Today we’re talking with self-proclaimed Vagina Coach and pelvic health evangelist Kim Vopni! We’re discussing challenges you didn’t even know could be fixed – such as bladder leakage, preventing tearing during childbirth, and even how to replace your own estrogen. Kim is extremely accomplished and well educated and offers advice both scientifically sound and relatable – the mother of two gives a real and personal look into how her techniques and programs work. We hope you enjoy this interview with Kim, and all the benefits of the pelvic floor therapy visits we’re sure are going to follow!
In this episode we’ll chat about:
- Becoming passionate about Pelvic Floor health
- Indicators of Pelvic Floor issues
- The process of seeing a Pelvic Floor Specialist
- Explaining the Pelvic Floor
- Kegels
- Having an overactive Pelvic Floor
- Accessing Pelvic Floor help without living close to a specialist
- What you should know before your first Pelvic Floor Professional appointment
- Painful sex and your Pelvic Floor
Watch the Video
Show Notes
We had a fantastic time talking to Kim the Vagina Coach, and she definitely taught us a lot! Make sure to check out her website, and her Youtube channel, to learn more about all the amazing programs and advice she offers!
Listen to the Audio
Read the Full Conversation
Hi, so today Kim the Vagina Coach is joining me to talk about all things at pelvic floor health. Kim Falcone is a self-professed pelvic health evangelist and is known as the vagina coach. She has a BA in psychology and a postgraduate certificate in health and fitness. She is a certified fitness professional who became passionate about spreading information on pelvic health when she was pregnant with her first child. She’s a published author, a passionate speaker, and a women’s health educator who’s also a mom of two boys. Kim is the founder of Pelvienne Wellness Inc, a company offering public health programs, products, and coaching for women in pregnancy, motherhood, and menopause. She’s also the creator of the ABB system, revolutionary birth prep, and recovery system for pregnant women. Kim certifies other fitness and movement professionals to work with women with core and pelvic floor challenges through her core confidence specialist certification, and pre-post-Natal fitness specialist certification. So welcome, Kim.
I would love to just hop right in and hear a little bit more about why you were drawn to be a pelvic floor evangelist.
Yeah, it was definitely not something I grew up thinking about. But in a way I kind of did. I didn’t think of it as a job. but I remember seeing a sex-ed class, and we had a childbirth video that sort of planted a bit of fear in me. I went home and looked at my mom a little differently, and then I kind of grew up with this fear/fascination of birth. And I said for years that I would not have children. I was not going to do that to my body. But when I met my husband and we decided we wanted to start a family, I wanted to have a different story than my mom.
She had an episiotomy birth, she had chronic lower back pain, she had a tummy that wouldn’t flatten, she stopped exercising, she had surgery for incontinence. So I was looking to avoid all of the above. And I had seen my sister-in-law give birth, and she used midwives. She was in a sideline position, she did perinatal massage. And then the following year I was pregnant. So I was kind of following in her footsteps and then also asking my midwives about what else I could do, what else beyond perinatal massage. And they had told me about a product called the EPI-NO, which is a biofeedback device out of Germany. I purchased one and had a good experience. I also used midwives and was in a sideline position, which is favorable for protecting the pelvic floor. But I do feel like that product played a role. And so I said, “well, why doesn’t everybody know about this?”
So I said, “okay, well, I’ll see if I can be a distributor” and I just thought I’d have a little sort of side business. And that’s what I did for a little bit. Then it turned into a full-time business in 2009; I was laid off from my full-time job, and a little bit before then I had said, “you know, I wonder if I could turn this into a business and be home more with my kids,” and you be in the entrepreneur world. Then my hand was forced, so I started using social media to get the word out at the time – really, it was just Twitter – and that’s how it happened. The term vagina coach, started probably about five years ago; I had been using the brand handle “fitness doula” for a long time because I was working primarily with pregnant women and new moms. But then as I was moving through the different life stages, and now approaching menopause myself and working with all people in that stage of life, I recognized that “fitness doula” wasn’t cutting it. It was really a lifestyle, a lifelong practice I was really trying to promote, and “fitness doula” didn’t necessarily resonate. So I was speaking at a conference, and most of the speakers really had been some sort of business coach. So when it was my turn to come up and speak, I joked that now you have a vagina coach for your business. And it just kind of came out and it was like a light bulb moment and I said, “that’s it, I need to embrace that,” Nobody likes the word vagina, it’s this hush-hush taboo. And if I’m talking about this, I just have to jump into it.
It sounds like you had a unfavorable birth with your first one. Have you dealt with some of these issues yourself?
Yeah, so I knew at the time was I wanted to prevent incontinence and I wanted to prevent tearing. So those were really my two main goals, which I did achieve. I had never heard the term pelvic organ prolapse. I had never heard the term diastasis recti or levator avulsion. And that is one part of the pelvic floor muscles. So there’s a group of muscles. And when one part of the muscle tears away from the bone, it can either tear away partially or completely. And that happens in about 30% of births. So it’s really common, but I’ve never heard of it. And it turns out years later, I find out that I had a partial avulsion, had diastasis, and my first son crowned sideways, which is the widest way to come out. And even my midwives were amazed that I didn’t have any tearing. So while I didn’t have external tearing, I did have internal tearing I also found out about years later. And so part of why I became so passionate about doing what I do is that I am not the only one who will tell you that “I wish I had known this,” or “ how come nobody told me.” And so while I had a favorable experience for them, really compared to so many other people, there’s still so much that I wish I knew, and there’s so much that I would have done differently had I known about all the things that I know now.
So then years later, not long after the birth of my second, within the first year or two, I remember being in an exercise class and doing jumping jacks and feeling like oh my god, I can’t do this because I’m starting to leak. So I have experienced stress incontinence. And then, several years later, I developed what’s called a rectocele. So that’s where the rectum bulges into the back wall of the vagina, and it’s a type of pelvic organ prolapse. Again, I’d never heard of it. But 50% of women have some degree of prolapse, and actually, at six weeks postpartum, it’s more like 80% of people have it. And it’s never screened for, never talked about. And so again, had I known about that much earlier, I would have done a few things differently, or at least known more symptoms earlier on. So I managed that, I’ve experienced a uterine prolapse, which I’ve reversed on my own. The rectocele seal I ended up having surgery for. So after about nine years of trying everything under the sun to fix it – it’s a tricky one to completely fix. And so yeah, so I’ve definitely experienced a lot of what my clients have experienced. And I think that people like that I share it from a personal perspective, too. I’m pretty open about what I share online, which sometimes I think, “Oh, my God, I can’t believe I’m saying this.”
It’s nice that you’ve kind of experienced all different sides of it – both like working through fixing it yourself and then needing to go with further medical procedures sometimes. In hindsight, you’d said like you found out these things years later; were there kind of red flags at the beginning, and things that other moms might not realize they had going on, that are indicators for them to know up?
So afterward, I remember, right after the birth of my first son – you have nothing to compare to because you’ve never given birth before, you can hear a few different stories here and there but not much else- but I remember feeling like I was sitting on an egg. I felt like I had this lump, and it wouldn’t go away. And eventually, it did. But that was kind of the first that’s a very common sign of organ prolapse.
So that was one, and then obviously the incontinence. So I knew about incontinence because I know my mum had dealt with it. And I felt like in my being naive and not having the knowledge that I do. Now, I remember thinking that if I prevented tearing, that would mean I wouldn’t have incontinence, I didn’t appreciate it being a group of muscles that we need an element of fitness for. So I just kind of thought, “well, I didn’t tear and I’m fine,” and so I just went back to exercise and didn’t use what I now preach, which is retraining and a kind of a rehab process after giving birth. So very common signs, leaking is very common, but not normal. So don’t accept it just because you’ve given birth or because you’re a woman or because media tells us that that’s just what happens – that’s a sign.
Urgency, frequency, low back pain. Feeling like something’s in your vagina, feeling like you’re sitting on a ball. Difficulty inserting a tampon or tampons getting pushed out. Difficulty starting a flow of urine and with bowel movements, feeling like it doesn’t always all come out. Those are quite common.
And the low back pain one I’m going to emphasize because so many people in the world have low back pain. It’s kind of just that “well, you just have a low back pain,” so a lot of people will see a chiropractor or get a regular massage; they go for acupuncture maybe, or maybe they see a physio. But there’s lots of research, and one study was recently done by a researcher out of Ontario, that showed 95.3% of women in her study, and they were all women with low back pain, had some form of pelvic floor dysfunction. So it’s not saying that low back pain causes pelvic floor dysfunction, but the two are very correlated. And so if you are a woman, especially a woman who’s given birth or been pregnant at some point in your life, and you experienced\ low back pain, I highly recommend pelvic floor physio. Any person with a vagina, but especially if you’ve had any of those symptoms, and even if you only had back pain, I would recommend going to pelvic floor physio.
And I think that’s going to be many people listening and watching this will be in that situation.
Yeah, it’s not something we’re told about. And I remember it was a couple of years after my second son was born that I found out about pelvic floor physio. So I had a pelvic floor physio referring patients to me to buy the EPI-NO, – I had started selling that product – and physios were referring them to me, and I remember saying, “oh, never heard of a pelvic floor physio.” So I reached out to them and said, “but what do you do, and thank you for your referrals.” But I’d love to learn more. So I went and sat down with them and learned more about what they do. And then that was where I thought, “Oh, my God, how is it that not every single person that’s pregnant is told about this during their pregnancy, and afterward and on an ongoing basis?” And so that kind of began me preaching about the pelvic floor. But it needs to be said – and the world is catching up a little bit, things have changed in the last, you know, 16 or 17 years since I started – but we do definitely have a lot of work to do in terms of increasing awareness. I think it’s something that the government should be paying for.
So say someone notices these problems and they find a pelvic floor specialist. What does that process tend to look like?
It is completely different from a pap, a lot of people associate any sort of evaluation of the pelvic floor with a pap smear. And nobody likes a pap smear. And usually, thankfully, a pap smear is quite quick, but it’s completely different.
So pelvic floor physios are physiotherapists with additional training in the pelvic floor, and they are licensed to evaluate and treat beyond the entrance to the vagina. So they can do internal evaluation and treatment through the vagina and sometimes through the rectum. And they use gloved fingers for that. The appointments, at least initial appointments, are usually about an hour. And that doesn’t mean there’s an hour of internal evaluation and treatment. That is, the internal portion is usually like maybe 5 to 10 minutes. So it’s very much a whole-body approach, looking at breathing mechanics, looking at movement, looking at posture, getting a detailed health history. Sometimes the internal part doesn’t even happen in that first session. But when the internal part happens, sometimes people feel a little bit squeamish or like “ I don’t think I want that it might be uncomfortable.” And I appreciate that; we all have different backgrounds and experiences that could potentially contribute to us not wanting that. I will say though it is an incredible education in your body and you will walk away saying “how have I lived for 30 years, 40 years 20 years, however many years without knowing this.” And so in terms of the knowledge you gain, and also the sense of empowerment – information is power, knowledge is power. And when you have an appreciation for a part of the body that has always been kind of like we just don’t talk about it, and it’s shrouded in mystery and shame – when we can embrace the importance of it all the jobs that the pelvic floor does, and know that we can play a role in keeping it healthy through our life stages – it changes the game.
With female parts, we have a lot of different hormone changes. We menstruate, we can carry children, we go through perimenopause, menopause; we have all this stuff that influences that part of the body. And being informed and understanding what each stage can mean, and how we can be proactive in it, can really change lives.
I am currently doing research for a program that I’m creating on surgery, because there’s nothing out there that supports people through that process, and everybody I’m talking to has either had surgery or is considering it because they’re dealing with some sort of pelvic floor challenge that they often feel resentful for because nobody told them about it ahead of time. They’re now limiting exercise and activity, they’re planning their life around their bathroom habits, they don’t feel like themselves; it interferes so greatly with our life. And incontinence, you know, we can put a pad in and kind of carry on, but prolapse and pelvic pain can really, really interfere with the quality of life. So if we get this knowledge ahead of time, and we are armed with who to see and what to do, it can mean that we don’t experience all of these negative aspects, the negative pieces of pelvic health. So yeah, I can preach about it all day!
Yeah, that really brought me back to thinking about my two pregnancies. And the first one, I just felt like my body wasn’t my own. I had no idea what was going on, everything was different. All these things are happening. But then the second time, I knew more of what to expect, I had more of that information. And I felt more in control and empowered. So it’s very similar to everything you just said; the more you know about what’s going on, the more you’re able to anticipate it. And it just helps with your overall well-being in so many different ways. Yeah, yeah, exactly. Exactly.
We delved a little bit into issues, but with what you were saying, I think it’d be great to touch on exactly what the pelvic floor is, and what it’s responsible for.
So the pelvic floor is a group of muscles, and they have slow-twitch and fast-twitch fibers like every other part of our body. The pelvic floor is three layers – we have two layers that are primarily responsible for closing and opening. So if you can think about our continents, we want to keep pee poo and gas inside of our bodies until it’s time to let it go. And we need muscles to be able to understand what is it that wants to come out and have the control to stop it if it’s not an appropriate time. So that’s primarily the first two layers.
The third layer is primarily responsible for organ support. So bladder, uterus, and rectum. So that’s an important job. We want our organs to stay where they should be!
They’re moving all around with pregnancy!
Yes! The pelvic floor is also responsible for our sexual response, so satisfaction or lack thereof. It plays a role in a kind of “sump pump” action. So the pelvic floor moves in coordination with our diaphragm with our breathing. And that makes it responsible, partly, for circulation and moving stuff through our body.
It also is the foundation of our core. So we have all heard core exercise and core fitness, but the pelvic floor has been left out of that conversation. It is the foundation of our inner core unit. And people who have goals of eliminating back pain, of strengthening their core, of flattening their midsection, that all comes down to optimizing that core system; but the pelvic floor is the place to start. We have to start there, and it has to be included in that initial conversation I guess. And we can see our external genitalia: we can see our anus we can see our vulva you know we can pry our lips apart or labia apart, we could see our urethra and our vagina. But we don’t see what’s up inside, and some people are not comfortable exploring with the finger, some people are, but it the muscles surround and support all of that and they play a role in again sexual wellness, core control, stability, breathing, ability to carry babies, birth babies, all sorts of stuff and they’re really it’s a part of the body that is so overlooked. We deserve so much more information at a much earlier age and stage of life.
Yes, definitely. This should be taught with all of the puberty and sexual talks, and getting to know your body. But it’s something I didn’t hear about until pregnant and similar to you the primary concern was tearing and leaking.
Yeah exactly. The NHS in the UK has recently stated that pelvic health should be taught in schools and is making moves to, which I think is amazing. And I hope that that starts to become adopted throughout the world because as you said when we’re learning about our bodies and menstrual health, and puberty, that’d be a great time to introduce how important this part of the body is and how to do kegel exercises and what is pelvic floor physio.
We’re told from a very young age to brush our teeth twice a day and floss and go see a dentist once a year. And we go even if we don’t have a toothache. And I think we deserve that same attention applied to the pelvic floor. Do your kegel exercises every day, make sure you’re participating in whole-body movement. And then once you become sexually active, see the pelvic floor physio once a year, even if you have no symptoms.
So, the annual kind of checkups for the pelvic floor should be every year, so I’m assuming then there’s going to be lots of changes over your lifetime, in order to catch anything. What are some of the things that can happen? I’ve had my babies, I don’t have any leaking. So it has been something I know, other people experience, and so I look to get information for that. But personally, I felt like I haven’t needed it as much. But it sounds like there could be a lot more to it than that.
Yeah, and so many people say that, like “well, I don’t have any problems, so I’m fine.” But I view it as rather than wait for a problem to happen, be proactive. Because as women, and especially as women who’ve given birth, we’re all going to go through menopause and there will be change. And rather than waiting for something to present itself, let’s be proactive, and see a pelvic floor physio for one.
But the other thing as we approach menopause – so there’s perimenopause, which is the 6 to 10 years prior to menopause; menopause which is one day on the anniversary of 12 months without a period; and anything after that one day is post-menopause. So the years leading up to it, we have all sorts of different fluctuating hormones, a lot of people will talk about irregular periods or very heavy periods. So we have hormonal flux. We also have young children, we may have aging parents, we’re probably working full time, it’s a stressful time of the life. So we have stress to manage as well. And a lot of people put themselves at the bottom of the to-do list, and there’s not a lot of attention paid to their health and well-being. And so then we get to menopause, we’ve reached the day, and then now we’re post-menopause. And as we’re getting closer to that, we start to notice things will change; people will start to develop incontinence, people may start to have symptoms with prolapse, they might start to experience pain and irritation with sex. And a lot of that is because of estrogen.
So we start to produce less and less as we approach menopause, and then after menopause, we are no longer producing it. The walls of the vagina, all throughout our pelvis, our tissues, love estrogen. And when we no longer have it, the tissues will start to thin and dry and will become irritated. So, the vagina we normally have folds within the walls of the tissue called rugae. And part of the purpose of those is to allow for sex, to allow for childbirth, and to help with lubrication. And those folds, as we approach menopause, and again when we no longer have estrogen circulating, those folds start to go away, the walls start to narrow. So it’s kind of like we have a pleated skirt that now becomes a pencil skirt. That’s a kind of a visual to have. And that can make penetration difficult, it can make daily activities uncomfortable because it’s irritated. Some people say it feels like I having sandpaper between the walls of their vagina.
So when we know that, rather than wait until we have a dry vagina, we can be proactive. In the meantime, just like we moisturize our face and use hyaluronic acid to keep moisture, we can do the same thing for our pelvic floor. So there’s a great product if you want to moisturize your vagina, go to moisturizeyourvagina.com. I’m not financially tied to it. It has a really clean product, it’s hyaluronic acid and vitamin E, and we can start doing that now. And then as we’re getting close to menopause, then kind of within like, you know, the average age is around 51. So kind of as you’re approaching that 51 ish, I recommend people get hormone testing and just kind of see where their levels are at. And consider using local vaginal estrogen. So that can be a cream. It can be a gel, it can be a little tiny pellet that’s inserted into the vagina that helps replenish the lost estrogen that we’d no longer produce. So that we can keep that suppleness. There are a couple of good books that I recommend one’s called Estrogen Matters and the other one is called The Estrogen Fix. Estrogen is so valuable to so many functions in the female body, and we have this fear around it. People are so afraid that estrogen is dangerous once we hit menopause, that we can’t have hormones because we’re going to get breast cancer, heart disease, and heart attacks. And a lot of that stems from the Women’s Health Initiative study, and these books point out the flaws of that study and actually all of the other research, good research, that supports the use of estrogen and how it can benefit our brains, our bones, our hearts, our vaginas, our skin. So I recommend everybody, again ahead of time, read those books, so we know how to prepare for that. There’s an estrogen window of 10 years from when we start menopause, where the first 10 years we’re supplementing with estrogen is really, really beneficial.
So yeah, pelvic floor physio, moisturize your vagina, if you’re approaching menopause starting to look at potentially estrogen, but even postpartum women. So we have declines in estrogen right after we give birth, and a lot of people will have dryness in their vaginas at that point as well. Supplementing with estrogen, local estrogen, at that point can also be beneficial.
And then, of course, one more thing: Exercise. So we’ve all heard of kegel exercises, and kegels work, but I take it one step further and make it a whole-body approach to exercise, to pelvic floor exercise. So do your kegels, but then coordinate with movements like squats and lunges and bridges, so that you can make your workout more core-pelvic floor. centric. And kegels are not a quick fix – in my opinion, they’re something we should be doing on a daily basis. Seeing a pelvic floor physio ensures you’re doing them correctly, but then make sure that you incorporate them into your daily activities and also your exercise and workout routine.
Okay, so are kegels as simple as what we’ve heard, just kind of squeezing like you when you’re peeing and hold it, or is there more to it than that?
There’s a little more to it. A lot of people interpret a kegel as a squeeze, and a lot of people are told “well sit on the toilet and try to stop the flow of urine.” And yes, those are the correct muscles. But don’t practice on the toilet. So every once in a while, like once a year, maybe check to see if you can stop the flow of urine. But don’t make that a habit, because that interferes with the whole elimination mechanism. But you can use it as a test.
So yes, that is the group of muscles. However, there’s a closure element, and there’s also a lift. So remember, we talked about the three layers of pelvic floor: the first two are the openings. And the third layer is the organ support. So we need an element of closure, and we need an element of lift. And then we need to make sure that we can relax and let that go. So many people focus on squeezing or gripping and thinking that they need to hold for so long, or maybe they put kegel weights in and think “well now my pelvic floor is going to be strong.” But sometimes the strength comes from learning to let go. A lot of people actually hold more tension in their pelvic floor than what would be considered optimal and they need to actually relax first and then start doing their kegel exercises. So if you check out my YouTube channel, I have a whole playlist on kegels. And it gives you different visualizations, different mental imagery, and different ways that you can use your own biofeedback, like your finger – or if you have a partner, partner’s finger, a partner’s penis. There are biofeedback devices as well. I always say invest in a pelvic floor physio first before a device, but not everybody has access to a physio.
And then I coordinate it with a breath. So it’s important to understand there’s a relationship between our breath and our pelvic floor. When we inhale, the pelvic floor lengthens. And when we exhale the pelvic floor contracts. So when we understand that relationship, then we can start to harness the power of our core. A lot of people do a kegel thinking of squeezing, and they do it while they inhale and they sort of suck up and hold. And that’s actually opposite to what physiologically the pelvic floor should do. So it’s a little more complicated than just squeeze and stop the flow of urine.
It’s interesting that the let go is so important, because with the birth of my first son, it was very prolonged, and we think part of it possibly would have been because I was so tight and it was really hard to let go. And recently, I tried Perifit, which I’ve seen you’ve worked with too, and that had a lot of interesting things to it. And I wasn’t as strong as I thought I was there. But the relax is my tough point; I can squeeze it in, but the relax is really difficult. Are there any tips for the relaxed side of it?
Yeah, it’s super common, and especially people who may experience prolapse or leaking, or maybe they just don’t feel as strong in their pelvic floor as they used to before, they will become guarded. And they’re usually kind of like trying to hold everything in unconsciously. They may feel weak, but they actually have overactivity in the pelvic floor, and they need to relax which seems so counterintuitive to so many people.
And when you said from a birth perspective, birth is an elimination, like peeing and pooping, those are eliminations as well. So when we pee, when we poo, when we birth, we need the pelvic floor to relax. And if we’re holding on to tension, then we might not completely empty our bladder or bowel, or we may get constipated, or maybe have a harder time and prolonged labor. Maybe we have pain with sex.
So in terms of what we can do with that, posture is a big one. So we spend a lot of time sitting, especially in this COVID world of sitting in zoom. We’re sitting in our chairs, and we’re often sitting slouched – and it’s not to say we can’t slouch, we absolutely can, we should move through all sorts of ranges of motion. But if we’re constantly sitting in one stuck position all the time, the pelvic floor can start to adapt to a shorter, more tension-driven state. And so sitting in a neutral pelvis, which is where we nod our pubic joint forward and then bring our vulva onto the surface of the chair. And then if you kind of wiggle back and forth, especially if you’re on a hard surface, you should be able to feel the bones in your bum. And like if you need to, you can pry your butt cheeks apart as well. So that’s kind of your tripod: two sit bones and your vulva at the front, rather than sitting with a posterior tilt where you’re more on your tailbone. So posture is a big one.
Learning to breathe is another. So, go watch my core breath video on YouTube, and that will kind of give you that relationship. Thinging about imagery, like blossoming your vulva or expanding between the sit bones or expanding your pelvic diamond – those can be helpful. But then there are things like taking a tennis ball – I have a posterior pelvic floor release exercise on my channel as well that you can look at – so there are different exercises you can do.
And then physiotherapy, they can use their fingers to do manual trigger point release. There are also different products like the pelvic wands and TheraWands that we can insert into ourselves, and kind of like we would take a device to take a knot out of our neck, we can do the same thing internally if we happen to have any tension spots.
And then the final thing that I love is hypopressives. So hypopressives is a specific exercise technique and the term hypopressive means low pressure. And it is really effective for early-stage prolapse, especially bladder and uterine, and it’s also really effective for incontinence. And it’s also really effective for down-regulating overactivity in the pelvic floor. So people with pain, people who have been told not to do kegels because their pelvic floor is too tight, people who may have been told they have a hypertonic pelvic floor. Hypopressives can play a really, really important role in terms of down-regulating that system.
So say someone’s noticing they’re having some issues, and it might be hard to access a pelvic floor physiotherapist locally. Are there online options, or what are different things that they could do?
COVID transformed pelvic health. And I think even the pelvic health physiotherapist will tell you that they didn’t think that their work could be done online, per se.
The gold standard is in-person evaluation, for sure. But obviously, COVID didn’t allow anybody to have access to that. And there are some people geographically or even financially who may not be able to access in-person care. Some of them do virtual care, and what a lot of physios will tell you why they love that is because it puts the power in the hands of the person rather than the provider. So while the providers do a lot of manual therapy, having to just rely on online, gives you access to teach the person how to do their own self-exploration or their own pelvic floor, myofascial release, or their own breathwork type thing. So yes, that is an option. And then there are people like myself. There’s a lot of practitioners who do online coaching, who have online programs, some of them are fitness-based, some of them may be yoga, some of them may be education-focused, or maybe even a blend of all of those. And it gives people the tools to understand what the pelvic floor is, to understand all the intricacies and how it works. And then all the different things that they can do without actually having to rely on a practitioner.
Is there anything else you would like to add?
I guess a lot of people will say, “well, how do I find a pelvic floor physio,” and you can search pelvic floor physio or pelvic floor physical therapy, and your city, town, province, country, wherever you are in the world. That’s one place to start.
You can also go if you’re in the United States, American Physical Therapy Association, if you’re in Canada, Canadian Physiotherapy Association, or even the provincial physiotherapy bodies. And then there’s also a global site called pelvicguru.com, and this was started by a physical therapist. The directory is global. It’s not an exhaustive list by any means. But there are fitness professionals, there are pelvic health physios, there are medical practitioners, all people who specialize in pelvic health can be listed on that website. So that’s another resource. And yeah, I would always just start with Google and just see, but I would also say when you call a clinic to book an appointment, double-check that the provider is licensed to do internal evaluation and treatment. Because there are some people who don’t, like me – I don’t do internal treatment, I don’t call myself a pelvic floor physical therapist, but people think that I am. So I want to be clear that not everybody who says they do pelvic floor therapy is licensed to do internal evaluation. And that’s a really important piece.
So let’s say someone is having some sort of issue and they want to seek help. What should they know for their appointment?
Yeah, so different pelvic health professionals will focus on different things. So some may focus on the whole life, some may focus on pre-post-Natal, some may focus on mid-life, some may focus on pelvic pain, you know, so you may want to look and see if the person resonates in terms of who they mainly treat versus what stage of life you’re in.
I also really like pelvic floor physios who have a background in, you know, maybe sports or biomechanics; movement practices. And because more and more research is coming out now about how important whole-body movement is for all of our body, but also for the pelvic floor. And it’s not just kegel exercises. They play a role, but we need broader movement. And we need to look at the surrounding musculature, both from a lengthening and a strengthening perspective. So people who have a background in movement and sport have kind of an additional layer that helps people get back to more functional activity. Because a lot of people complain, “well, you know, I don’t exercise anymore, I’m afraid to lift or I’m afraid to do these things because of my leaking or because of my this.” And when we can work with somebody who has a background in movement and the pelvic floor, it’s a really good match
Is there anything else that they might want to know heading into the appointment?
And so again, usually, your first appointment is about an hour, some maybe it’s a little bit longer. So assume it’s an hour; some people will do the health history online, some will do health history with you in person. And a lot of it is done fully clothed, so I recommend wearing exercise clothing because they will be looking at how you move and maybe do some muscle test-type things.
And then when you do the treatment part, in some ways it’s kind of like going to a doctor. They’ll give you a gown to put on and they’ll have some sheets; you’ll be lying on a treatment table. And the physio will usually be sitting beside you, and kind of your knees will be bent. And so they aren’t, they aren’t necessarily looking right at you, but they’ll be kind of sitting beside you and making sure that they’re talking to you, they will walk you through the whole thing, they will ask permission at every step. If you ever don’t want it to happen, it’s not a forced thing by any means. You provide consent the whole way.
And the other thing that is really important, I think, is to ask or find a practitioner who will assess you in standing. So sitting, lying down is usually where you start. It’s always where you’re going to start. And that provides some information. But when we stand up against gravity, things work differently. Things position themselves differently, everything changes. And that’s often when people experience symptoms; they don’t typically feel heaviness or pressure or leaking when they’re lying down. So it’s important to have somebody who will assess you in standing as well. It doesn’t always happen on the first appointment, but knowing that that’s coming is important, I think for people to know.
And I guess the last thing I would say is that it is an intimate therapy. And, you know, you can find somebody online and you go see them. And if you don’t jive with them, it’s okay to go and see somebody else. So you want to find somebody who you feel comfortable with, in order for it to be as successful as it possibly could. And it’s okay to see 1,2,3 – most people don’t have to do that, you know, they don’t have to have a search and they usually they find somebody they like. But just know that there are other practitioners. And if you haven’t found the right fit for you, you can find someone else.
And this is your health and your well-being, and you want the improvement. So don’t let a bad match get in the way of that. There are a couple of questions that came from the community. One person had mentioned that after their last kid who’s now three, they’re having trouble orgasming, and were wondering if that can be a pelvic floor thing.
Absolutely it could be. So when we were talking earlier about overactivity in the muscles, when we have more tension, that can be one contributor. So when we have tightness in the muscles, we don’t have as much circulation and blood flow. And blood flow and circulation are important in terms of achieving orgasm. So that could be one, there could also be laxity, so maybe there’s not as much sensation. There could be inhibition, so maybe people feel different, or they feel that they look different, and they are always thinking like, does my partner see? And then we’re kind of ruminating, we’re not necessarily present, so that can be a piece of it as well? So there are all sorts of different things. I would absolutely see a pelvic floor physio for sure. And address and see if there’s anything functionally within the muscles, there could be maybe nerve damage, which is very common, especially with vaginal births. So maybe there’s something like some nerve entrapment that needs to be resolved. Yes, so 100% tied to the pelvic floor.
So with the nerve thing, is that kind of separate from the kegel pelvic floor therapy? Or does it kind of go hand in hand?
It would be more starting out with manual therapy, to release tension first, potentially converting hypopressives. And depending on what the pelvic floor needs, so is the person on the more lax side and they need more upregulating? Then yes, we would want to incorporate kegels sooner than later. If they were already up-regulated, then I would work on releasing first with maybe a couple of kegel exercises to go through ranges of motion, but work on relaxation first, and maybe some manual therapy to release tension that could be inhibiting that sensation.
It’s interesting how everything just plays a role and goes hand in hand. Another one, I think we’ve kind of covered it in different points we’ve talked about, but painful sex. We’re okay with not having incontinence or things like that, but painful sex.
Just like we just said, if we have muscles that are holding on to tension that can make penetration difficult. So it could be penetration that’s hard. Or it could be that, you know, penetration is not too bad, but it still hurts while it’s happening. Some people have pain where they feel like something is in the way almost on the inside. That can sometimes be prolapse, it could sometimes just be tension as well. And those would be the most common I would say, or it could also be dryness, like your dryness within the tissues as well. So I want to know a little bit more about what type of pain it is. There are lots of different pain like you can have pain in the entrance to the vagina vestibular edenia you can have pain with sex, dyspareunia, you can have pain in and around the vulva. vulvodynia. So there are all sorts of different pain types. So I want to know a little bit more in terms of what type of pain the person is happening is it pain with the thought of penetration, or with penetration, or after and so there are different aspects but 100% if you have access to your pelvic floor physio, for sure. It’s very treatable.
It’s something that does come up. It’s not like your body’s broken from it, it is a common thing just like incontinence can be, but you can deal with it.
I think we covered everything on my list. Is there anything else you want to mention or kind of one last reassuring thing to say to people dealing with these issues?
I always say that you know, light bladder leakage is not just part of being a woman and the symptoms from prolapse are not something we need to just live with. There are so many options, pelvic floor physio, I think is our best first line of defense. And then, you know, seeking out practitioners like myself who can help from a movement perspective or learning hypopressives can be really beneficial as well. So yeah, so don’t wait for a problem to exist. Take steps now; you may already have a problem now or challenge right now, and put yourself at the top of the to-do list. Mothering is easier, life is easier, activities are easier when you are feeling well. And when you are working, and you’re not distracted by symptoms. So make sure you put yourself at the top of the to-do list and keep yourself there, and make sure you understand that pelvic health is something for life. And the more we pay attention now, the less likely we are to have things that stall us in midlife and beyond.
We had a fantastic time talking to Kim the Vagina Coach, and she definitely taught us a lot! Make sure to check out her website, www.vaginacoach.com, and her Youtube channel, to learn more about all the amazing programs and advice she offers!
