Kim Vopni, the Vagina Coach, is the founder of Pelvienne Wellness Inc and Core Confidence Education. She’s on a mission to break through taboos and redefine how we think about women’s health. “I want women to know how to connect to their pelvic floor so that they can overcome challenges like incontinence and organ prolapse and regain a sense of control and power in their lives,” she shares on her website. In this insightful interview, she explains what pelvic floor exercises are, and why you need to be doing them.
You’re an intimate wellness coach. Tell us what that actually involves.
I am a personal trainer and my focus is on the female pelvic floor. The pelvic floor is a central part of our sexual wellness and the topics I talk about with people can be quite intimate in nature or influence their ability to be or feel intimate.
What is Pelvic floor?
The pelvic floor is a group of muscles that closes off the base of our pelvis. There are three layers of pelvic floor muscles. The first two layers are primarily responsible for closing openings. This is a long way of saying that they help with our continence and ensure that stool, gas and urine do not leak out of us when we don’t want it to. The third layer is primarily responsible for organ support. In the female body there is the bladder, the uterus and the rectum. The pelvic floor also contributes to our pelvic and spinal control and stability and plays a vital role in our sexual response.
Why should every woman learn about pelvic floor?
Because the pelvic floor plays such a central role in so many aspects of our life including our sexual wellness it is critical that we as women learn what the pelvic floor is, what the roles are of the pelvic floor and how the various life stages that we go through influence the function of the pelvic floor. The majority of women will become pregnant at some point in their life and pregnancy and childbirth are known risk factors for pelvic floor dysfunction. When women are given a complete understanding of the pelvic floor prior to any issues they have an opportunity to prevent or minimize some of the more common challenges like incontinence and organ prolapse, pelvic pain and even low back pain. Menopause is also a time of life that all women will go through and it is a time of depleted estrogen and hormone imbalance. Our vaginas and our pelvis like estrogen and when we no longer produce it the tissues in the vagina become less supple, they may become dry and irritated, and things like incontinence and prolapse and painful sex can often become bigger issues. Unfortunately media tells us that these conditions are just part of being a woman or a normal part of aging and therefore so many women accept them as normal. Women often feel alone and like there is nothing they can do about their situation but the opposite is true. There are an amazing pelvic health professionals and also some products available that can help women transform their pelvic floor function.
What are the factors that bring about the weakness of the pelvic floor?
Pregnancy and childbirth are arguably the most common risk factors. Falls on the tailbone, accidents, jobs with heavy lifting and even posture can all contribute to pelvic floor challenges. One thing to highlight is that many people associate incontinence or organ prolapse as weakness and to them that weakness means laxity however weakness can also result from over-active or non-relaxing pelvic floor muscles.
Based on your experience, at what age should pelvic floor exercises start?
I believe the conversation about pelvic health should start when we introduce the concept of sexual wellness and menstrual health to our teens. When we can educate the younger generation we then wouldn’t be a society that waits for a problem to start and then tries to fix it. We would instead be planting the seed that prevention is most important. Just like we were told from a young age to brush our teeth twice a day, floss and see a dentist once a year for a checkup, I believe that same practice can be instilled for our pelvic health as well. Daily pelvic floor exercises once people become sexually active and seeing a pelvic health physiotherapist once a year would go a long way to improving pelvic health outcomes for women.
Many women think pelvic floor exercises are for expectant mothers and mostly those who have given birth naturally. Is this the case?
Pregnancy is often the time when women first hear the term kegels or pelvic floor exercise and while kegels are important during pregnancy it is a time when learning how to relax the pelvic floor is arguably more important. Pregnancy is a great time to introduce information around pelvic health, however, as stated earlier, introducing the conversation before pregnancy I feel would provide more benefit. Pregnancy is also a time to introduce the concept of pelvic floor recovery postpartum. More and more research is pointing to a 4 to 6 months recovery time with some people needing up to a year rather than the current six-week green light that most people wait for. It is important to note that pelvic floor challenges like incontinence and prolapse are not something that only people who have been pregnant can experience. Anybody with a pelvic floor can experience pelvic floor dysfunction, even men. The female pelvis is more prone to challenges due to the shape of the pelvis, due to the openings and to the fact that most women will become pregnant and give birth at some point in their life.
How often should one do the exercises?
Kegels are a form of pelvic floor exercise and have been shown to help improve things like incontinence and symptoms from pelvic organ prolapse and even chronic low back pain. Like any muscle group we need to use it or we lose it. Research suggests that we should do three sets of 10, 10 second hold three times a day, however I like to teach kegels as part of a movement to practice. I have a 3C approach which is that kegels need to be done correctly, they need to be done consistently and they need to be done coordinated with movements like bridges and squats. We can also train our pelvic floor functionally by adding kegels to activities of daily living like lifting bags of groceries, transferring laundry, picking up our babies and even pushing heavy doors open.
Is there a wrong way of doing the exercises? Anything to watch out for?
Kegels are often prescribed but they’re very rarely taught which means most people are doing them incorrectly. We do have some research to show that over 50% of women are thinking they are doing a kegel but are actually doing them incorrectly. The most common muscles used in place of pelvic floor muscles are the glutes and the inner thighs. It is also common for people to hold their breath. Speaking of breath, the pelvic floor moves in synergy with the diaphragm. Every time we take a breath in the diaphragm descends, the ribs expand, the belly expands and ideally the pelvic floor also expands and lengthens to allow air to come into the body. With every exhale the pelvic floor contracts and lifts, the belly naturally draws inwards towards the spine and the diaphragm moves back up helping to expel stale air. Many people who starts a kegel practice find that they either hold their breath or they do their pelvic floor contraction on the inhale. The contract and lift part of the kegel should happen on the exhalation rather than on the inhalation.
Is there a right time?
Whatever time they get done is the right time.
Does the need for intensity of exercise vary with age?
As women approach menopause it actually serves them better to reduce the intensity of exercise or at least the number of times they participate in high-intensity exercises. High intensity exercise raises our cortisol level and during perimenopause and post menopause, hormones can be in flux, blood sugar regulation can be a challenge and participating in high-intensity activity can exacerbate the issues. I recommend a walk everyday, strength training 2 to 3 times a week for about 20 mins max and yoga 2-4 times a week. It is also common for people to experience pelvic floor issues like incontinence and prolapse during perimenopause and post-menopause and that often leads them to avoid exercise altogether. Working to optimize the pelvic floor and finding the fitness routine that helps rather than hinders key.
For someone already facing weaknesses of the pelvic floor, where should they start?
I always recommend everybody start with seeing a pelvic floor physical therapist. That is my number one recommendation for everybody regardless of whether you have symptoms or not. Pelvic floor physical therapists are physical therapists with additional training in the pelvic floor and they are licensed to assess and treat beyond the entrance to the vagina. They can help screen for and treat any challenges, ensure you are doing kegels correctly, and help you tackle your problems so you can get back to moving and participating in life. I will add that once people have an understanding of how to do a kegel correctly it’s important to bring it into movement and to make sure they do their exercises consistently. We need a kegel lifestyle. Kegels are not a quick fix.
Are there any quick fixes or short cuts?
I think most people would like a quick fix or a short cut and there are some products on the market that tell us that all you have to do is sit on a chair and you will have 13,000 kegels done for you but this ultimately doesn’t translate into function. I don’t believe pelvic floor fitness is something we should outsource. We need to do the work. Use it or lose it.
Do all other exercises help with the pelvic floor?
Kegels are a form of pelvic floor exercise. The pelvic floor muscles do not work in isolation but rather as part of a team. While it is important to connect with, and understand how to voluntarily contract and relax the pelvic floor we can also benefit the overall function of the pelvic floor with movements such as squats and lunges and bridges and clams to name a few.
There’s so much about Kegel. What is Kegel? Is it the same as pelvic floor?
The term kegel was created by Dr. Arnold Kegel in the 1940’s. He saw his patients having difficulty contracting and relaxing the pelvic floor following childbirth. He used biofeedback to help his patients connect with their pelvic floor so they could see what was happening even if they couldn’t feel what was happening. He termed the exercise a kegel exercise which is a voluntary contract lift and release of the pelvic floor muscles. Kegels are an exercise and the pelvic floor is a group of muscles.
Does drinking too much or too little have any implication?
A lot of people who experience incontinence will restrict their fluid intake thinking it will help prevent leaks or help prevent the overwhelming urges they get to release their bladder. Unfortunately this in turn concentrates the urine which then irritates the bladder and will lead to the bladder signaling the person more often. It is important to drink water consistently throughout the day to stay hydrated and ensure that the urine does not become concentrated. A full bladder is about a cup and half of liquid so if people are drinking a large volume consistently throughout the day they will most likely need to go more often. It’s generally accepted that drinking half your body weight in ounces of water would be a good place to start. Normal avoiding of the bladder is once every 2 ½ to 4 hours which equates to about 5 – 9 times per day and ideally nothing overnight or at most once during the night.
Any aids you can recommend to help with the pelvic floor strengthening?
Pelvic floor physiotherapy is always my first recommendation. For those that don’t have access to pelvic floor physical therapist there are some devices on the market that may be helpful such as the Elvie and the Perifit and also the Vfit. Some people may benefit from kegel weights as well however I always say, before investing in a device, invest in a pelvic floor physical therapist appointment and they can help you determine what your pelvic floor muscles need and if the device would be suitable.
Are there any other myths about pelvic floor that you can bust?
There are many myths about the pelvic floor and I think one of the most common is that light bladder leakage is just part of being a woman or that sneeze pee is something that happens as you age or just because you’ve had children. I think many women also believe that it’s too late for them – that they have been experiencing their challenge for too long and that there’s no hope for them. It’s never too late to make change.
Could you provide assurance for the way forward for our readers who want to live a Stellar Woman life inside out?
Pelvic floor challenges are very common and the good news is that they are very treatable. Pads are not something you need to accept as your destiny and there are many professionals who can help. I highly recommend you seek the help of a pelvic floor physical therapist as your first step and then ensure you develop a pelvic floor fitness program that includes kegels coordinated with movement, yoga and stretching to help release tension in the hips and side body and a daily walk. I also encourage everyone to talk to their friends, talk to their sisters, talk to their mothers, talk to their aunts. The more we talk about and share this information the more we will create a better future for the younger generations. Pelvic health is not taboo nor is it something to be ashamed about. It is something we should embrace and explore openly.
To find more about Kim’s work visit her website www.vaginacoach.com.