Vai Kumar: 0:10

Welcome to Freshleaf Forever, a podcast that gives you fascinating insights week after week. Here's your host, vaikumar. Hey folks, welcome to another episode on podcast Freshleaf Forever. Have you wondered why pelvic health is seldom discussed? Well, that's why our guest, kim WapneyV, is here with us today on the show. With us today on the show because we both strongly feel it's time for pelvic health to be discussed and offered to women at all stages of life. It's time to break through taboos and redefine how we think about women's health, and not just like bladder leakage women's health and not just like bladder leakage, which oftentimes is considered just part of being a woman. But there's so much more challenges that women face when it comes to pelvic health.

Vai Kumar: 1:17

Our guest, Kim Vopni, is a restorative exercise specialist. She's a public speaker, a book author in fact, multiple book author and she's also the host of a thriving podcast, between Two Lips, where she brings guests and thought leaders to address several matters pertaining to pelvic health. She is also a certified personal trainer, a certified pre and postnatal fitness consultant, a certified Pfilates instructor and a hypopressive method trainer. She is a certified menopause support practitioner as well. So it's with great joy that I bring Kim Vopni here to podcast Freshleaf Forever. Let's get to the episode. Hey Kim, welcome to the podcast. How are you doing today?

Kim Vopni: 2:19

I'm doing well. Thanks so much for having me.

Vai Kumar: 2:21

Well, I guess a lot of women's topics. Whatever women go through, definitely, they remain silent for the most part, and first of all, I want to start by thanking you for your work. So, when it comes to women's health, like I said, a lot of topics are considered taboo. So why, would you say, pelvic health is so significant, kim?

Kim Vopni: 2:51

Well, thank you for having me on your show and for the support and kind words. I really appreciate that, and podcasts like yours are a way of helping break down this taboo and getting this information into the hands of of more listeners and um empowering them. So the I mean there's the, the umbrella of women's health, which has historically always been underserved, I would say I, you know, women haven't been included in research until really fairly recently. And, uh, and that's really shocking when you think about it, and one of my favorite the guests that I've had on my podcast, dr Stacey Sims, has the term women are not small men and we deserve our own research and we shouldn't just be, you know, because we're a smaller person, to just back off the dose of a drug or something like that. So there's the women's health umbrella, and then there's pelvic health, which is, I would say, even more underserved, starting to become more. In the years that I've been doing this, but because there's discomfort with even saying the word vagina there is, you know, I've had multiple posts taken down from social media for you know, saying that it is inappropriate because I use the word vagina and or sex, or you know, it's kind of mind boggling when you really think of it. Thankfully there's been some progress and now I can use the term vagina openly.

Kim Vopni: 4:31

But there's a cultural perpetuation of shame and taboo and embarrassment and we don't talk about that and in, for instance, my mother's generation so I'm 53 and my mom will be 80 this year and that generation was very much you don't talk about that and you just just carry on and it's not discussed. My mom thankfully she was very open with my brother and I. She's a. She was an operating room nurse. She was very. She told us the proper terms. She was an operating room nurse. She told us the proper terms. She told us about the body. She taught us things.

Kim Vopni: 5:10

At the time it felt uncomfortable when you're learning it with your brother, but I'm thankful that she planted that seed of normalizing our bodies and being able to identify parts and not using code names or strange names to name something like a vagina or an anus or rectum or something like that. So I think that is kind of part of what has a few things that have kind of perpetuated or created this taboo or don't feel comfortable talking about it, what I see now social media has played a big role feel comfortable talking about it, what I see now. Social media has played a big role. I feel like the younger generation is much more open to conversations around things that are uncomfortable to talk about.

Kim Vopni: 5:53

So, there's, there's a lot more voice being brought to, to differences and and that type of thing. So I'm, I'm, I applaud that and I'm super excited because I think generations to come will be more informed much earlier on and I feel like there will be, as a result, less, less suffering.

Vai Kumar: 6:14

Yeah, I mean when you said you know, even some of your social media posts and stuff were taken down earlier. Yeah, whatever, when you say vagina, it's misconstrued for something inappropriate that you are putting out to the digital world and digital community, right? Yeah, you're trying to do the right things in terms of propagating awareness, in terms of educating people on women's health. Yeah, sometimes we just have to fight the hard battles, but I think it's worth it. So what role does tightness of the pelvic floor play, then, when it comes to women's health, or anyone's health, say, right from constipation? A tight pelvic floor, I believe, is like a hindrance, right? So what would you say to that, kim?

Kim Vopni: 7:03

Yeah, the pelvic floor is a group of muscles, so it's not just one muscle, it is a collection of muscles and it's this you know some people describe it as a hammock or a sling. It's the muscles that connect, they attach at the pubic joint, the tailbone and the two sit bones on our side. So those four points sort of make a bit of a diamond shape. And the muscles that close off the base of our pelvis is considered the pelvic floor and its roles are to support our spine and pelvis, to support our internal organs, to manage our continence, play a role in our sexual functioning and also work in relationship with our breathing diaphragm for things like circulation and moving lymph, basically moving things through our body. So these are really important jobs and we've never been told any of this. We might have heard the term Kegels. We don't appreciate that, like other muscles in our body, they like to be taken through a range of motion, they like to be strengthened, they like to be lengthened and we need a balance of length and strength in order for those muscles to do all the jobs that they need to do. And what is now? Now, I personally don't work with people, I don't do internal evaluations, I'm a personal trainer and I apply fitness techniques to the whole body, but specific to the pelvic floor. And then there are therapists, pelvic floor physical therapists, who can do internal evaluation and treatment, and my colleagues in that space will tell me that it is becoming increasingly common for people to have tightness in the pelvic floor, and there are certain things that can contribute to that fear shame, uh like trauma, either psychological trauma, trauma, uh, that could be physical, from a fall, maybe surgeries, um uh, pain, um like. I can go on and on the.

Kim Vopni: 9:11

There's a long list of contributors to what can contribute to tightness. There's also then the symptoms that people experience, such as incontinence, so that's where urine or gas or stool would leak out of the body without us wanting it to come out. That symptom can then indirectly also create tension, because when we're afraid of leaking, whether it's gas, stool or urine, the muscles are kind of on high alert. We are on high alert, our nervous system is on guard. Same if we have another condition called pelvic organ prolapse, where the bladder, uterus rectum can start to shift out of their optimal position. Part of the role of the pelvic floor is to support those organs, and if we have this sense of vulnerability and feeling like something's going to fall out. We're going to be guarding.

Kim Vopni: 10:02

So the symptoms from pelvic floor dysfunction. We could have those symptoms because of tension, or we could develop tension because of those symptoms, or again because of all the other things that I've already listed. So, kind of getting to the root cause as to why do we have this tension, and then knowing that we have an option, an opportunity, lots of opportunities to let go of that tension. But if we have muscles that are overactive, non-relaxing, not lengthening appropriately, if they're held in sort of a short, tight state, then their ability to react at the right time if we laugh, cough, sneeze or jump, react with the right amount of force needed to offset that increase in pressure from that activity is going to be hindered. So that's like very kind of high level how tension can interfere with the function of that group of muscles.

Vai Kumar: 11:03

Okay, you mentioned fear. You mentioned a lot of psychological trauma and factors like that. We all live in a virtual world now. Could prolonged sitting also be a root cause of all the pelvic floor dysfunction? Potentially can that build up over time.

Kim Vopni: 11:21

Yeah, yeah, I'm glad you brought that up. It didn't say it on the list there. But posture how we hold ourselves through the day, and prolonged sitting so prolonged sitting can be can hinder us in many, many ways. But usually if you're sitting in ideal posture and you're and and that and you spend your whole day there, that's better than sitting with poor posture the whole day, but it's still not moving that much. We benefit from a diversity of movement, as does the pelvic floor, rather than being static, and our whole body would benefit from more movement.

Kim Vopni: 11:55

But most people, over time, as they're sitting, they start to slouch, their tailbone starts to kind of, they lose the curvature in their low back, their pelvis is tilting underneath them, they're hunched over usually.

Kim Vopni: 12:09

So all of that is interfering with the relationship of the diaphragm and the pelvic floor that I spoke about earlier. So we're not breathing as well, we're not breathing as deeply, we're not getting that synergistic movement of the pelvic floor with our breath. The muscles are adapting to a shorter state, so over time they are starting to develop more tension. Even the footwear that we wear, even the clothing that we wear, like there's so many different influences to the pelvic floor and I don't want to say that we all have to have, you know, flowy clothes and walk barefoot for the rest of our life. Of course we want to be stylish sometimes and that's fine, but just being aware of how the things we put on our body and the things that we put in our body, how they influence how we feel, how we function, how our muscles can react, so, yes, 1000% sitting, especially sitting with poor posture, can definitely be an influential role.

Vai Kumar: 13:08

And even when you said flowy clothing or whatnot, you know how much we subject ourselves to. Whatever is not ideal is is again that's. That's a huge component to how we feel, or what we subject ourselves to. Right, spinal stability people don't realize spinal stability and pelvic floor function are related. Also correct, it has a huge bearing on it, is that right?

Kim Vopni: 13:36

Yeah, the pelvic floor attaches to the base of our spine, which is the tailbone, and to the pubic joint and to sits bones. As I mentioned, it's the foundation of our core. We've all heard of core exercise and core fitness and workouts and that's been a buzzword in fitness for years, but never in that conversation. I've taken many different fitness certifications. Never once was the pelvic floor ever mentioned in any of that core conversation. And yeah, that's a major function and role of the pelvic floor is to provide control to transferring loads from upper body to lower body movement. You know, keeping everything contained and held, so to speak, within the pelvis is a really important job.

Vai Kumar: 14:32

Okay. Okay, you mentioned Kegels earlier. I used to always think when it came to the pelvic area, that was the be all and end all of it. Obviously not, so I guess there comes your buff muff method. Can you help listeners understand why you came up with that and what does it help address Kim?

Kim Vopni: 14:51

Yeah, a Kegel exercise. So there was a doctor named Dr Arnold Kegel who witnessed in his patient population that, after giving birth, women struggled with the control of their pelvic floor. They didn't have that same capacity for function as they did before, and so he used a biofeedback device that helped women see this group of muscles. I don't mean like physically see it, but they could see on a screen. It would register this movement of them contracting and relaxing, because the pelvic floor is inside us. We can't, you know, stand in front of the mirror like we do and flex our bicep muscle and see it. So it's. We need visualization, we need cues, we need things like biofeedback to help us connect with this group of muscles. So he, he's the, the, the person who came up with the Kegel exercise, which is a voluntary activation and lift and release of the pelvic floor, and so that has been kind of the what, what is thought to have been the only exercise available to us.

Kim Vopni: 16:01

If any people had heard anything about the pelvic floor, it was usually Kegels, and that was it. If any people had heard anything about the pelvic floor, it was usually kegels and that was it. We've never been taught how to do them correctly, we might have been given a brochure. We go to google. We see things like it's the muscles used to stop the flow of urine, so sometimes people will practice on the toilet, and so we have evidence to show that kegels work when they're done correctly and consistently. We also have evidence to show that Kegels are most often done incorrectly, not our fault. We've never been taught, as I mentioned.

Vai Kumar: 16:29

Oh, I knew it was. I thought he, like you said, you know sit. Oftentimes I was told yeah, you can practice it best when you're trying to urinate sitting on the toilet. You know it's a contraction and relaxation of those muscles. So, yeah, I guess there's more to it now and relaxation of those muscles.

Kim Vopni: 16:45

So, yeah, I guess there's more to it now. Yeah, and that's a way that we can identify the muscles. If you can stop the flow of urine, then that's a start into being able to access that group of muscles. But you definitely don't wanna practice on the toilet. We just wanna sit and pee Once in a blue moon. If you wanna test to see if you can stop your flow of urine, go for it, but don't practice your contract and relax while you're trying to pee.

Kim Vopni: 17:08

That will create other issues, especially infection and mind-body disconnect, and it's not going to serve you. But the limitation with Kegels is the general recommendation is three sets of 10, 10 second holds three times a day and that's done either lying down or seated. And there's a couple of challenges there. One, not very many people are going to commit to doing something three times in a day, and the other is it's a static exercise, sitting or lying down, and we are. We should be upright and moving more than we are, but we need the pelvic floor to be able to respond to the times we're moving and oftentimes leaking or feeling vulnerability from prolapse or pelvic pain is happening when we're moving. So we need to train the pelvic floor in a way that it can respond to those movements that we do, appropriately React, at the right time, with the right amount of force to manage our continents, support our organs, support our spine and pelvis and and if we only did this exercise sitting down, we were missing out on an opportunity for that retraining of the reaction time and that type of thing.

Kim Vopni: 18:20

So that was, you know, coming from a fitness background and looking at all of the fitness principles that I use to train people and train all the other muscle parts in the body, I just took that same philosophy and applied it to the pelvic floor. I said this is a group of muscles type one and type two muscle fibers, like the rest of our body. Let's train it in a similar capacity. So that's where I developed a pelvic floor fitness routine that is very much a whole body approach. It's not just a sit and do three sets of 10, 10 second hold Kegels every single day. So it helps with diversity of movement, it helps with bones and muscle and heart health help all the other things that we benefit from, and it also helps um with compliance because, again, three sets of 10, 10 second holds three times a day. Very few people are committing to that and the long-term, the long-term likelihood of somebody carrying on with that is very low. But if you build it into a workout, a fitness routine, it's it's more fun, it's more engaging.

Vai Kumar: 19:33

How is it similar to Pilates? Or how is this something you know different? Are we talking? You know different elements here.

Kim Vopni: 19:42

I do a lot of resistance training, so there are some movements that would be similar to what you would see in a Pilates class or a yoga class. There's also cardio. There's also high intensity interval training. There's lifting heavy weights. It's kind of a. It's all the things I like. I don't like one thing.

Kim Vopni: 20:05

I like a diversity of things and, just like our gut health, we benefit from a diversity of foods.

Kim Vopni: 20:12

Our, our body benefits from a diversity of movement. So, uh, some exercises you will probably have seen before in other classes or other types of movement modalities, and some of them might be new to you, and uh, and then we just apply fitness principles of strengthening and lengthening. We always there's a huge emphasis on releasing because, again, most people are coming in with more tension than what would be considered optimal. So we always release tension first, then we go into an activation, then we do a release again. We're aiming for around a 15-ish, 10 to 15 minute workout, at least initially. As people continue on with me and as they're progressing, we might do a few longer workouts, but I try to keep things in a reasonable timeframe so people can do it and fit it into their busy lifestyle and it's not something that I'm asking you to add on to something else. I'm trying to cover it, as this is your fitness routine for your heart and your bones and your brain and your pelvic floor and and all the things.

Vai Kumar: 21:15

So it's a whole, whole body and it's more like a wellbeing routine that you incorporate. And is this like a app that people sign up for? And is this like a 21 or 28 day thing that, if I'm not mistaken?

Kim Vopni: 21:31

I do have a 28 day challenge, so I used to run that challenge just on its own and now I've incorporated into kind of a bigger program. But people can access it through the Buff Muff app app or they can. Once they're a member, they can log in through a web browser as well if they prefer. And the general, I guess, yes, it's whole body. They come in and they get a bit of education to start out with, and some people get a little bit impatient with that because they're like where are the exercises? And the exercises are coming.

Kim Vopni: 22:05

But I want to also establish that it is not just about exercise.

Kim Vopni: 22:11

Pelvic health, as with our whole body, health, is way more than just a couple of exercises.

Kim Vopni: 22:17

It's our posture, it's our breath, it's what we're consuming, how much water, how hydrated we are, our hormonal status, our stress, our sleep, it's all of these things, and so I'm not an expert in every single one of those, but I bring in some experts and other people who can highlight the importance of how to sleep better, how to poop better, you know all these types of things, knowing that, indirectly, that's all going to help support our overall health and our pelvic health as well. And so then they, they do. They learn a series of basic exercises, how to coordinate that into movement, and do a few workouts. Then they do a 28 day challenge. That's the 10 to 15 minute workout every day for 28 days to help establish that routine. And if people want more, they can choose to come and progress to the level two challenge. This is where they would join the membership and they have access to coaching and the community forum and way more workouts, way more, just way more stuff to keep them progressing.

Vai Kumar: 23:21

That's wonderful when it comes to breaking the stigma that's there in society about women's health, because a lot of times it almost seems like women are kind of, you know, being in pain feels like it's something to be endured, right, oh yeah, it's normal, it's part of the process. So, oh, my mom had it. So then I think, ok, maybe that's the norm, I'm probably supposed to just not say much about it. So what challenges did you see, kim, in terms of getting people to even feel and understand that, okay, that doesn't have to be a norm. And then for you, for them to, you know, kind of feel that, okay, you know now, like for them to cross the bridge, okay. So what were some of the challenges that you faced? And convincing people that, hey, you know what this is, what is the cause of this? This is what is the cause of this.

Kim Vopni: 24:20

I'd still feel that, um, that that resistance from people. There still is a reluctance on some level, having done this for so long. Once you get testimonials and word of mouth, that definitely helps people trust that this is something that has the possibility to work. But there's many people who are stuck in that I've tried everything and maybe they aren't. They think they've tried everything, but they may just not be aware of all of the other options or opportunities that exist. So I'm trying to come in and open up some doors and people can then choose what feels best for them, if anything but, um, but I still I have. I've been doing this for 20 years and I would say that it is. It takes a little bit less convincing now, but it still takes some convincing. There's still people that don't necessarily one. They don't trust stuff on the internet, which I get it. There's lots of scams, but you have to go after.

Kim Vopni: 25:21

Yeah, yeah, exactly. And then two some people have had very negative experiences with their care team or care providers To go after the it's, it's. They don't want to work. Sometimes people just want the quick fix and a big you know. People say, oh, you talk too much and you ramble and you do all this stuff on all of my posts and I think, cause there's a lot to say and there's a lot more that I want to get across to people to help them understand not that I'm creating a big to-do list for them, but there's all of these opportunities for change and that the body is an incredible adaptable thing that we have and if we give it the right inputs, change is always possible. So it's easier said than done, but, um, but I just keep, I keep preaching and the more word of mouth and testimonials I get, it kind of helps build the community a little bit stronger.

Kim Vopni: 26:27

The other thing I actually feel in some ways, a lot more resistance from the medical world. With all due respect, we need medicine and when we need pharmaceuticals and when we need surgery, they are incredible and we are so fortunate to have them. I don't view them as our best first line of defense for preventive health, for pelvic health. They can, if we do end up needing surgery, go down that path. But so many people are sent down that road much too early and haven't done that root cause investigation. So I really want to try to get all of the information out and people recognize that it's not just about a couple exercises and that there is hope and there is opportunity for change. It does require some commitment from you, from the person. There is some work to be done, but it doesn't take hours a day.

Vai Kumar: 27:23

It's really quite simple to implement and hopefully, yeah, just want to give people a chance for them to kind of heal themselves, right, because our body is like such a powerful tool, like the mind-body connection. If we are able to tap into that, I think we can just overcome so many issues. I think we can just overcome so many issues. Let's just dive a little deeper. So pelvic floor dysfunction we started off saying it can even right from everything from constipation, right Sexual function, bladder leakage, fecal incontinence. What other things do you see? And how do you think people are able to overcome these? And what kind of would you say if you were to say, oh, there is just much more to it than just those terminology alone? What is happening behind the scenes when it comes to why the pelvic floor is contributing to all of these?

Kim Vopni: 28:28

A big shift that I'm seeing now, because the majority of the people who are in my community are in that sort of perimenopause, postmenopause transition and there's a significant hormonal shift that is happening, and a major one is estrogen. So once we reach our menopause, we're now in a low estrogen state and we will stay in that state unless we are replenishing or replacing our hormones with hormone therapy. And there's a whole category of menopause called genitourinary syndrome of menopause, which is specific to the vulva, the vagina, the pelvis, the bladder. The symptoms that could be genital, urinary or sexual, and there's a host of symptoms under each of those brackets, so to speak, and statistics are between 50 to 80% of women will experience at least one of those symptoms, but generally more. And that could be thinning of the tissue, dryness and this is around the vulva and the vagina. Thinning of the tissue, burning, itching, irritation, pain, and that could be pain with insertion, it could be pain with touch, it could just be pain with no touch. We may have urinary symptoms like urgency, so feeling like all of a sudden you have to get to the bathroom and you don't feel like you can make it on time. Urinary frequency, feeling like you're always needing to go to the bathroom Urinary incontinence we talked about. So the leaking that can happen with exertion, pain, sometimes with pain around the bladder, utis that's a significant risk of a low estrogen state in the vagina is increased risk of UTIs and then sexual symptoms. So we may have we're more likely to experience different types of infection and insert of sex in particular can be very painful.

Kim Vopni: 30:36

And I cannot tell you every single day multiple people who have been post-menopause for years being treated by care providers who are still struggling with pain and have never been offered vaginal estrogen. It blows my mind. We have so much evidence about the efficacy. It is the gold standard. We have evidence about the safety no cancer risks, no blood clot risks. We have evidence about the safety no cancer risks, no blood clot risks.

Kim Vopni: 31:09

But then we're struggling against the mainstream medical system that has black box warnings that tell you that you are going to get cancer, you are going to get blood clots and all these crazy diseases. So people are afraid of taking this incredibly beneficial therapy and there's several doctors right now petitioning the FDA to change that because it is not evidence-based as it pertains to vaginal estrogen. So that's something that I consider to be almost like an essential nutrient. It's not a nutrient, but I'm using that term as we reach our menopause for the rest of our life. So the hormonal piece is significant and it's something again, I urge people, especially when they're younger, get informed about hormones, about our cycle, about hormone therapy, so you can then be armed to make the best decision and work with a practitioner to find what's best for you. But vaginal estrogen is one thing, that is, it plays such a role in so many aspects of, again, genital urinary sexual symptoms, so that's something that we can't overlook.

Vai Kumar: 32:09

Okay, and it seems like one in three women suffer from incontinence, right? Is it like so is there help for women across all age groups? Or how is it like? How do you think people respond when you see firsthand, you know, when they start implementing movement of the pelvic floor muscles and all of the routine that you are talking about? What kind of a transformative experience is it for women, and does it apply to women of all age groups?

Kim Vopni: 32:48

Short answer yes, it doesn't matter I've had. The oldest member in my community is 93. You can make change at any age. Of course, if we can intervene earlier, that's even better, if we can mitigate some of these things from happening in the first place. But yeah, statistically, anywhere between 30, 40% of women will experience incontinence. I do think that is much higher because that is reported cases and so many people just don't talk about this with their doctors and suffer in silence with it. So I think that is higher Prolapse wise 50% of women who've given birth have some degree of prolapse super common, so very common.

Kim Vopni: 33:30

Not openly talked about or screened for, yet influences so many women's lives. When they have the right information and they can make changes that they didn't even know, like taking vaginal estrogen, like addressing constipation, like addressing sleep, like addressing their posture or their footwear, like starting exercise all of those things it can happen pretty quickly. So in my community there are people within days are not like, are sleeping through the night again, because they didn't know that there was behaviors, they didn't know that dehydration was playing a role, they didn't know how they could overcome these signals. They just thought I've got the signal. I need to respond, and there's ways that we can retrain the bladder so very quickly within.

Kim Vopni: 34:19

You know, I've seen it as four days, I'd say. The most common is around the two to three week mark, the most significant change where people are like I don't have to wear incontinence pads anymore and I'm having enjoyable sex again, and I don't have the bother of the bulge as much as I used to. It's usually around the like four to six week mark. The other thing that I see, though, is people, once they get to that point, they think great, I'm cured, I don't need to do this anymore. But, as I said before, this is a lifelong. This is not a quick fix. We need to be consistent with it, or it will return, just like we brush our teeth in between seeing dentist visits. If we don't have a cavity, we don't stop brushing our teeth, we carry on with that maintenance program, and the same applies to the pelvic floor.

Vai Kumar: 35:06

Yeah, it's a constant process, you know you said yeah, brushing teeth again. You know we all wear retainers if we got braces right, so otherwise the teeth start to move back. So I guess you know great dental analogy there. What about distinction in terms of we talked about you touched upon organ prolapse, right People who have given birth? What about prenatal, postpartum and menopause stages? Is there like differences in condition that you notice in terms of what kind of help women need and in terms of organ prolapse, do people even realize they have something going on?

Vai Kumar: 35:49

Again, it's a question of a lot of us women, I think, enduring stuff we are all so great at. We just don't seem to have that attention that we need to give ourselves much more, as we do others right in the family or, you know, in the social circle. Well, we always seem to care for others much more than putting ourselves in the forefront. So what about anything in terms of signs that people should watch for and what should just tell them that hey, that's an SOS? And in terms of these different age groups the prenatal, postpartum and menopausal what kind of a distinction do you see in terms of what they go through with the pelvic floor functionality overall?

Kim Vopni: 36:40

Yeah, functionality overall. Yeah, so, signs and symptoms obviously, leaking urine is an urgency. Low back pain is one. Pelvic pain, painful sex constipation, feeling like you have something inside your vagina, like if you're a tampon wearer, feeling like your tampon's not sitting quite correct, feeling like something's going to fall out, feeling heaviness or pressure, especially as the day goes on. Seeing or feeling a bulge around the opening of the vagina. Those are some of the more common signs and symptoms. But even there are some people who have a bulge very close to the opening, who have no symptoms and have no idea. So symptoms do not indicate severity. They aren't always indicative of what the problem is, and that's part of the reason why I recommend everybody see a pelvic floor physiotherapist once a year, even if you have no symptoms, and especially if you do no symptoms, and especially if you do. So that's who we go to for screening and helping evaluate function, looking for things that could potentially become a bigger problem down the road.

Kim Vopni: 37:50

In terms of prenatal, postpartum menopause, when I first started this work it was in the prenatal space. My intention was getting this information to women ahead of time, before childbirth. It's well established that pregnancy and childbirth are they greatly increase our risk for pelvic floor dysfunction. So if we have this knowledge, if we're doing pelvic floor exercise, if we're understanding posture, if we understand breath and, in particular for pregnant women, if we are looking at birth positions and training for birth, training the pelvic floor to respond appropriately during childbirth, could we mitigate some of these risks. So that's kind of where I started.

Kim Vopni: 38:34

And a first-time mom, a first-time pregnant mom unless they were starting to experience things like pubic joint pain or low back pain, they're not really that motivated, to be completely honest, about doing pelvic floor exercise. They don't yet have a problem to overcome, so it was a harder sell. Then, on the postpartum side, I had started a second company called Belly Zinc where we manufactured a postpartum wrap, so embracing what many cultures do around the world that honor and revere this postpartum recovery phase, whereas in North America it's a sprint back to the gym and to not look pregnant as quickly as possible. So we wanted to change that and we designed a postpartum wrap and coupled it with a restorative exercise program. We wanted pregnant women to purchase it, so they had it for immediately after they gave birth. And what? In both of those instances, the most common customer we had was the second or third time. Mom, who had already been through it, who had now, is experiencing problems, wishing they had done things differently the first time, and now they want to do something different the second time.

Vai Kumar: 39:49

Realize it.

Kim Vopni: 39:50

Yes, yeah. And so there's the diastasis, or diastasis, which is where the two six pack muscles in the abdomen, that the outermost abdominal muscles, the connective tissue that holds them in place at the midline, thins and stretches and those muscles move away from the midline and can create some challenges for some people. And then all the other symptoms that we were talking about. The other thing with postpartum is we go into a low estrogen state after the birth of our baby. We go into a low estrogen state after the birth of our baby and that is a glimpse into that low estrogen state of menopause. The difference is we will, postpartum, come out of that and we will go back to our normal kind of fluctuations of estrogen Postmenopause. We go down and we stay down, unless we are supplementing with hormones to some extent. So those are kind of a few of the nuances there, but my hope is that in my lifetime it becomes more the norm for pelvic floor physical therapy as part of your pregnancy.

Kim Vopni: 40:58

I wrote a book called Prepare to Push so training for your birth, honoring your recovery and not sprinting back to the gym. We need to do exercise, we need to do movement and we're going to train when we're pregnant for motherhood, or lifting a car seat, for lifting a stroller, for doing that while you have a baby on your side, or a toddler or diaper bag, or whatever it is that you're training for, but bring it into real life situations and movements. So we're we're training for life. What we're doing in the gym should make life easier to, if that makes sense, um, and the pelvic floor. When it's working well, it will allow us to do that with more freedom and more success.

Vai Kumar: 41:40

Pelvic floor is often what holds us back. Yeah, and posture right. You're lifting so much you're lifting a baby. All of a sudden you're carrying a car seat and you don't know what else has happened to your organs during the process of childbirth and labor. What about supplements? I heard you mentioned that. So creatinine, collagen and all of this in terms of menopausal women. What kind of a significance do these have in terms of building strength and in terms of you know, all the elasticity and everything?

Kim Vopni: 42:14

right now there's really no research as it pertains to creatine in the pelvic floor or collagen in the pelvic floor. There's some studies with floor, there's some studies with vitamin D, there's some studies with sea buckthorn oil. So I'm hopeful at some point in my life that there will be research about these. But if we look at creatine is one of the most I think it is the most researched supplement in the world and it's for muscle and we thought of it. You know, the people who used to take it were the young bodybuilders.

Kim Vopni: 42:48

But, now there's more and more studies coming out to show that this is really a beneficial supplement for anybody and especially post menopause women. There's some evidence for bone support, for muscle support. There's even some cool research regardless of stage of life but from a brain health perspective that's typically in higher doses. But I look at the literature that exists with creatine and muscle and again I'm saying the pelvic floor is a group of muscles, so we can hypothesize that if it's having this influence on other muscles in our body, could it not arguably have the same thing, the same action, within our pelvic floor? So creatine, I love creatine.

Kim Vopni: 43:37

I'm a huge supporter of supplementing with creatine everybody, especially postmenopausal women, with creatine everybody, especially postmenopausal women. The other one is collagen, which there's. I've been taking collagen for a number of years and there is some research about people who have experienced certain types of pelvic floor dysfunction, who have deficiencies of certain types of collagen. But there is no research about supplementing with collagen as it pertains to overcoming pelvic floor challenges. But again, like creatine, I'm looking at this saying well, if we have studies about how it can influence skin, hair, nails and the different. So that's mainly type one and type three collagen. That's the same type of collagen that we have in our pelvic floor structures. So if supplementing is helping the other type one and type three collagen that's the same type of collagen that we have in our pelvic floor structures. So if supplementing is helping the other type one and type three, could it arguably not help the pelvic floor as well?

Kim Vopni: 44:32

Again, hypothesizing I never in my body, I was never able to say oh, I took creatine or collagen and I noticed that I was able to do more Kegels or you know, overcome. I was never symptomatic enough to notice a significant change. However, looking at the literature and the research, for all of the other reasons why it's beneficial for my whole body, I'm I take those religiously. The other one, uh, vitamin d, that there's oodles and oodles of research about vitamin d for so many things of health, uh, our health, but also with pelvic floor so that's something else are anyways deficient in vitamin right, right, exactly.

Kim Vopni: 45:17

So vitamin d is on there. Sea buckthorn oil is. Oral intake ofabuckthorn oil has been shown to help with post-menopause vaginal like the dryness that we experience in that low estrogen state, so it's not going to. I don't promote it. As a way you know you don't need estrogen if you're taking seabuckthorn oil. I definitely think the majority of women would benefit from being on estrogen. Taking C buckthorne oil, I definitely think the majority of women would benefit from being on estrogen, and we also have this additional C buckthorne oil for those that maybe have been without estrogen for a long time and they're really still struggling with some level of dryness or irritation. C buckthorne oil orally is something that I do recommend as well.

Vai Kumar: 46:01

Okay, what about fecal incontinence, say, in conditions like IBD, inflammatory bowel disease and things like that? I personally wrestle with IBD. I have managed it pretty well. I can relate to all the things that you're talking about because I do a mix of yoga and Pilates and I know how magically my pelvic floor movement and you know, using those muscles and incorporating strength and flexibility has resulted in a phenomenal transformation for me and I did not. Little did I know that Kim Walkney existed up until recently, that you know. I got in touch with you, but thank you for coming on this show again to create this awareness. But I guess, from a fecal incontinence standpoint and blood circulation, lubrication, everything you know all the flow how is all this movement impacting and improving stuff for people? Can you talk a little about that, kim?

Kim Vopni: 47:10

The principles of overcoming fecal incontinence really are similar to, if not exactly the same as, overcoming urinary incontinence, that the pelvic floor is responsible for the opening of the urethra, the opening of the vagina, the opening of the anus it's manages all three, and so the principles of creating length and strength in that group of muscles as a whole.

Kim Vopni: 47:36

We might tweak cues or visualization or certain poses like exercises that somebody may do their pelvic floor muscle training in, but really the fundamentals posture, breathing, avoiding constipation, activating and relaxing the pelvic floor remains the same. People who have additional layers like, as you say, with IBS or C or D or whichever one or other types of even autoimmune conditions, it's. But exercise still is indicated for pretty much every single person in the world, regardless of what they're dealing with. So the pelvic floor, again, is not immune to that. And when we are activating and taking the muscles through range of motion with whole body movement, by nature we are increasing blood flow and circulation. And when we impart a load that the body needs to adapt to, including the pelvic floor, that's how we get stronger. So the diversity of movement is important, the sets and reps and load is important, but just fundamentally moving, not staying static is going to improve the function of the pelvic floor.

Vai Kumar: 48:57

Okay, Okay, what about, specifically? Would you say a particular form of exercise is beneficial, Say I just asked you something about Pilates earlier. Whatever you incorporate, is it like? I know you have talked a lot about breath, you know getting the breath right, getting all the movement and getting the strengthening part. So I see whatever you do as a combination of everything. Is that a fair assessment, or do you just focus specifically on more of yoga-like movements or you focus more on like weight-bearing exercises? Is that something that you can throw light on?

Kim Vopni: 49:39

I really, I like a lot of different things. I don't think that there's one thing People will often gravitate towards. You know, I really love yoga, I really love Pilates, I really love whatever. So doing what you love is also important. If you're doing an activity that you really hate, that's not going to serve you in many ways. So finding things that you do like, but in trying to do some different things within there. But one thing that I would say I do emphasize is resistance training. I think that the more and more research is coming out about how important our muscles are, how, from a longevity perspective, reducing our fall risk, all of that it's so, so important to have muscle mass, to have strong muscles, to have supple muscles. So resistance training is a big part of what I do, but I balance it out with some yoga and some stretching and other types of things as well. But I would say, if I was to pick one thing that I focus on, it would be resistance training.

Vai Kumar: 50:44

Your pelvic floor, yeah yeah. Then there's pregnancy fitness. There's the inside story. Why don't you talk about all of these? You know whatever these books cover, and then we'll go for some rapid fire or quick takeaways for different sets of people and you know we'll just come to a closure on this wonderful conversation.

Kim Vopni: 51:13

All right. So my first book was called Prepare to Push, and that was again looking at how we can apply the principles of training and specificity to childbirth. We need to train for childbirth. The next book was the Inside Story and that was kind of looking at the main categories sort of like prenatal or pregnancy, motherhood, menopause as three main life stages that majority of people will go through. Everybody will go through menopause who reaches midlife.

Kim Vopni: 51:43

The next was pregnancy fitness. So that was with my two business partners in Bellies Inc. We were commissioned by Human Kinetics to create almost like a manual about fitness and pregnancy. So that was, uh, that was that one. And then the last, most recent one was in 2020. That was it's called your pelvic floor and it's more of a um, it's a, it's a book for the consumer to understand a lot of what we talked about here what the pelvic floor is, how it works, what are some common signs and symptoms that things are not going well, and then, of course, what we can do about it through the various life stages that we go through.

Vai Kumar: 52:23

Okay, okay, perfect. Quick tips and takeaways. What should prenatal women focus on?

Kim Vopni: 52:32

Learning to release tension in the pelvic floor, paying attention to their posture and training in the more common birth positions so that they build strength and pelvic floor, like building the response of the pelvic floor in those various birth positions, like sidelining, sidelining or squatting or kneeling, that type of thing.

Vai Kumar: 52:58

Okay, and then women of childbearing age. What do you see as a challenge when it comes to people being able to get pregnant and is something relating to movement and our lifestyle that's impeding? Again, we have talked a lot about pelvic floor as the focus. Would you say anything specifically to them in terms of emphasizing movement and anything else that may be very significant?

Kim Vopni: 53:26

yeah, sometimes there can be. You know that stuck tension can interfere with fertility. So when we're optimizing the blood flow and the circulation, that can sometimes create a more favorable environment for fertility.

Vai Kumar: 53:41

Okay, what about teens? They experience so much of, I mean, menstrual pain, and there is just a lot of agony there as well. Again, that's a topic that again seems to be more of endured than addressed, right? So what would you say to that, kim?

Kim Vopni: 54:04

That's a great time to start seeing a pelvic floor physical therapist. Sometimes the pain can be as a result of muscular tension. Sometimes it can be, from you know, a position like an organ that's not in the right position. Sometimes it can be endometriosis related. Um, so they, your pelvic floor PT can help you screen for other conditions but also introduce that concept of I help you manage this really important group of muscles. And if you're experiencing pain during your cycle, one aspect could be muscle function. So we can look at that together and then you'd have some strategies and tools to help release the tension which can help mitigate cramping for some people.

Vai Kumar: 54:48

And we have talked so much about the pelvic floor. We talked about spinal mobility, spinal stability, everything. What about hip rotations and releasing tension in the hips? Is that contributing in any way to any of this?

Kim Vopni: 55:03

that's happening below 1000% and it's a huge part of what I do is is working on mobility within our hips and building strength in the lateral hips so that we can transfer loads, we can walk, we reduce our fall risk. Um, it's often there's a couple of stretches that I have in my program that one of them is called the stacked butterfly, which nobody really likes that one because it's tough and it sort of highlights how tight we are and we think about how many hip replacements and knee replacements we have. A lot of it is to do with the wear and tear on the joints from poor posture, from tightness in the muscles that's not allowing that freedom of movement. So that is a huge part.

Vai Kumar: 55:44

Okay, can people, even in the osteopenia and osteoporosis range because we addressed it in a very broad sense earlier in terms of people of all age groups, but even specifically somebody you know in the osteopenia or osteoporosis category, still can they benefit from all of this in terms of the building strength, the program, and so definitely, like I said, whatever I've been doing has resulted in a better bone density in my case. So I can personally attest to whatever movement or whatever strengthening of the pelvic floor brings about. But just wanted to ping you on that. What about menopausal women? What should they focus on, kim?

Kim Vopni: 56:31

Vaginal estrogen and pelvic floor exercise and seeing a pelvic floor physical therapist once a year.

Vai Kumar: 56:37

Okay, awesome. So I think we have just offered a lot of pointers here in terms of why women should not just silently endure whatever they have been going through and I guess anyone, be it a woman, be it a young girl, be it a woman of childbearing age, menopausal women or even men of all ages, I think the pelvic floor, the hip, mobility, all of the function and movement, I think we cannot underscore it any better. So, no silent suffering off the pelvic floor is the biggest takeaway for me from this podcast and anybody who's wanting to learn more vagina coachcom is my website.

Kim Vopni: 57:43

If you put vagina coach into Google, you'll find me somewhere on social media. Instagram is typically where I'm most active. I also have a YouTube channel with some free resources. My podcast is between two lips another area for some free information, and you can also find links to my books on my website at VaginaCoachcom.

Vai Kumar: 57:59

Awesome, awesome. Thank you so much for joining us today. Such a pleasure talking to you and I'm sure listeners of both of these podcasts can just get to know more of each other and I'm sure they can mutually benefit from a lot of information that we are putting out. Listeners, as always, follow the podcast, rate the podcast, leave a review from your podcast app of choice, follow me on Instagram, @vaipkumar, and YouTube for the podcast and for all things digital media and lifestyle. Until next time with yet another interesting guest and yet another interesting topic. It's me Vai, along with the wonderful Kim, saying so long. Thank you.