Breakthrough Pelvic Tips for Menopause Support and Strength

00:00Real quick, the only ask I could ever have of you guys is to help spread the word so we can help more women lose body fat, build muscle, reach their goals, and feel insanely confident. And the only way we can do that is if you rate, review, and share this podcast. So the single thing I ask for you to do is if you could leave a review. It will take you 10 seconds, and it will mean the absolute world to me and may change the world of someone else. Well established in the research that Kegels are an effective way to overcome pelvic floor dysfunction like pelvic organ prolapse, like incontinence. But never have we been given proper education on what a Kegel is. So most people, and this is even established in the research as well, most people do them incorrectly. And then they think they don't work. So then they don't do them. And so we need, if Kegels are going to work, you need to first do them correctly, and then you need to be doing them consistently.

00:54What is going on, everybody? Welcome back to The WarriorBabe Show today. Very, very, very excited and honored to have Kim, the vagina coach on the show today. Kim is a leading expert in women's pelvic health, and a passionate educator, and also the founder of the vagina coach. And with her practical approach that she has with the wealth of knowledge she's going to share with us in this podcast today, she's changing the conversation around pelvic health and empowering women worldwide. So get ready for what I'm so excited is we get to talk about the vagina on our podcast today. So I'm super stoked. Kim, welcome to the show.

01:38Thank you for having me. It's always a good day when we get to talk about vaginas. Let's go. So Kim, just like open it up, share a little bit about you, your background, and why you're so passionate about what you are sharing. Thank you. Yeah, thanks for having me and for sharing knowledge. You know, that's how the world will move forward in this realm is when we're all talking about it. And I grew up with a bit of fear about childbirth. I saw a childbirth video and part of my sex ed. And when I went back home and talked to my mom about it, my mom was an OR nurse. She was very open about bodies and anatomy with my brother and I.

02:16And she told me about her birth and she told me she'd had episiotomies and that and then I as I was continuing to grow up saw her experience incontinence when she was running. She had chronic back pain. She had a tummy that wouldn't flatten no matter what she did. And she would often say, oh, it's because of your brother and you like it was the picture was painted that pregnancy and childbirth aren't necessarily friendly to the female body. So I grew up saying I'm never going to have kids. And that was my story until I met my husband and decided I didn't want to start a family.

02:48And then it was about educating myself and how I could have a different story than my mom. So I thought, well, maybe if I have a cesarean, I don't have a vaginal birth. Maybe I'll be fine if I have a cesarean and learned more about that. And that's not the answer. And anyway, I became pregnant. I used a product called the Epino, which is a biofeedback device for the pelvic floor manufactured in Germany. It's a doctor who saw women in Africa using gourds of increasing size to prepare their perineum and pelvic floor for birth. And he thought that's a great idea, but that's not going to fly in, you know, in the rest of the world.

03:23So he designed a medical device. Epino stands for no episiotomy. And it's a device that allows you to connect with a part of the body you can't see, which is the pelvic floor muscles. And when they contract and relax, you have the device inserted. It's like a little balloon. And when you contract and relax, it reads on a little gauge. So you can see the contraction and relaxation. And in the last few weeks of pregnancy, you would leave it inserted in it. You gradually inflate it to a bigger diameter to stretch the tissues, not so much pre-stretching, but introducing these concepts of stretch and pressure and discomfort,

04:00which is what you're going to experience during childbirth with the intention of basically the principle of specificity from fitness, trying to apply it to the pelvic floor specific to birth. And so I used this, had a great experience. I did prevent tearing. And in with my knowledge at the time, I thought if I don't tear like my mom did, or if I don't have an episiotomy like my mom, then I won't have incontinence. And that, that was my very basic knowledge at the time. And that is not correct, but that's what I thought was accurate. So did I use it with my second son developed incontinence?

04:32And I thought, well, wait a minute. Why, why do I have this? I didn't tear. And I, you know, I thought I did all the right things. So then around that time, I was thinking I was going to turn this into a business. And I started to learn about pelvic floor physical therapy. I started to educate and work with as many people as I could to learn and wanted to basically bridge this gap because it was all very medical and where we're talking about muscles. So why were we not applying the same principles we do for other types of training in the body to the pelvic floor?

05:08And so that's kind of where it started. It was an e-commerce store initially, and I had the Epino plus many other products. I then formed a second business called Bellies Inc. And I was working with a pelvic floor physical therapist and another trainer like myself. And we wanted to optimize postpartum recoveries because we were seeing, we know pregnancy and childbirth are risk factors for pelvic floor dysfunction. So if we can impart knowledge ahead of time, have people birthing differently than they are, have them optimize and even honor that recovery process, could we help?

05:41So we designed a postpartum wrap and coupled it with restorative exercise, juggled the two businesses for a while, and then started to move things online. We created a certification course for fitness professionals who wanted to help women with incontinence and organ prolapse and what have you. And that's where I am now. So almost 19 years later, and the majority of what I do now, Bellies Inc. has been sold and I help support women preventing and overcoming common pelvic floor challenges.

06:14That's awesome. That's so cool that, and thank you for sharing that whole story, kind of like A to Z there. But starting out with like your own personal experience, well, really your mom, then you were like gathering up, holding the story for yourself. You're like, nah, I want to rewrite the script. And then you learned, you know, you go on through your own experience and then you're like, oh man, like this, I want to be able to help people. Like that's just, I love those stories because it evolves from your own personal pain or experience. And then you learn and then you're able to spread the word. So that's super cool.

06:45Yeah. And you see the voids and you think, well, I can't be the only one that wants to know this or that, you know, and then, and seeing my mom struggle and then starting to understand how common it is and how currently people think that it's normal. We have pad companies telling us it's just part of being a woman. And so there's this acceptance that we should be wearing pads for the rest of our life. And I wasn't okay with that. I'm not okay. Let's go changing the script. I love it. Breaking the norms, baby. Cool. All right. So for, you know, the listeners listening,

07:17can you just share like, what is the pelvic floor? Yeah. So as I've been saying, it's a, it's a group of muscles that closes off the base of our pelvis and we can't go to the mirror necessarily and flex our pubococcygeus muscle. We can't necessarily see them. So it makes it a little bit more challenging to access. But if you can think about the landmarks of our pubic joints, so you can even wherever you are right now and put your fingers on your pubic, people say pubic bone, but it is actually a joint at the front. And if you're sitting on a hard surface chair,

07:47or even if you're standing, pull the flesh of your butt cheek away and you should feel a bit of a bony point in your bum. And those are your sits bones, your ischial tuberosities. Those are also attachment points for the pelvic floor. And then on the backside, we have our triangular bone is the sacrum. And at the base of that, we have our tailbone or our coccyx. And that's also an attachment point. So pubic joint coccyx to ischial tuberosity is sort of like a diamond shape. That's where the pelvic floor muscles attach. And it's muscles, plural. It's not just one muscle.

08:18It's three different layers. And the first layer is primarily responsible for sexual response. Second layer, primarily responsible for continence. So if we think about our urethra, our vagina, our anus, the three openings, the muscles help manage those openings so that they stay closed when we don't want things to come out and that they open when we do want something to come out or in the case of insertive sex, something to go in. And then the third layer is primarily responsible for supporting our organs. So we have bladder, uterus, rectum,

08:48and we want them to stay in their proper anatomical position. And the pelvic floor plays a role in helping them there. The muscles attach, as I said, to the base of our spine and to our pelvis. So they play a role in our core stability. And we think in fitness, we've heard core exercise and core fitness for decades now. And nobody has talked about the pelvic floor as being part of that core. It's the foundation of our core. It also works in synergy with our diaphragm, with our breathing muscles. So every time we're breathing in and out, the pelvic floor is moving in concert with that.

09:24And that in and of itself is a way to strengthen the pelvic floor, also learn to relax. The pelvic floor is just coupling it with the breath. So those are the main functions of the pelvic floor and where it is, what it does. And when things are working well, we don't even think about it. It's just there. And again, we don't see it in the mirror. So we just don't even necessarily even know that we have a pelvic floor. But when things are not working well, then we may have painful sex. We may not be able to orgasm. We may not be able to have anything inserted.

09:55We may leak urine. We may have very strong urges to go to the bathroom and not make it in time. That could be both urine and anal. We may feel like, you know, I feel pressure or heaviness, or I feel like something's in my vagina when there's nothing there. So we might be starting to experience prolapse. We might have chronic back pain, might have joint pain in our pubic joint or tailbone. So these are just a few. There's many different challenges people can have with the pelvic floor, the most common

10:26being incontinence and organ prolapse and pelvic pain. Ladies, are you feeling frustrated with body changes you're experiencing during menopause? It's time to take control. If you're between 45 and 65 years old and tired of struggling with body fat and muscle loss, Warrior Babe is here for you. At Warrior Babe, we've helped over 18,000 women just like you lose body fat, build toned muscle,

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11:27Wow. Okay. So my brain just went to like three different buckets there that I want to like circle to each one of them, but make sure we get to those three. My brain went to like, okay, we have pregnancy issues, right? Like there's incontinence with that. There's exercises, things that you want to pay attention to. Also ensuring that you have the pelvic floor is stable, right? For pregnancy and for afterwards. Then my brain went to like the core, which I love that you brought that up because I would

11:59definitely want to circle back to speaking about that. And then incontinence is like floating above all three of these, but then the diaphragm and breathing. And what I've never thought about it this way, but how you said it too, as well as like, it's a muscle that we don't see. So like, how do we know that? How do we know it's even working? Right? Like, how do we know those things? Yeah, it's hard to know. And a lot of what I do is help people like feel or understand that relationship or the

12:32position of the, the, the pelvic floor, it's movement that it does move, that it's okay to move with visualization and imagery and posture and different positioning, because just saying to somebody, relax your pelvic floor or activate your pelvic floor is, especially if you don't even know what a pelvic floor is or where it is, it's, it's not something you can just do willy nilly. And we might've heard in classes, you know, engage your core or brace or, and different cueing, maybe pull your belly button to your spine.

13:02And those are all well-intended. But again, when we don't have knowledge of what the true core actually is, we will interpret those cues. Everybody will interpret them differently. So it's trying to find the best cue for a person, trying to find the best position for them, showing them things like imagery and showing them the models, like the pelvis model that I have, that they can then see what we're talking about and understand what, what it looks like or what it is within their body.

13:32So we bring that little, little, that cool thing out guys, if you're watching through video, actually, I would highly recommend that you just listen to this entire podcast through video, but I know some of you guys only have the, you know, Apple or Spotify or, but I want you, can you demo? Yeah. Can you demo what this is and what the pelvic floor is? And just as a sidebar that whether you have male or female anatomy, you have a pelvis, you have a pelvic floor. Being a vagina coach, I work with people with vaginas. I work with women and, but a lot of the principles that we're talking about will apply posture,

14:05breath. There's different visualization and cues. The male pelvis is not so wide. It's a little bit narrower. They don't have a vaginal opening. They don't have a vagina. They don't have a uterus. They don't go through menstrual cycles. They don't go through hormonal changes. They don't go through pregnancy birth. They don't go through menopause. Like there's, there's. They're not super humans like us women. Yeah. Thank you very much. Thank you very much. So I just wanted to put that there as a disclaimer, because I'm asked all the time, will these exercises work for men? Short answer.

14:36Yes. But so here's the pelvis. So as I'll turn it this way, this is the pelvic floor. So if this is a person laying down on their back, so here's the anal opening. Here's the vulva. Here's the vagina. Here's the erythra. And this is, this is a layer. Here's a layer. You can't see the other one on the inside. So multiple layers of muscles, but essentially there's the attachment points, pubic joint, the two sit bones, and you can't see it here, but the tailbone here at the back. Okay. So this is the pelvis and you can see this is be our spine at the back.

15:11If I turn it around here is our sacrum and there's that tailbone. So we have our two hip bones. We have our sacrum. And then this here at the front is actually a joint. People do refer to this as a pubic bone. It is actually a joint there. Inside we have the bladder, the uterus, and the rectum. And up above here would be our diaphragm. And when we breathe in, there's, there's, the diaphragm is, is in a resting state, kind

15:42of like an arc. And then when we inhale, the diaphragm flattens and spreads. So our ribs ideally are expanding to allow that to happen. Then what is happening or what ideally should be happening down below, I'm just going to turn this to the side, is the belly expands and the pelvic floor is lengthening as well. Again, we don't necessarily see that, but we can with imagery in different positions feel almost like there's a fullness in our pelvic floor perineum. Then when we exhale, the pelvic floor contracts and lifts.

16:12The belly moves inwards. So there's that pull your belly button to the spine cue. That's kind of what we're asking it to do in a sense. And then the diaphragm will come back up. And so there's a kind of, as I saying, like there's this dance that's happening with the pelvic floor and the diaphragm as we are breathing. And if we have disordered breathing, if we are holding ourselves in ways that the pelvic floor isn't able to move through that range, we may not, this dance might not be happening

16:44very well. We might have more shallow breathing, not getting as much oxygen. We might feel tired all the time. We might start to have pain in the pelvic floor. Or we might start to become symptomatic because if the pelvic floor is being held in a shorter, tighter state, it's not getting good blood flow, not getting circulation, not moving through its range of motion as we breathe. If that makes sense. Yeah. Yeah. Yeah. That totally makes sense. So you've highlighted some of the struggles there. How would one know that they are like, what are common struggles people face?

17:15You're kind of already like you pinpointed it a couple of times. I guess what I'm searching for is like, how do we know, I mean, we would experience the pain. We would feel the things. How can we make that better? Yeah. So sometimes like back pain, 95% of women with low back pain have some form of pelvic floor dysfunction. And yet we go to massage therapy. We go to acupuncture. We go to chiropractic. We stretch yoga. Like, and all of those things can absolutely be beneficial. But so often the missing link is the pelvis.

17:49So pelvic floor physical therapy is always my number one thing. And I argue this is something we should be doing every year, even if we have no symptoms, just like we go to the dentist for a checkup and a cleaning. Why are we not taking care? Why don't we do that care for other parts of our body, especially the pelvic floor? So we go, we've been conditioned from a young age, brush, floss, go to your dentist once or twice a year. And then we get a clean bill of health from the dentist. It doesn't mean that we then stop brushing and flossing.

18:22It means we continue doing what we're doing and we go back again for another checkup and they screen for things before they become big issues. And if we had that same practice with the pelvic floor, then maybe a little bit of niggly back pain could be understood. Maybe early signs of pelvic organ prolapse could be caught before they're a big issue. Maybe changes to the tissue, like low estrogen states or the beginnings of autoimmune conditions like lichen sclerosis could be caught earlier before they become major issues.

18:53So back pain is very common. It's also very common with prolapse. Leaking urine, obviously you're going to be aware if you are leaking urine when you're not sitting on a toilet, urine's coming out of you. That is incontinence. You do not have to be an older person in a nursing home to experience incontinence. You can be a young, fit teen. It can happen to anybody at any time. If urine is coming out of your body when you don't want it to, that is incontinence. It's very treatable. There's stress urinary incontinence where you leak a little bit of urine when you laugh,

19:26cough, sneeze, jump, lift, push. There's urgency where you're fine, but then you see a bathroom or you're putting your key in your front door when you get home or you hear running water. There's lots of triggers that all of a sudden it sends off an alarm and your bladder gets very excited and starts to send you like a major sensations that you have to get to a bathroom right away. And you might leak a little bit or you might have a full release of your bladder. There's frequency.

19:56I feel like I have to go to the bathroom all the time. I'm in there every half an hour. That's not normal. Every two and a half to four hours would be considered normal. Constipation. Constipation is, like you said, you talk about poop. Poop is, it's like a vital sign. And if we're not pooping well every single day, that constipation is going to contribute to bearing down and trying to strain to get a poop out that's damaging to the pelvic floor. And it is also that stool that doesn't get eliminated creates urgency and can increase

20:28stress urinary incontinence as well. So if you have incontinence, sorry, if you have constipation, it can be damaging to the pelvic floor, but your pelvic floor muscles could also be contributing to why you have constipation. If you have tightness. Okay. So thoughts here, because I hear this all the time with women that are like postpartum where they're like, I can't do pop anything like pop squats or pop lunges because they're going to like, I'm going to, I'm going to, I'm going to, you know, I'm going to have incontinence.

21:00Exercises. Kegels, right? Kegels, would Kegels help? Do Kegels work? Yes. Okay. Yes. So Kegels are very, it's well established in the research that Kegels are an effective way to overcome pelvic floor dysfunction, like pelvic organ prolapse, like incontinence. But never have we been given proper education on what a Kegel is. So most people, and this is even established in the research as well, most people do them

21:31incorrectly. And then they think they don't work. So then they don't do them. And so we need, if Kegels are going to work, you need to first do them correctly. And then you need to be doing them consistently. And my bias is also that Kegels. So you talked about pop squats and all the more dynamic explosive movement. If we had somebody do Kegels and they sat in a chair or they did them while they're brushing their teeth or they sat at a red light, which is where we often hear, that's when you can

22:01do your Kegel exercises. It may help a little bit, but that is not going to translate long-term into the explosive movements. We need to retrain the reaction time of the pelvic floor and build up its resilience and capacity to respond to explosive movements rather than doing a static exercise, hoping that it will translate. Like, so like you should be doing exercises and like women should be doing exercise. Like you're saying, like, it's like going to the dentist. People need to really focus on the health of the pelvic floor every single year.

22:34So would you say like postpartum is almost too late to be like trying to make it better? Like this should be. It's never too late. You can, I have a 92 year old woman in my community who has made changes and she has never had any education at all through her whole life and was experiencing incontinence and prolapse. So change is always possible. But yeah, if we can step in ahead of time and we can't a hundred percent always prevent, but if we can reduce our risk, it would change the world.

23:04Honestly, it would change the world. So, and the other piece that I'll add there is my bias has been, we need to train the pelvic floor dynamically. So yes, we have established evidence with Kegels and voluntary contraction and relaxation of the pelvic floor. Now, thankfully we have some evidence showing that Kegels done prior to resistance training or Kegels done as part of a resistance training, which is what I do is more effective and people get results quicker. So, and like some people say, well, if I'm doing exercise, CrossFit, doesn't matter what type,

23:43boot camps, yoga, Pilates, doesn't matter. If I'm doing whole body exercise, is the pelvic floor not being trained? It is. But we can see from research that it is better when we, it's like me doing a whole body routine will have some effect on most muscles in my body. But if I really want to get stronger in a certain part, I need to do targeted exercises for my back or for my biceps or for my legs. And the pelvic floor is no different.

24:13It's a group of muscles, type two, type one muscle fibers, and we need to take it through a variety of movement. We need to make sure that we emphasize relaxation and suppleness as well as contraction, endurance holds, quick contract releases, like the more explosive movement. And as we age, we lose more type two muscle fibers. And we have a lot of type two muscle fibers in the pelvic floor. So if we're losing those, that's that explosive movement. We need more of that type of training as we're aging to offset the fact that we are losing more

24:48type two muscle fibers. So what are some effective exercises that listeners can incorporate to make, to help pelvic floor health? Yeah. I take like an ABC approach. We need ideally that the pelvic floor is in a good position in the body, a good alignment with the pelvic floor so that that relationship with the breath can happen. We then take that and we use, I call it the core breath. So B for breath.

25:19And we reestablish that connection. So we just go through some, whether it's in child's pose position or seated or laying down, it doesn't matter. You can try it in all of those positions so that you can feel that movement with the pelvic floor and get connected with it. Then we see coordinated. So alignment, breathing coordination. We coordinate that core breath into movement. And then we apply the principles of progressive overload and principle of specificity. And we start to do more sets, more reps.

25:51We add more speed. We, you know, you work with all the other variables and things like squats. They are, the pelvic floor is very active in a squat, lunges, bridges. So if we take those and we add the core breath to it, we are killing two birds with one stone. We're activating the pelvic floor when it's, and it's almost like plyometrics. We already know it's active.

26:22And let's add voluntary activation to it to kind of harness that engagement within that, that movement. And, um, so there's no like magic exercise per se. It's about the principles of ABCs and then progressively overload the pelvic floor with a diverse range of movement. I love it. I feel like I need to add, uh, a pelvic floor specific exercise, uh, into like a weekly routine.

26:54Like, like that's, yeah, that's important. I didn't realize how important this was until you're sharing all this insights and knowledge. So thank you. Yeah, you're welcome. And I think the, the other, the other piece that hopefully will help. Cause sometimes people are like, I'm fine. I don't leak. I'm on a back pain. I'm good. My pelvic floor is good. I've never given birth before. I'm, you know, whatever, all the reasons. And that's great. We all want to be symptom free. However, again, we want to come in and, and ensure that we aren't trying to overcome a

27:29problem. Let's try to prevent that problem from happening in the first place, because the perimenopause menopause transition, we have an additional layer of, so we have age-related muscle loss, age-related strength loss, bone loss, like all the things. And then as we get to menopause, we have a steep decline in estrogen. Guess what's all around the pelvis and the vulva and the vagina and the bladder? Estrogen receptors. And so when we have a loss of estrogen, anything that was, you know, we might've been symptom

28:00free or we might've just had, oh, I only leak if I really jump hard on a trampoline. Any of those things that we could kind of excuse away, all of a sudden, either you get symptoms for the first time or they become much stronger. Urgency, frequency, irritation, bladder, sorry, painful sex, and also an increased risk of UTIs. So yeah. So low estrogen states are going to exacerbate or bring on, and it's over 80% of women will

28:30experience genitourinary syndrome of menopause, which GSM is the umbrella of all of the signs and symptoms we've been talking about that happen around that menopause transition. And they do not get better with time. So can you demonstrate an exercise? Like, I don't know, it's hard to do on a podcast, but like, how would you do a squat right with engaging the pelvic floor effectively? Okay. So I am currently sitting in a chair and if you are sitting somewhere or even if you just

29:03want to do an air squat, that's fine too. What happens with the pelvic floor when we are going through the range of a squat is we're standing up. I won't stand up right now, so you'll lose my face. But if we're standing up, as we lower down into the squat, our pelvic floor is lengthening. We're breathing in, we're lengthening, we're getting ready. Just before we stand back up, the pelvic floor is starting to engage. And then as we're standing, it's contracting and lifting. So if I go through that range of motion, if I'm standing here and I'm going to inhale and

29:38you can like different cueing, you can think of blossoming your vulva. You can think of these four points expanding away from one another as you take a breath in. Okay. So I inhale, I'm lowering down into, sorry, my camera went blurry, my squat. Just before I stand back up, I'm exhaling, engaging. So I'm going to think of picking up a blueberry with my vagina and my anus, or I could think about sipping a smoothie through a straw with my vagina. Guys could think about pulling the turtle into the shell.

30:09And then I come back up. Okay. So I inhale down, exhale, activate first. Then I stand back up, inhale down. And the reason initially why you exhale and engage just before you stand up or come up out of your squat is because part of what we need the pelvic floor to do is be strong, have endurance and be supple, but we also need it to react at the right time.

30:42So sometimes leaking urine is because our pelvic floor is tired, overworked in a shortened state, doesn't have a lot of power left. So it's kind of like, Oh, I almost, I almost could control that, but I couldn't this time. Sorry. So we need to release tension. We need to remind it that it should be pre-contracting just before we exert our movement or whatever it is that we're doing. As we progress, then eventually we would exhale as we were standing up from a squat.

31:14Maybe now we're going to add some resistance. And the intention is that we shouldn't always have to think about picking up a blueberry or sipping a smoothie through a straw when we're exercising. We want to get back the point where the pelvic floor is working automatically, but that doesn't mean then that we need to take out, that we don't need to do pelvic floor exercise anymore. So I always am adding pelvic floor at some point in my routine because I, I understand the importance

31:46of it and I want to do everything I possibly can as I'm aging to maintain that group of muscles and that function. So if you think about exhale on exertion, that's a common strategy with a lot of fitness and, uh, picking up, doing a bicep curl, exhale, pick up my blueberries, then curl. Inhale, let my blueberries go as I lower back down. Push-ups, pull-ups, we can apply it to anytime we're exerting. We initially retrain and we exhale first, then do it.

32:18Then we exhale as. Thank you. Thank you for the visuals. I love the visuals. My brain works and operates that way. The visuals and it works and operates with analogies or when you're pinpointing like straws and blueberries and all that kind of stuff. So that's awesome. So I want to circle back to the pregnancy side of things before we dive into like the core for women that are, what, what are, what are some key considerations for exercising safely during pregnancy? That's changed a lot over the years and it has gone from being very restrictive to now,

32:54uh, there's more freedom and there's even more research coming out because it was always, you know, yes, you could still move, but it needed to be very gentle movement and you could only walk and you could only swim and you couldn't lift over X number of pounds. And, and more research, one bit of current research was looking at heavy lifting loads with pregnancy. And, um, there was still incontinence, but there's a lot of other reasons why incontinence is happening. We can't just say, Oh, it's because they lifted heavy.

33:24Um, and so I say exercising safely is exercising within however you're exercising. You want to consider certain movements and that you're not, it's not going to be, um, you know, having hitting your belly or, you know, those types of things, certain positions. And I still do look at it as during pregnancy. We're not, some people may, uh, I forget the name of the woman.

33:54Uh, is it Tia, the one that just did the CrossFit, the, the road competition. So there are some people who are training for something very shortly after, but I view birth as the event that we are training for when we're pregnant. And we look then at what are the best, the most optimal birth positions? What are some of the ways that we can move during labor and let's move and train for those. So principle of specificity, uh, a plank hold to me, that's not something we necessarily

34:24need to do. And, and is there an increased, like being in a prone position where I know that my belly is stretching and the connective tissue is stretching. Why, why do that? If it's not something that's necessarily going to make me stronger for birth, I'm not going to labor in that position. I'm not going to birth in that position. So I would be looking at, I do, would do lots of squats and lots of lunges. And I would do some four point kneeling and deadlifts, like taking through a range of motion

34:55rather than a static held position like that personally, um, lift comfortably as long as you aren't feeling like start feeling and becoming aware of symptoms or pressure or heaviness, because we are at an increased risk just by being pregnant. We have an additional load on the pelvic floor. We have hormonal changes that are happening. We have stretch to the abdominal wall and the connective tissue that is part of our core control mechanisms as well. So let's pay attention to our alignment.

35:25Let's pay attention to our core breath. Let's coordinate it into movement that is training me for my event, which is birth. And the other thing, when we are training for an event, there is always an element of a recovery period that's, that's, um, brought into our training protocols. Birth is the same. We aren't going to go back. Ideally back to the gym at two weeks. We are wanting to harness that recovery period. Give the tissue time to heal. Doesn't mean we're not doing anything. We can start the core breath.

35:57We can start gentle pelvic floor activations. We can start things like the bridge and work on creating more control in our hips based on the biomechanical changes and hormonal changes that have happened during that nine months of pregnancy. Retrain the system at six weeks. To me, that is not time to go and just be like, yeah, you're fine. Everything's great. Go back to what you were doing. That's my green light to go to pelvic floor physical therapy and get your internal evaluation. See what the position of your organs is.

36:29We know that a vast majority of people at six weeks postpartum vaginal birth or cesarean birth have some degree of pelvic organ prolapse. So let's let the body adjust. Let's let the body heal. Let's retrain. And then again, progressively load back to what you were doing. Don't wait for six weeks. And then all of a sudden you're back to where you were before. Right, right, right, right. So in that window of time, as a recovery, you mentioned the recovery process. What are some exercises that women can do following birth and leading up till they can start getting

37:04back into the progressive overload of strength training and stuff? Hey, hey, just want to drop a huge appreciation to you guys listening to the show. It means a lot. I hope you guys are enjoying it. And there's so much more to come with it. If you are enjoying it, hit the subscribe button. I'd appreciate that tons. And also it would help this podcast reach others who need to hear these messages, too. Thanks so much, guys. Let's get back to the show. Yeah. So I always start within the first week with the core breath. Just get reconnected. There may have been some tearing. There may have been some there is loads of pressure on the nerves.

37:37So there may be some disruption in messaging. There may be some tearing. I think I say that already. Sorry. And so we need to let that healing time happen. But when we can start adding in gentle contraction and relaxation, we get blood flow. We get circulation. We get stimulates nerve growth factors. So that's important. Then we start to say, all right, let's do some bridges. It's almost like a gentle inversion. It's like we're guiding the organs back to where we want them to be, working on our glute strength, gentle.

38:09Then we can start like clams or bent knee lifts, working on the lateral hips. Then we're going to get more upright as we can accommodate more maybe pressure on the perineum. So especially in a vaginal birth, we will have swelling. It'll be quite tender in the vulva and the pelvic floor. So maybe not sitting upright is going to be comfortable right away. But we do want to get upright against gravity. We want to start doing some squats because what do new moms do a lot of? They pick up their baby.

38:39They put it down. They pick up a car seat. They put it down. They pick up laundry. They put it down. So, yeah. Yeah. So we want to train those movements. Ideally, we've been training them throughout pregnancy. Now we're training them again with a little bit lighter load, but still some loading. And six weeks to your physio, your pelvic floor physio. And then we're going through the same principles. And it's more like four to six months before we're back to the heavy lifting and the more explosive movement.

39:11There was a great article or protocol shared by Grannie Donnelly and her team. She's a physical therapist in Ireland. Absolute physio is her handle. And she put together postpartum protocol for return to run. And it was, you know, logical. It was allow tissue healing. Here's some early restorative exercises. See a pelvic floor physical therapist. Here's your prerequisite exercises to do that will show that you have regained the capacity to manage the loads of running before you go and just start running again.

39:49And lots of movement practices are like that. You need to be able to do this move before you can do this one. So it's just it's so logical that we've just everything about pregnancy and birth. We've just sort of like, oh, you're fine. You get sent home from the hospital and you're good. Just wait six weeks and now you're fine. And we don't even so many people don't even have an internal evaluation at six weeks now anymore, which I think is crazy. So it's we want to harness and and and honor the need to recover. There has been a lot of change that has happened to the body.

40:21And then there is a birth and vaginal birth or cesarean, essentially a surgical birth. We need time for those tissues to heal and we need to reconnect and we need to then progressively overload them. Look, I've never had a baby and I've never been pregnant, but I feel like just by this conversation with you that I can go into postpartum knowing that tools and resources and education and insight from what I'm learning from you right now. And I know a lot of listeners, if they've a lot of them are 45, 65, 75.

40:52They've been through the process. So probably resonating very you are resonating very hard with them and sharing more valuable insights that they probably maybe didn't know about. So maybe they could tell the younger people in their lives. Yeah. Yes, exactly. You mentioned there you put up like a little plug about lifting heavy. Is that like first? Well, you meant that I've been seeing some moms that are pregnant that I follow on Instagram that just crush it. Like everyone's totally like individual, as you're saying, it's totally an individual case and like being aware and aware of how your body is responding to things.

41:25But when you are pregnant, is lifting or even in general, is lifting heavy a bad thing? We can't like blanket statement say heavy lifting is that. We can't because a lot of these people, we don't know, but maybe they have been training and that's very comfortable. That might even be a lighter load to what they used to do before they were pregnant. We don't know. Of course, we see and it looks very heavy or we might say, but that might be lighter for them.

41:57It might be heavy for me, but maybe it's light for me. Like we can't just use that term heavy. It's really comes down to the person's execution of an exercise and how they manage their intra-abdominal pressure. If we are chronically bearing down with a lift, regardless of what that weight is, or chronically bearing down with a certain movement pattern, constipation, chronic coughing, that is what is the problem.

42:32And so we need to look at what is that person's strategy of how they are managing pressure, change their breath, change the position, change the load, change the frequency, like change, see what variables we can change to give them a better strategy that would help mitigate some of the potential risks of that chronic bearing down. Does that make sense? Yeah, totally makes sense. You've mentioned breath a couple of times here and throughout. What are, and I know you shared a little bit of the demonstration when you were doing a squat of one to, you know, exhale and inhale.

43:08But when you're recovering during postpartum in those weeks, what are some breath work exercises that one could do? Same. Core breath. Yep. Core breath. Yep. And what I will often say in that first week, again, it might feel very tender, especially if you've had a cesarean, you have an incision, it may not feel great to activate the muscles. But ideally, you would have been doing them throughout your pregnancy. You understand that relationship.

43:38And so now you just, you inhale and you exhale, visualizing what's happening in the pelvic floor. You're not adding that voluntary, like picking up the blueberries or the jellyfish or the milkshake. You're visualizing what's happening. And then every once in a while, just try a gentle contraction. If it feels accessible, do a couple more. And then we just start, it's just building capacity. And that's what then is going to stimulate muscle memory and blood flow and circulation and all that sort of stuff. But it doesn't have to happen right then and there. But that's the same.

44:10It's the same thing. Core breath. And is that in alignment with how you mentioned like earlier Kegels for the long time we've been taught how to do them wrong? Is that the core breath and thinking about the blueberries and the straws? That's the way you do Kegels the right way? Yeah. So many people, I would say probably like 95% of the people who are in my program, when they're first learning the core breath and the alignment, all those, they're saying, I've been doing this all wrong. And it doesn't like you're alive, you're breathing.

44:41I don't want to say that, oh, you've had, you know, you haven't been breathing properly. Kind of, but it's just a bit of a mind shift because usually they've thought of a Kegel as, oh, because I need to suck something up. They'll, well, they will inhale and suck up and then let go. So when we think of physiologically what happens in the body, the inhale is where the pelvic floor is lengthening. So if we're trying to take a breath in while contracting the pelvic floor at the same time, we're never going to get a great breath and the pelvic floor is never going to go through its range of motion.

45:13So I'm literally sitting here and doing the breathing at the same time, trying to think about engaging the core, the pelvic floor. Yeah, in a way, like when I'm working with people one-on-one via Zoom or I don't necessarily do in-person stuff anymore, but one way that I, within my scope, can see if somebody has the capacity to activate and relax their pelvic floor is to ask them, sitting or wherever they are, ask them to contract and hold their pelvic floor. So I don't give them any cues. I just ask them to do a Kegel or to contract and hold their pelvic floor.

45:46And then I'll say, keep holding, now take a breath in. So if they are, if they are, have a decent strategy of contracting and holding their pelvic floor, and then I ask them to take a breath in, then I will say, was it harder, easier, or the same to take your breath in? And if they say harder, then I'm thinking, okay, they probably had a decent activation of their pelvic floor. They could hold it because that made it harder for them to feel like they could take a deep breath. If they said easier, then I would say they're probably, they didn't really activate their pelvic floor.

46:19And that didn't interfere with the ability of the diaphragm to come into its nice flat state because the pelvic floor lengthened. Are you with me on that? Yeah, I'm following. I'm trying to do it at the same time. Yeah. And probably a lot of people are listening or trying to do it at the same time. So you're saying if I can, if I'm engaging my pelvic floor, pelvic floor, not core, pelvic floor, and taking in a deep breath, it should be hard? You should not really be able to take in a deep breath. Like when we, so here's the pelvic floor, here's the diaphragm.

46:52Okay. When I take a breath in diaphragm flattens, pelvic floor lengthens, and this exhale pelvic floor contracts and lifts. So if I contract and lift the pelvic floor, and now I try to take a breath in, usually the diaphragm wants the pelvic floor to relax. But if I'm holding it here, it's, it's going to be hindered in its ability to totally let air come in. And people might, when you see their ribs, ideally when we breathe in, we have a lateral expansion in our rib cage.

47:23So if we look at somebody in there, there's no movement in the ribs, and we see a little bit more of this happening. That's also another indication that they're probably not connected well yet to their pelvic floor. How would one get connected to their pelvic floor? Keep doing this? Alignment, breathing, coordination, practice. Yep. ABCs. ABCs. Okay. Awesome. Thank you for all of this so far. This is so, so good. Let's transition over to the core. Why is, why is core, you talked about a little bit earlier, but bringing it back here.

47:56Why is core stability important for the pelvic floor and then, and pelvic health? And then what are some exercises that we can do to strengthen the core while protecting the pelvic floor? Well, the pelvic floor is what's helping us with that core control. And so when we think of the, people think of the core as maybe more aesthetic. I want to strengthen my core so that I have flat abs or so that I don't have back pain. I hear that all the time.

48:27Right. That's why we do it. Like, we're like, yeah, if that's going to flatten my midsection, I will do all the core exercise in the world. So, and Kegels, if we're doing the core breath and recording it into movement, you will get a flatter midsection. Because we are, so here's the pelvic floor, here's the diaphragm, but we also have the transverses abdominus, the deep abdominals. When we're taking a breath in, the pelvic floor lengthens, the belly expands, or at least it should. Exhale, contract and lift the pelvic floor. The belly button is moving inwards towards the spine.

48:58We don't have to think of pulling belly button to the spine. It just, it naturally co-contracts with the pelvic floor. And that is, this is an engaged core. When we exhale and engage, the transverses in the pelvic floor are creating that cylinder, like the canister is held. That being said, we don't, like, rigidity is not necessarily control or strength.

49:28We need that to be kind of fluid and dynamic, but the pelvic floor is what's creating the core control. And we need that core control to transfer load through our body, to lift heavy things, to have freedom of movement, to maintain balance, to keep our bones strong. So the core, our center, is what gives us more capacity in all of the other things that we want to do that help with our overall health and well-being.

50:03If we are hindered in our core, if we have a weak core, then it may be tightness in the pelvic floor. It may be laxity in the pelvic floor. It may be the timing is off. It may be that we don't, it's not working in synergy with the diaphragm. It may be like sometimes we can have bony shifts, maybe from an accident or a fall that are influencing how the muscles work. And maybe they're not working in a balanced way.

50:34So there's lots of different reasons why we may not have great core control. So then we come back to the principles of ABC, get back in our alignment. What is it? What do we need to lengthen? What do we need to strengthen? Work on that coordination and the breath and then progressively load. And a lot of the, you talk about postpartum, there was one piece of research that we used in that company. I said we started called Belly's Inc. And it was meant to optimize that postpartum recovery with wrapping, abdominal wrapping, which is used in many cultures around the world and restorative exercise.

51:12And that we had one piece of research that looked at eight weeks postpartum. The abdominal wall. So there's something called diastasis recti where there's the connective tissue that holds the six pack muscles in their position at the midline. It stretches and thins and often the rectus will move away from the midline and can create a bit of a gap larger than what would be considered normal than a normal size gap. And there's one piece of research that looked at if there's nothing done, like at eight weeks postpartum, that is the position of the abdominal muscles.

51:52That's what it's going to be unless there is some sort of intervention. And we said, well, let's harness that first eight weeks then and provide things that will encourage realignment to the rectus, tightness and activation in the connective tissue. So we put together an eight week protocol that had things like bridges, clams, bent knee lift, standing on one leg and transferring load, like building up balance in the lateral hips, squats, lunges, functional movement that we knew moms are going to be doing, but that are also going to stimulate the pelvic floor with the deep abdominals and the thoracolumbar fascia to create tension in that connective tissue.

52:37So that we are managing loads that we are going to be doing while we rotate in the car to put a soother in our baby's mouth or write like all the, all the, we call them movements of motherhood. Like you want to see a lot of variety of movement, follow a mom around for a day. Totally. Yeah. Totally. This has all been really good information. So going, circling back to the Kegels and resistance training, one or the other, do we, or both?

53:10Both. Both. We, resistance training alone, whole body, it, there will be some overlap. I will say it will help with pelvic floor, but not enough in my opinion. And there has been research looking at Kegels compared to resistance training compared to both. And the, the resistance training alone, exercise alone was not enough to overcome the challenges.

53:40So I believe both. And I believe that we, and again, I'm not just saying this because, oh, I just believe it. We have evidence to show when we couple it with resistance training, it is, we get more activation. There was also a urogynecologist, Dr. Bruce Crawford, who I worked with for a number of years. He, he was the first person that I found who was talking about the pelvic floor with a fitness perspective in mind. He's a urogynecologist.

54:10He performed surgeries and he said, I'm a good surgeon and I've performed a surgery. And this person is back X number of years later for the same surgery. I did a good job. What's happening. There needs to be, there's other explanations here. And he took wireless EMG, surface EMG of the pelvic floor, the inner thighs, the glutes, and the transverse abdominis. Now critics are going to say at surface EMG, it's not, it's not perfect.

54:42Totally get that, but it did give us some information about activation of the core, the pelvic floor, what movements. So he looked at 150 different Pilates yoga strength training movements. Where is the pelvic floor most engaged? And what if we add that voluntary pelvic floor activation? So it was the first person that was, this is back when did Twitter come on the scene? Because I remember I came onto Twitter and I started putting in hashtag pelvic floor and

55:12I found him. And so this is probably 12, 13, 14, I forget. So I said, I reached out to him immediately and I said, oh my gosh, you, you are the first person that's not talking about isolating the pelvic floor and nothing else can move. It is part of a system and a part of a team and we need to train it dynamically with movement. And, and that's what his research was showing as well. Here's where the pelvic floor is most engaged. Let's add a voluntary activation to get more pelvic floor engagement.

55:42So we can do pelvic floor with our resistance training. I always do a little bit in the mornings of, I do a, another practice called hypopressive breathing, which is also great for the pelvic floor. And I do a few just laying on my back, just like connect core breath, connect with that movement. And then at some point in my day when I'm doing my resistance, I do my loaded dynamic pelvic floor muscle training. Nice. Okay. Solid. Start incorporating this into like, you know, thinking about it.

56:12That's the way I'm like, how can I integrate this? Like slowly, like as a, as a new, right? Like bringing more awareness to it and making sure, okay, I'm like mind to muscle connection, but now I'm like mind to, mind to pelvic floor. Mind to muff. Mind to muff. I like it. Perfect. No, but this has all been great stuff. Like I keep saying, oh, I want to know last thing before we wrap it up here. Why, what, what, what do you use for the vagina demonstration behind you? What do you typically share? The vulva.

56:43Yeah. What do you typically share about that with that thing? So this is, this is the vulva puppet. It's bigger than I thought I wasn't ready for it. It's large. Yep. It's large. So I will use this for anatomy, just teaching people the, the different parts. I will use it when I'm talking about vaginal estrogen and application of vaginal moisturizers and estrogen creams. I will use it sometimes when we talk about the core breath. Like a lot of times I will have people during the inhale, you want to think of blossoming your

57:14vulva. So I can, right. Picking up. So even though this is not really what's happening, it kind of gives people an idea of something being drawn, drawn inwards and upwards. So that's typically what I use the. Awesome. It's literally a puppet. That's great. Awesome. Kim. Well, I'm going to have all your links below in the description where everyone can find you. But where do you hang out the most where people can come and connect with you? So Instagram is where I hang out the most.

57:45All of my social media channels are at vagina coach and yeah, Instagram is, is currently where I like hanging out the most. Awesome. Well, thank you so much for sharing your insights, your knowledge here on this podcast. And I love what you're doing. Keep going with it. Keep changing the conversation, the narrative on it and bring more awareness to pelvic floor. Very important after hearing all your information today. I really appreciate you having me. Thank you. Of course. Hey guys, real quick. If you're interested in taking your body to the next level, lose body fat, build more

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This transcript was generated automatically and may contain errors.