an or nurse. And she was very open about body health and anatomy. And my brother and I were also curious with questions about what she did as a nurse and all that kind of stuff. Very early on, we learned all sorts of things about the body. And also in my sixth grade of school, we saw childbirth video. And that sort of planted a seed of fear and fascination at the same time. So I came home and I said mom does that would happen to you. And she had a Pz ostomies, which is where they cut the part of the perineum, part of the pelvic floor.

Unknown Speaker  4:05  
Thinking it's creating more space for babies and thinking it was doing a good job. But they've learned over the years that it's really not helpful and could create more harm. But that was what was pretty much standard practice back then. So this is just another note, I didn't I'm not interested in this pregnancy childbirth thing. So I grew up thinking I'm not having children. And then when I met my husband decided I didn't want to start a family. I was really determined to have a different story than my mom and my midwives had recommended a product to me called the epi No, which is a biofeedback device manufactured in Germany. And it basically was invented by a gynecologist from Germany who was in Africa and saw women using gourds of increasing size to prepare their perineum and pelvic floor for birth. And he thought, well, that's great, that's very innovative, but that's not necessarily going to fly in North America. How can we make this more mainstream so he worked with physiotherapist and midwives and other doctors to create this product that is trying to mimic what the

Unknown Speaker  5:00  
gourds were doing but it is a medical device silicone attached to a gate, I use this, I had a great experience. And I thought, how is it that not every single person who's giving birth is using one of these? And I contacted the company? And I said, Could I be a distributor in Canada, and they said, Sure. And it was very easy. And I bought, I think five units. And I again, it wasn't the supposed to be a business, I thought, I'll just do this on the side and help my friends and other people. That's how it started. And it was very much a side business for a few years. And then in 2009, I was laid off from my corporate job. And by now I have two children. And we had moved to Ontario for my husband's work. We didn't have any family close by. I was working full time. My kids were both in daycare. And I thought, you know, I wonder if I could be home with my kids more. And then I thought, well, maybe I could turn this app, you know, the product, maybe I could turn it into a business and I gave myself a year and then three months later I was laid off. So I thought okay, here we go the universe's said, Just do it. And I started a website and started to try to sell this product. It was my first introduction, really to pelvic health. And I started to have pelvic floor physical therapists referring to me, and I'd never heard of them before. So I started to learn from them. And I said, Okay, well, this is a group of muscles, just like we have muscles in the rest of our body. And I've been a personal trainer for many, many years. This is before I was in my corporate role, but I said we should be using fitness principles to train this part of the body. recertified my fitness and I started to build a more elaborate website with other pelvic health products. And I created a course called prepare to push to help women learn about the pelvic floor before there was an issue because what was happening is most people were realizing the importance of the pelvic floor after they were now dealing with incontinence, or they had organ prolapse or chronic back pain, correct. I wanted to come from an angle of prevention, which is where I came from. And then I recognize as I was doing that for a couple of years that the postpartum recovery was also overlooked and not talked about, and we needed to have more sound recovery principles. So I formed a second business called Belize Inc, with two other women, one of which was a pelvic floor physical therapist. And we were trying to take principles that we've seen from other cultures around the world who practice what's called Mother warming, or mother roasting, and they use belly wrapping. And we wanted to couple that with restorative exercise. So we manufactured our own wrap and put it together with exercise. And now I was starting to focus on this Belizian company. My other business was sort of running on its own, so to speak. And we also then said, Okay, well, here we are, we're fitness professionals and physios. And we know that there's a huge void in the fitness industry. So let's create a certification course that helps fitness people understand about the pelvic floor and be able to work with your clients within the scope of what personal trainers do, and fitness professionals do. We did that. And we were kind of juggling all of us had our own independent businesses. And we were juggling this Belize Inc for a while. And that's kind of how it all started. And that's now been, it's almost 19 years ago. Now, just after the birth of my first son, bellies, Inc, we sold the product side of the business in 2020, but still lives on, but just not under our hands. And we still very much support the product that we designed. And each of us are back working independently in our own practices. And actually, interestingly, we've all kind of transitioned more to the perimenopause menopause population, because what we recognize is, so we started with this, let's prevent in pregnancy. And then we all met and started to optimize postpartum recovery. And as we're growing our businesses, all three of us, were now going through perimenopause. And now, two of us, I think, are post menopause. And we said, this is a conversation that needs to span through all life stages. Here I am. This is why I asked you to tell your story because it is very interesting. I give you a lot of credit for bucking the system of it and doing the entrepreneur thing which can be a little scary. But it did combine some of your past experience and being a personal trainer, and it all fits. This is awesome. I did have a question for you back up because you mentioned this belly wrap thing. Can you explain that a little bit because I'm curious about that. Now, when we think of our core, everybody's familiar with the word core and core exercise core fitness that we've been talking about that for years, what has been left out of that conversation is the pelvic floor so the pelvic floor is the foundation of the core. And the pelvic floor also works in synergy with our deep abdominals, and so deep muscles around our spine called the multifidus. So our deep abdominals, the transversus abdominus, some people call it the corset muscle, the pelvic floor and the multifidus. You don't need to know the fancy words. Just think of some deep back muscles, deep abs and your pelvic floor all work together in synergy and that's how we manage our continents. That's how we have organ support. That's how we're stabilizing our spine and pelvis in movement and getting that core control that we are all looking for. When we are pregnant. There is an ever increasing load on the pelvic floor. We have stretch

Unknown Speaker  10:00  
On the abdominal muscles, we have the influence of hormones through different joints and acting on muscle as well. There's all these postural and biomechanical changes that happen that can interfere with that synergy of that deep core system. Another part of that that I don't want to leave out of the conversation is the diaphragm. We call it the core for the pelvic floor or the diaphragm, the transversus. And the multifidus are that inner core unit that are really, really vital and important. The changes that happen in pregnancy and through childbirth as well, whether it's vaginal or cesarean can hinder the synergy between that core four unit, what many cultures around the world view the postpartum period as is like the body has opened during pregnancy and birth, and now we need to support it to close that's very basic wording, but we've had stretched to the abdominal muscles. So the to six pack muscles have moved further away from the midline, there's been stretch to the tissues as well. The pelvic floor the vagina has definitely stretched if you've given birth vaginally, if you've given birth, Venus's area and there's been stretching opening from a surgical perspective, we want to come in and close that to rebuild and regain that core synergy. There's something called form closure and force closure in the pelvis form being the alignment of the bones force being the muscles, we come in with this approach of we need exercises that help retrain the synergy for that force closure. While we are hindered in the form closure with all the changes that have happened in and around the musculature in the bony pelvis, we can help from a form closer perspective with wrapping and many cultures call it belly binding, we always call it belly wrapping. And it's actually kind of more like pelvis wrapping as opposed to just belly. We come in and try to almost quote unquote, close the bones by providing some support by wrapping around, if you think about where you put your hands on your hips, if you're feeling angry, those are your hip bones, your part of your pelvis. So just a little bit under that wrapping around. We always used to talk about it like when you take a brand new baby and you wrap them up really, really tight. Can't think of the word for that swaddling, swaddling Thank you very much. So we always used to call it swaddling the mama, like we swaddled our babies, and it makes them feel secure. And then when we put this wrap on, it offloads the tissues in a sense, but also provides support. And then when we add the exercise, it can make it easier to sense and feel. And because we have that additional support, when we're working on the recovery exercises, people can feel them better, and they start to become more effective than if we didn't have so we were noticing this in our own clients and patients. And we just took inspiration from Southeast Asia, they have been Kung rapping. And we looked at all the other cultures and what they're doing and we combined it with a bit more mainstream Exercise and Movement focused, created. We call it the ad rep the after baby but AB for abdominal as well. The reason I wanted you to explain that is even though this audience is older, or midlife 50s Plus, we have daughters now that are having children, and I think it's important information to share. I appreciate you don't get to that. It's also important that many of us even though we're in this perimenopause, menopause stage of life now many of us have been pregnant and given birth at some point. And that separation to the abdominal muscles, that all of the changes just because we're not newly postpartum. It doesn't mean that we can't benefit from the retraining, I wouldn't necessarily put somebody in a rap right now that is really more designed for that early postpartum. But the restorative exercise piece is hugely important. Oh, for sure. For clients now that come to see you say they're our age and 50s, maybe even 60s, and they're coming to see you what typically are their symptoms, what are their issues that they're dealing with? The two most common for sure are incontinence and prolapse and also linked in there is back pain and also sometimes pelvic pain. So those would be the most common incontinence and prolapse are the two most but back pain is very closely tied to pelvic floor dysfunction. So that's usually a piece of the pie, no pun intended.

Unknown Speaker  14:20  
leaking urine, feeling like they have to wear a pad all the time feeling like they maybe can't make it to the bathroom in time. So they have some urgency. Also feeling like they have to go to the bathroom all the time. So people will say I have an overactive bladder or I have a very small bladder. They self diagnose themselves as having overactive bladder, which is a medical condition. But oftentimes when people are going frequently, they've trained themselves actually to do that. It's not because they actually have the medical overactive bladder. This isn't as common but it is something that people can experience as well which is anal incontinence. So that's where gas or stool can leak out. Urinary Incontinence is where urine comes out of the body

Unknown Speaker  15:00  
When we don't want to and then you know incontinence would be gas or stool. Then on the prolapse side, pelvic organ prolapse and June is actually pelvic organ prolapse month and this week that we're in recording this it's world continents week. So there's some attention being drawn to the pelvic floor, which is great. Yeah, my timing is so good. I don't even know it. I know, serendipity. pelvic organ prolapse is where the bladder, the uterus and or the rectum can shift out of their proper anatomical position and bulging to or descend into the vagina. And statistically, actually, prolapse is more common than incontinence. So incontinence is usually kind of the 30 to 40% and pelvic organ prolapse, for women who have given birth is about 50% of the population and many don't even know they have it because it can be asymptomatic at early stages. And it's not something that is typically screened for even when we go through paps and other things people always say, But why wouldn't my gynecologist have told me this. And typically, unless we've gone presenting with symptoms that could be associated with a prolapse, they don't always disclose that you have one which I hope changes. Those would be the two most common in in pelvic pain, that's a very broad category. It could be pubic joint could be tailbone, could be painful sex, it could be vulvodynia, so pain without touch, even just pain with the thought of insertion Dajin isthmus. There's lots of different categories under the pain side of things. And then low back pain we had one Canadian study looked at women presenting with low back pain and 95.3% of women with low back pain had some form of pelvic floor dysfunction. That's usually part of what somebody they don't necessarily know that it's associated until we start to address it. But when they start to optimize their pelvic floor, their back pain improves. Wow, you were talking about incontinence and stress incontinence would be maybe from running, jumping, walking even. Yeah, stress urinary incontinence is the most common. That's what all the ads are telling us that it's like bladder leakage. And it's just part of being a woman. And I disagree with that. Standing up from a chair, getting out of bed to walk to the bathroom in the morning, doesn't have to be super high impact activity, laughing coughing, sneezing, jumping, pushing a door open or anything that's increasing our intra abdominal pressure. So if you think about that core four that I described our diaphragm on top, pelvic floor and bottom, deep abdominals in the front, multifidus in the back. Inside that core canister, we have something called intra abdominal pressure. And we all have it, we all need it, it's part of our core control and stability. And different things throughout the day will increase that and decrease that. And we can't say that every single person when they stand up from a chair, there is x amount of pressure being created. It's different across people, it's to do with strategies, all sorts of differences in their variables. But if we manage the pressure, well, if the pelvic floor can accommodate that increase in pressure from above, then it closes the openings and nothing comes out and we're good. If we aren't managing our pressure, well, that standing up from a chair or that cough or sneeze or whatever it is, when the pelvic floor can't react at the right time or with the right amount of force, then we may have leaking, or we may have less support for the organs or we may start to have some discomfort and pain and start to compensate. Because we don't quite have the capacity in place. So that's stress incontinence or stress urinary incontinence. Urgency is where we something triggers us and we maybe then have these alarm bells, like I have to get the bathroom right now and we might leak a little or we might lose complete control. And we can have a mixture of the two of those which is mixed incontinence. And then analyze I mentioned this gas or stool. I mentioned to you that my dad was a urologist. He called that garage door urgency. Yep. Because he says it always happens when you're waiting for the garage door to go up and you have to pee like all get out and garage door just doesn't go up fast enough. Yeah, it's also called key in the door syndrome. Yep, key in the torso.

Unknown Speaker  19:10  
That's funny. Can we train our bladders? If we go a little longer and hold it? Can we effectively train our bladders not to do that at times 1,000%. A big part of overcoming incontinence is understanding some of the behaviors, maybe some of the dietary lifestyle choices that you've made that are contributing to some of what you're dealing with. Part of the urgency or feeling like you can't make it or we're starting to leak a little bit. It can be from things like not drinking enough water. When we are afraid of leaking. We are afraid we might have urges or we feel like we're going all the time. We're just going to say Alright, well I'm just not going to drink water and then I won't have anything to leak out and then I won't have these urges to go so it seems logical. But our bladders they don't lay

Unknown Speaker  20:00  
I concentrated urine. And if we're not drinking, the urine becomes very concentrated that's irritating to the bladder and it's going to signal more strongly and more often to empty. Staying very hydrated is a part of the retraining process and part of overall bladder health. It's also helpful for constipation, because a lot of people dealing with pelvic floor dysfunction also have constipation. And constipation can contribute to incontinence, and prolapse. Constipation can also be a result of tight pelvic floor muscles that aren't relaxing to allow complete emptying either. We'll talk about that after but we need to make sure that we're pooping well, so drinking lots of water will help with that. And we also want to make sure that our urine is not overly concentrated, we can use a bladder diary to help us identify some of the more common bladder irritants and if they are irritating to us. So the more common ones would be caffeine, alcohol, artificial sweeteners, acidic foods, spicy food, for some dairy for some, those are kind of the more common doesn't mean that all of those are irritating for everybody. But if you start to track, and notice that every time you have your coffee in the morning, you have stronger urges, or you may leak or you have to go more often, that's possibly a trigger for you. Okay, and then it's behavioral as well. A lot of people as I mentioned, if they think that they're going to leak or they think that they aren't going to make it to a bathroom in time, they may start to go just in case. But I had a client who she was a golfer, she's retired, she's never given birth, she was 65. I believe at the time, chronic low back pain, always going to the bathroom and leaking. She was always wearing a pad. And she said, I have seen my mother, I've seen her and depends, I do not want to be like my mom. She was paying just before she left the house, she'd pee when she got to the golf course she'd be at nine holes, she'd pee when she finished she pee when she left to go back home, she pee when she got home, like it was just like constant. Part of it was retraining and just saying okay, you may feel an urge, but you've trained your bladder, because you're going so often your bladder has got the signal like Pavlov's dog that you want to empty when it's half full, as opposed to completely full. So now we just have to give it new messages and say we're going to delay that and retrain it, we're going to talk to our bladder and say, I know that I've contributed to this, but we're going to do it now differently. Make sure you stay hydrated, strengthen the pelvic floor with exercise. And in her case, and for most in the age category were in I would add in vaginal estrogen as well. Is there a genetic role here with incontinence? There is some evidence to show that there could be a genetic link. I don't want to put all of that to say that if you if your mom did you will for sure. Or if your mom didn't, you are scot free, it can play a role. Yes. And it can also be connective tissue related as well, potentially, there is a bit of a connection there from our heritage, but I don't want to put all the eggs in that basket. Okay, I know my dad used to always tell us to do our kegels. If he was still alive, he would be 92 He was old school. I know exercises for pelvic floor have changed a lot. And it's gone way beyond kegels. Can you explain what's happened there in that world of exercising, and how you can effectively help patients, it has changed. I think the messaging has gone through all sorts of different routes of this is good known now it's bad now, okay, now who's doing this but differently. And really, at the end of the day, it's key goals. key goals are a great exercise, they are very evidence based. We have loads of evidence to show that they work when they're done correctly, and when when they're done consistently. But so many people we also have research to show don't do them correctly. And that's not their fault. We've never been taught at any point in our life, we ever been taught how to do key goals. And so we might have been told a couple of times here and there. And then we go to the intranet, and it says it's the muscles that you use to stop the flow of urine. And then some people think that we should be doing it on the toilet and but we need different cues, we need a full pelvic floor assessment really to really ensure that we're doing them correctly. But we also have now and this is kind of my bias and my approach. Keep those alone while they are effective. And while they do work, most of the time you're doing them maybe laying down in your back or seated. Some people do them at every red light in their car. And

Unknown Speaker  24:26  
while that's better than nothing, if you're doing them correctly, that's better than nothing. It's not training the pelvic floor dynamically. And when we talked earlier about intra abdominal pressure and needing the pelvic floor to react at the right time with the right amount of force. If we're not training it during movement, we're missing a big piece of the puzzle in my opinion. My approach and what now more and more research is supporting is yes, let's do Kegel is let's understand the connection, how to activate and relax that group of muscles. There's also a lift component it's not just a squeeze there is a

Unknown Speaker  25:00  
bit of a lift, and then there's a let go. And it works in synergy the pelvic floor with that breathing diaphragm. So think to that core four diaphragm on top pelvic floor on the bottom. When we inhale, the pelvic floor lengthens when we exhale the pelvic floor contracts and lifts. The exhale is where we want to add on our Kegel are our core cues that as I call them to activate, but we want to make sure we're relaxing as well. Once we kind of get that mind body connection, we start to incorporate it into the breath, and we want to add it into movement. So we may start with a gentle movement, like a pelvic tilt or a bridge exercise, then we can get into things like squats, or push ups or even bicep curls with resistance training, we're taking the principles of fitness, where if we want to build muscle, if we want to get stronger, we need to impart a load that we need to adapt to. Once we have adapted and it's becoming easier, we need to then progress ourselves. The pelvic floor is really no different. It's a group of muscles like we have in the rest of the body. And just doing three sets of 1010 second hold key goals every day, we get to a point where it's like, yeah, there's no more room for improvement. We need a little bit more variety, and we need some more challenge. It's not that the Kegel has necessarily evolved, but we've gone through people saying eagles are bad. Kegel had been demonized. Some people say if you have a tight pelvic floor and never do Kegels, then we have other people who like just do Kegel is all the time 300 day and you're you'll be good at settle in here saying we need to understand what the person's pelvic floor would benefit from, right? Do they need a little bit of focus on relaxation to start, but I'm never going to say never do Kegels. And I'm also never going to say just do 300 giggles I'm going to make sure that this person has a whole body movement approach where they are training the pelvic floor dynamically, as you were talking about the breath and the diaphragm and everything. I started sorry, breathing for eating and doing Kegel because it just gets in your head. Yeah. Okay. I want to know what that feels like. Yeah, and most people, when they start doing that, they think, Oh, I've been breathing wrong, or I've been doing it the opposite way. Your breathing your life. It's not that wrong. But physiologically, the pelvic floor lengthens on the inhalation and activates and lifts on the exhalation. When we slow down and try to get that mind body connection. It's kind of an aha moment for people. And it can be very cathartic and relaxing as well. It's like, I call it the core breath. And when you do the core breath, and you're actively thinking about lengthening and blossoming, your vulva and expanding your sit bones and then activating with some sort of a cue, like, pick up blueberries with your vagina and your anus or sip a smoothie through a straw with your vagina. All of a sudden, it's like, oh my gosh, this makes so much sense. I have been doing them wrong, or I've been breathing opposite. They just have this newfound connection that is really, really helpful. You have to think about it though. Oh, yeah, you got to train yourself takes a lot of coordination. That's the most common thing people say is it's gonna take me a while to get the handle of this. But the more you practice, yeah, as I'm sitting here, I'm like,

Unknown Speaker  28:09  
I have to work on this one. I do want to talk about the different challenges so pre and post hysterectomy so you work with patients who are post hysterectomy, I assume? How are their challenges different than someone who is pre hysterectomy. I work both pre and post and not just hysterectomy. But any pelvic surgeries, hysterectomy in and of itself. There's different forms of hysterectomy. So it may just be the removal of the uterus. It may be the uterus and cervix and maybe fallopian tubes. It could be all sorts of different iterations and there's also different approaches to hysterectomy. But overall, when we take the uterus out of the body, it's like a keystone, Oregon and there then is a void where the uterus used to be. It's a space where other things can start to shift into having a hysterectomy increases your risk of pelvic organ prolapse. You know, great. If the reason you had a hysterectomy was because of pelvic organ prolapse, that risk is further increased. Now, again, part of why I preach pelvic floor physical therapy so much and why I'm hoping that messaging in the medical system changes a little bit and becomes more collaborative with pelvic health professionals is women are not told that women are not given that information, especially if they've had a hysterectomy because of prolapse and they removed another symptom free of anything amazing and they go back to their life and they haven't done any rehab or restoration and then now they're like, I had a hysterectomy, whatever a year two, three years ago and now I've got a bladder prolapse. had they known of that increased risk, then I feel like we can mitigate that. Again once they've eliminated symptoms like maybe they've been had tried pelvic floor exercise before and it didn't help and they choose surgery which there's an absolutely no shame in having a hysterectomy for whatever reason.

Unknown Speaker  30:00  
I argue we need pelvic floor exercise and physical therapy even more after any type of pelvic surgery. To manage the scar tissue, make sure we have optimal blood flow and circulation making sure we have balanced contract and relax of those muscles. And that we are aware of our, our movement biases, like what do we do for movement? And is there strategies we're using that we aren't managing our pressures well, and then how could we then change our movement so that we are managing better and maybe incorporate something like hypo presses, that's an exercise technique that is really great for pressure management. But that information is just not shared. A lot of what I'm doing is helping people become aware of that increased risk, making sure they're working with a pelvic floor physical therapist to help with the scar tissue management, but also making sure they have that internal evaluation at least once a year for screening purposes. And then I'm helping them manage their movement, most often with Hypo presses and also my buckmoth approach, which is I explained earlier, pelvic floor, Kegel with whole body movement exercises. And then there's also a hormone piece in there that I want people to consider as well, because I mentioned vaginal estrogen is something that I would recommend for women around 4550, somewhere in that starting in that zone, and staying on it for the rest of our life. So we have estrogen receptors all throughout our vaginas in and around our bladder. And when we are no longer producing estrogen, and there's not as much estrogen circulating around, the tissues become thinner and drier. And that can increase our risk of UTIs. It can contribute to painful burning sex. For some people. It increases urinary incontinence and frequency and urgency. When you remove the uterus, even if you have left the ovaries in, more and more research is showing that that will be surgical menopause. But a lot of people say well, if you kept your ovaries, then your hormones are fine, but we're showing that it is happening sooner. So I would want to have them work with a hormone practitioner, getting somebody started on vaginal estrogen, but then also potentially systemic estrogen if needed for that. Brain Health and sure bones and all the other things. I am on the vaginal estrogen, I will tell you, game changer. It's amazing. Awesome. I want to talk a little bit about I know you were talking about exercise, are there aids or tools on the market that you will recommend to patients, exercise tools or pelvic health tools or even I've seen some at home type of laser Kegel exercise or things? Absolutely. But my disclaimer there, my caveat is it's never my first recommendation. Okay, if you have money to purchase one of those devices, you have money to go see a pelvic floor physical therapist, if you have that geographically accessible to you, I always recommend that you put your money into a pelvic floor physical therapist assessment first, that teaches you a lot it will help you understand why do you have these symptoms, it's kind of root cause medicine in a way, we have all these amazing devices that are out there. But if we're just constantly buying these, and we're throwing them into our vaginas, and we're following this practice, if we're not actually using the muscles appropriately, and we don't quite understand why we have these symptoms. I don't mean to bash allopathic medicine, but it's like the pill for the ill naturopathic and functional medicine is saying, but why do we have this? Let's figure out why. And then we can start to address it. I think pelvic floor physical therapists first help us understand the why. And then if we could benefit from some sort of device, my favorite ones I really like the V sculpt V sculpt is the name and Canada in the United States. It's called the Wii Fit. It is a device that uses red light therapy, infrared heat and Sonic vibration to help with lubrication. And it can also help with B think of whole body vibration platforms that you stand on that, yeah, help recruit more muscle fibers. It's kind of the same philosophy. If we do our key goals against that vibration, we can get more blood flow and circulation. But then the red light and the heat are penetrating and helping with collagen production as well. We're losing that as we're aging, and this is a really good way to help offset that. So that's one of my favorite devices. I really love that one. Kegel weights can be really helpful. I was talking about we want to progress we want to have some variety in our pelvic floor exercise routine. If somebody knows how to do Kegel correctly, they've coordinated into movement, they're looking for some way to progress. Maybe that's now the time we could use some Kegel weights. There's a couple of different varieties or some that the weight is on the inside. So we inserted into the vagina and then we could do our pelvic floor contractions with it inside in various different positions. Some people put it in and wear it during their shower, for instance, there's also somewhere that weight is actually outside the body so it weightless a egg shaped part is inserted into the vagina and the weight actually hangs outside so the weight moves around a little and we have to manage that which I think is really a

Unknown Speaker  35:00  
Innovative as well, oh. And then we have things like parry fit and the LV, which are biofeedback devices, and they attach to apps on our phone. And so a portion of it is inserted into our vagina. And there's a Bluetooth piece that is outside that signals our app on our phone. And it gives us feedback. So when I contract and lift, it should register on my app as some sort of movement. And it's usually in the form of a video game, like you're a bird in the sky, and you have to avoid the clouds or you are frog that has to jump over mushrooms or something like that.

Unknown Speaker  35:35  
Those can be really helpful, especially for people that don't have access to a physio, they can at least give you an idea of Do you have an element of this contract and relax capacity within your pelvic floor, and it can help build up that coordination. And it's more engaging than Yeah, just doing Kegel. So of course,

Unknown Speaker  35:54  
I like those as well, they can be helpful. But again, I would never recommend those as my first right line of defense. That's something that I think can be supportive. Once you've laid the groundwork and you've seen a physio, I agree with you, I like the idea of getting a really good idea of what your issues are. So you know what to work on. Otherwise, you may just be shooting in the dark. We have talked about vaginal rejuvenation on the podcast in the past. And do you ever recommend that as an option for patients that can afford that? Yeah, it's again, never what I would recommend first, but if they've tried a lot of other approaches, and they're still not quite where they want to be, then there's tons of different types now out there. Some have more robust evidence than others. So I would make sure that the person really understands if somebody who's not aware of all of the different types and they see vaginal rejuvenation, they just think that that's the same that everybody gets. There are some that are ablative lasers, there are some that are radiofrequency there are some that use heat, understanding what that clinic is using and doing your research. And not just the pamphlet that they provide you do your own research about what is help with, like Mona Lisa touch does have some decent evidence behind it, especially for the population we're talking about here. So that's one there's diva. There's Thermae. There's Vivi like there's so many different ones, I was offered a trial of a Vive once, just to get a sense of what it felt like I didn't have any issues for me to be able to report back on it just felt like just like a wand that's inserted in it. And it just felt warm, felt quite warm. And it was okay, relaxing. And it was nice, but some of them are ablative, and sometimes they require some numbing creams, and you'll have some downtime, make sure you know what you're getting into, and that it's going to help with what you are trying to address. I think we're lucky that we have all of these things. But they're expensive, and they're not a lifelong fix. Be prepared that this is something that you potentially would be doing on a regular annual type basis, usually, like it's two to three sessions to start and then maintenance. It's costly. I've had some people that have absolutely zero results, and I've had others who have had some success with it. It's a bit of trial and error. I appreciate that. That's really great advice. The message I keep hearing you say is you got to work on the foundation first and work on the core issue. Part of the podcast is that I do get questions from listeners. And I did get a few. Awesome. I thought I would ask you a couple of those. Do you work with men who have bladder leakage? Well, I don't work with men. That being said, they have a pelvic floor they have that core for like we do. The mechanisms as to why they may experience incontinence are typically different. They're not birthing babies, we're talking people born with the male anatomy, the cueing would be different. So as I mentioned, just I threw out a couple of cues like imagine sipping a smoothie through a straw with your vagina or picking it blueberries with your vagina in your anus. What was researched for men actually was the best Q was shorten your penis. And what then became adopted was pulled the turtle into the shell.

Unknown Speaker  39:11  
Not a lot of men want to think about shortening their penis.

Unknown Speaker  39:15  
They do the same breathing like core breath, but they would just inhale and they would think about spreading their sit bones. They don't have a vulva to blossom. So we would think about lengthening the perineum. And then they would think about as they exhale, pulling the turtle into the shell or pulling your scrotum away from a flame or walking into a cold lake or making your penis damp. It's the same principles. It's just different cueing. And again, when we go back to root causes very commonly with men, it's prostate. It's around the time with prostate challenges that this will start to show up for your female patients and your male patients. How long does it take to start to see results if someone's being compliant, if somebody's being

Unknown Speaker  40:00  
consistent and doing things correctly, my buffer off challenge is 28 days, 10 minutes a day. If somebody is doing that people notice change within the first couple of weeks, very few people have a complete cure, all symptoms are gone. But they definitely notice like I had a comment the other day a woman said, I didn't go to the bathroom before I went to bed. I slept through the night and I woke up and went for well, she went to the bathroom, but then she went for a run and she didn't have any leaks. We're on day 20 of the June challenge. So 20 days in it change can happen very, very quickly with not a huge amount of effort. Yes, there is a little bit of effort involved. But it's not like I'm asking you to do a whole extra hour. Yeah, of exercise. No, in a day, it's 10 minutes. And once you get those fundamentals, you can coordinate it into the work that you're already doing. It can happen in as little as two weeks, I would say it would be more like around the month to two month mark where people are feeling like their symptoms are significantly improved or totally gone. That story that was a big win. I think that's fantastic. We have wins like that all the time. And it's life changing. One woman I remember from, I think it was the very first challenge ever ran. And her comment was, oh my god, I haven't had to buy pads that I have been wearing for 10 years. Oh my gosh. And when you do the math on how much money people spend on pads, if we ended up over a lifetime, it could be upwards of $70,000 Oh, God, then think about what's happening to our environment, right. So when you can get rid of that need, it's life changing their sex life improves, you can participate in activities that you're avoiding before you start to poop better, it's life changing. The other thing I'll just say on my little caveat there, change can happen very quickly. But I always every single time I do a challenge, I'll have somebody coming in, hey, I did your challenge two years ago, and now I'm back because I didn't stay consistent with the exercise. And so I'm back again, it's a lifestyle that I'm trying to create here. It's not just a Get in 20 days later, you're cured. You never have to do it. Again. It's a philosophy. It's a life commitment. But just listening to your patients stories. It's a quality of life issue. Huge. It can be huge for people. I would love to know what you see on the horizon for incontinence and pelvic floor advances, anything cool coming down the pike. What's interesting right now is stem cell therapy and PRP. So when we think about the Medi spa, some of which are offering vaginal rejuvenation, a lot of them have the Vampire Facial. And some people have seen this where it's micro needling but we use our own blood, not the blood but the plasma. PRP is platelet rich plasma blood is drawn from our body and put in a centrifuge, they take out the plasma and then re inject it into parts of our body. So it's used regeneratively and skincare, all sorts of things. There's something called the O shot, which the way it's marketed is for improved sexual response and orgasm, the PRP is inserted right around the clitoris and into the front wall of the vagina. That's the on label. That's what it's used for. However, there are off label uses that we're looking at could this potentially help with other things like lichen sclerosis, which is a skin condition that is really quite painful and difficult to manage for some people. That is cool. And stem cell therapy is another piece of regenerative medicine that I think has huge potential here for especially people who have birth injuries where there's been some disruption to the muscle and some pulling away of the muscle from the tendons that attach to the bone that no matter how many kilos you do, no matter how much vaginal rejuvenation, whatever, it's not helping. I think that there's some really cool promise there. There's also I recently interviewed a woman. She's a professor doctor in Australia, and she's using stem cell but also 3d printing for pessary. So pessaries are like orthotics for a pelvic floor. And they can be very, very helpful for eliminating symptoms and bother from pelvic organ prolapse and providing support to the walls of the vagina so the muscles can work better. There's also another company in Canada doing this another company in the United States that are using imaging technology to look at that individual person's anatomy and then 3d printing the appropriate support for them, which is super, super cool. The Canadian one I know they're in their clinical trials right now the United States when so I'm not sure where they're at and the podcast episode was fairly recent on mine with Professor Garbutt. That's all kind of cool. I think there's always new and interesting surgical approaches as well. So another doctor I interviewed Dr. shoebury. He is specifically working with people who have had those birth injuries that to date have been considered inoperable, and that's just what you have to live with. But he's using

Unknown Speaker  45:00  
3d ultrasound, pelvic ultrasound to really get a full picture of the anatomy and using some pretty cool surgical techniques as well. Lots of things lots of stuffs happening. That is awesome. There's hope. Absolutely. But it starts with you, Kim does start with you.

Unknown Speaker  45:16  
You do have a podcast, it's called between two lips. I highly recommend people check that out. And then if there's anything new you're working on, and also tell people where they can find you. My website is vagina coach.com. And if you go to any of the social media channels and put at vagina coach, you'll find me, I run a monthly challenge. The first of every month that new buffman challenge starts. So that's held in my buckmoth app. If you go to the app store and you go find buff MUFE app, there is a free pelvic health one a one that anybody can have access to that give you some of the foundations of what you need to know and learn and how to do the core breath and how to coordinate it into movements. It's a good place for people to start understanding what my philosophy is, and then they could choose to join into the full challenge if they want to. Well, I am going to check that out. Awesome. For sure. I appreciate the tip. Kim, thank you so much for being here. I really appreciate it. I appreciate you having me Thank you.

Unknown Speaker  46:22  
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