Kim (00:01.742)
All right, welcome to the questions from my community. We are gonna jump right in. And this one is from Mariu. I'd like to ask a few questions. One, I was told by my pelvic floor PT that my problem is actually tension in my pelvic floor muscles. So with the breath that you teach, how do I approach these since Kegels are not recommended for me?
So it's very common for people who have been told they have a tight pelvic floor to avoid Kegels. They are told they shouldn't do Kegels and that it's gonna make their situation worse. And while I agree that at least initially we may not want to focus so much on the activation of the pelvic floor, I am not of the belief that
just focusing on relaxation is the answer. A tight muscle, or tight muscles, a tight muscle is not a strong muscle, and it benefits from strengthening. How we approach that strengthening, initially if somebody is dealing with tension, may look different. So first of all, this person said she was with a pelvic PT. Had somebody come to me and said they think they have a tight pelvic floor,
then I would recommend they see a pelvic floor physical therapist or pelvic floor PT. So that's always my number one recommendation. Anybody who's been here for a while knows I say that ad nauseum. I myself am not a pelvic PT. A lot of people think that I am. A pelvic PT is a registered physiotherapist or physical therapist who has additional training in the pelvic floor and they are licensed to evaluate and treat beyond the opening of the vagina. I am a personal trainer and I apply fitness principles to the group of muscles called the pelvic floor and work.
very closely with pelvic floor physical therapist. So that would be my number one recommendation. Try to get to the root causes to why you have tension. Is it stress? Is it posture? Is it inactivity? Is it fear, trauma? Is it scar tissue related? Is it a guarding response because you're afraid of leaking or because you feel vulnerable from a prolapse? Like there's so many different contributing factors to
Kim (02:29.74)
tension, having more tension than what would be considered optimal in the pelvic floor. So we want to get to the root causes to why and that then can help us create maybe a treatment plan or a protocol or a path going forward in terms of how to address it. So what I do in my scope of practice is I help people look at posture. I help people understand holding patterns, help people with their breath. I have
a bunch of different release exercises. Some look like they're very specific to the pelvic floor. Others don't look like they have anything to do with the pelvic floor, but they do. So like a belly release or a hamstring release or a thoracic release. So people guiding people through exercise and posture and breath work that can over time contribute to adaptations that help alleviate or reduce that tension.
The other piece is again, the Kegels or the core breath that I teach. The core breath is essentially way back when I had started Belly Zinc with my two business partners. We've all heard of Kegels, but Kegels have a bit of a bad rap. Nobody really knows what Kegels actually are. I do wanna give a shout out to Dr. Arnold Kegel who developed the exercise. He saw women suffering and needed to create something to help them.
And he used biofeedback to help women learn how to contract and relax their pelvic floor. And out of that was the Kegel exercise. What's happened over time is there's misinterpretation of what a Kegel actually is. And many think of it as just a squeeze. They don't understand that there is a lift component or that there is a let go or a release component. So a lot of people end up just squeezing and holding and squeezing and holding and squeezing and holding and not necessarily focusing on the letting go. So I don't want to take anything away from
Dr. Kegel, but what we wanted to do was help people understand that the pelvic floor is part of the core and that the pelvic floor works in synergy with the breathing diaphragm. So we started to call it the core breath. So the core breath is essentially a Kegel that does involve the contract, the lift and the let go. And as I said before, a tight muscle is not
Kim (04:53.545)
strong muscle and strengthening tight muscles is still an essential component. So somebody who comes to me and thinks they have or knows they have a tight pelvic floor would begin with the release work begin with the breath, the core breath without the voluntary activation. And then once we progress to the kind of the whole body movement part of the program in a series of say, two sets of 10,
Every second or third rep, they would add a voluntary activation, but not on the other reps. So only every second or every third rep would they add that voluntary activation. The other reps, they would focus on the inhale and expand and then exhaling without that voluntary activation. So the pelvic floor will still be naturally contracting on that exhale, but we aren't adding the voluntary cue like pick up your blueberries or
sip a smoothie through a straw with your vagina. Over time, the intention or the idea is that as we take the muscle through its range of motion, it is reminded that there is a relaxed phase that doesn't have to be on all the time. And eventually the person may do it every second rep, every rep, but always really focusing a lot on that release and that relaxation component.
The other thing is hypopressives. That's a whole other exercise technique that I do recommend that has a great capacity of helping normalize tone. So even a lot of PTs that use the technique in their practice have found that people with pain, which is often associated with overactivity or tension, will experience a reduction with the hypopressive method. And one final note, there was a piece of research that looked at max voluntary contractions.
eliciting a greater relaxation response. So initially somebody coming into the program, I wouldn't recommend that they do a max voluntary activation on that second or third rep. I would just have them activate however they feel like they are. But I again recommend everybody see a pelvic PT and when that person goes to their pelvic PT, they can play around with the effort. Do they get a better relaxation response when they do a max
Kim (07:17.991)
voluntary contraction? Or do they get an adequate amount of relaxation with just a regular amount of effort? So that is my recommendation with regards to what to do if you have a tight pelvic floor. It's not just about only focus on relaxation and, you know, get your pelvic floor as endowed as possible or only focus on activation and build up
more and more tension. We want to balance between effort and ease. Okay, this is from Paula. She says, Hi, I'm 79 and lately I have been leaking with very little control, especially if I get up in the middle of the night. I have a pelvic floor PT appointment in August. What can I do in the meantime? So for Paula, given her age, I'm always recommending vaginal estrogen. If somebody is
nearing or is beyond menopause. Vaginal estrogen is something that I consider almost like an essential nutrient. I have a full blog post article that I'll put into the show notes all about vaginal estrogen and other helpful therapies for genitone urinary syndrome or menopause. But in the article title, I put vaginal dryness because that's what a lot of people search for. So I would recommend, Paula, that you ask your doctor about
local vaginal estrogen if you aren't already using it. I would also ask what has changed. So you said lately I've had leaking with very little control. So what in the last six to 12 months has changed in your life? Are you experiencing constipation? Has there been some sort of stress that has happened? Change, a move, a loss, anything? The other thing that I would have you pay attention to is bladder irritants.
So what are you consuming during the day or even closer to your bedtime that could be potentially a bladder irritant for you? What's your hydration like through the day? How much water are you drinking? And then I would also have you pay attention to some of your habits. When are you going to the bathroom? Is it a just in case pee? Is it every time you leave the house? Do you pee five times before you go to sleep? When are you peeing when your bladder hasn't necessarily signaled you?
Kim (09:43.142)
And then I would also say, what is it that's waking you up? A lot of people wake up in the night for some reason and will think that it was their bladder. And then they will go to the bathroom and they'll empty and then they'll go back to bed and they might wake up again. And then they think it's their bladder again. And so over time, it trains the bladder to signal you at one 30 or four 30 or whatever time the night we get into habits. So using distraction techniques,
when you wake up, if you feel like there might be an urge, and again, that urge may not be why you're waking up, it just, when you wake up, sometimes it could be from a hot flash, sometimes it could be from stress, sometimes it could be from hot temperature in the room, sometimes it could be from a partner snoring or you snoring, sleep apnea is a contributor to waking at night to pee. So when you feel, you've woken up and then you think it's your bladder and if you feel it,
there's a sensation or a signal from your bladder, you can intervene with distraction techniques to calm that response and let the bladder know that it doesn't need to void, that you are in control, not your bladder. This is not something that happens overnight. No pun intended. It can take a little bit of time, but with consistent application of pelvic floor exercise, with understanding the root causes with
estrogen with retraining the bladder and investigating things like sleep apnea or also blood sugar. So insulin resistance or blood sugar challenges diabetes that also contributes to waking in the night to pee. So the managing those leaks can be in part to the strength of the muscles but those urges can sometimes come because of behavior or loss of estrogen.
and the muscles. So we need to know how, again, with the root cause and then how we can use all the things to come in and help mitigate that response.
Kim (11:53.446)
Okay.
Kim (11:58.471)
This is from Christian. Good afternoon from Scotland. Quick question about hyperpressives. How many repeats do you do? Do you always do three deep breaths in between each apnea? I think I'm getting the hang of it and I'm trying to focus on letting go of the belly, so not activating the belly while also sucking in from the top. So with hyperpressives, the term hyperpressive means low pressure and there's
Some people call it the hyperpressive method. Some people call it low pressure fitness. So those are terms you can search. I also have an episode from last year with Becky Keller, who is a pelvic floor PT, all about hyperpressives, and she's now the lead with low pressure fitness USA. So a hyperpressive, there's an apnea, which is a breath hold portion. We get into different poses. We do a breath.
or sort of inhale -exhale cycles, followed by an apnea, which is a breath hold. And during that apnea, we close our glottis and we expand the ribs as if we were taking a breath in. But because there is no air coming in, this creates a change in pressure and a sort of a suction, almost like a vacuum effect where there's an inward upward motion of the abdomen. And so...
she had said, I'm trying to learn to let go while sucking in. So it's we are not sucking in, we are not voluntarily activating any muscles to make the apnea happen. We're simply expanding the ribs as if we were going to take a breath in, but because no air comes in, that's what creates that involuntary response of the vacuum. The general practice is multiple poses.
over about a 15 to 20 minute time period. And in each pose, we would do three apneas. And in between each of those apneas, we would do three breath cycles or three rest breaths. So inhale, exhale, inhale, exhale, inhale, exhale. Let all the air go. Close the mouth. Some people need to plug their nose. Then you
Kim (14:18.725)
Open the ribs as if you were taking a breath in, but because there is no air to come in, that will create the involuntary response of the suction. You then hold that apnea for as long as you can. Then when you feel like you need to take a breath, you just basically open up and it sounds like a really sudden, loud sniff when people are doing it. As you progress with hypopressives, as you become more trained, more conditioned,
you may be able to hold that apnea for longer and longer. And once you can hold it for, there's no magic number, but if somebody's holding an apnea for say 15, 20 plus seconds, what we could do as a progression is to drop one of the rest breaths so that they would do two rest breaths in between each apnea. And then eventually one rest breath in between each apnea. There are some people who do no rest breaths. I'm at the one rest breath,
doing hypopressives for a little over 12 years or so now. And I built up to that practice. And I personally can't really fathom doing no rest breaths in between. It's a challenging practice. But every once in a while I do try it just as a way to again kind of nudge my boundaries to see if I could be able to go through a 15 to 20 minute practice with just, with no rest breaths in between. But general rule of thumb as you're starting,
Three breath cycles or three rest breaths in between each apnea, three apneas in each pose. I find a 15 to 20 minute practice four to five times a week to be the one that moves the needle the most from a symptom relief perspective. Most people I'm working with are dealing with prolapse. So that is hypopressives. Okay, this is Tammy.
With regards to vaginal estrogen, I am on hormone replacement therapy. Would vaginal estrogen be replacing my pill form within my protocol or could I use it in addition to? Vaginal estrogen is hormone therapy. It's local hormone therapy, meaning it is inserted into the vagina and stays and acts locally in those tissues. Very little, depends on the dose, but
Kim (16:47.012)
If you're using a standard vaginal estrogen dose, very little will go systemically. I don't want to say none will, but it's really staying in within the pelvis, within the vagina, around the bladder, in and around the pelvis. It's not necessarily going elsewhere. So somebody who is on systemic hormone therapy, meaning full body. So for instance, an oral tablet,
or a cream or a gel or a patch that is put on the arm usually or the leg.
Systemic hormone therapy, I don't want to say it won't help at all with the vaginal symptoms, but local vaginal estrogen is really the gold standard as it pertains to genitourinary syndrome of menopause. And just like systemic hormone therapy won't really move the needle much on GSM, local vaginal estrogen will really not move the needle on hot flashes or
the bone protection aspect of hormone therapy or the heart protection, like all the other reasons why we benefit from being on hormone therapy, vaginal estrogen won't really address that. So using both systemic and vaginal is ideal for most. And we're kind of starting to move past the fears around estrogen, but there still are
a lot of care providers who are not informed with menopause or with hormone therapy and will basically make you afraid or they will not prescribe at all. They definitely wouldn't prescribe both. So finding a knowledgeable practitioner about menopause, about menopause hormone therapy is really, really essential. There are a few people who I recommend all the time. One is Dr. Kelly Casperson.
Kim (18:51.874)
I have put out an invite to her. She has said, yes, she will come on the podcast. We just haven't coordinated the time yet. So hoping that that will happen. I recommend listening to her podcast, You Are Not Broken. She also has a book of the same title. She is a urologist, talks a lot about menopause and hormone therapy and pelvic health challenges. So she's a fantastic resource. I would direct you also to Dr. Rachel Rubin, also a urologist. Dr. Corrine Men.
is an OB -GYN. She also brings a really cool lens from a cancer perspective. Being a cancer survivor herself, she's now very much an advocate for hormone therapy for women who have a history of breast cancer, maybe who are even currently being treated for breast cancer. She sees a lot of pain and suffering that she believes is not necessary for that population. So those are a few people I would recommend. Also Karen Martel.
She has also been on the podcast. She has a podcast called the hormone solution. She is a hormone specialist herself. She has a team of people who can help even from a prescribing perspective. So you can work with her directly. She has a coaching program as well, where you can get help and guidance on hormone therapy and people who are trained and up to date in the most recent research and also the most recent, sorry, on the most up to date forms of and types of delivery for hormone.
therapy.
Kim (20:23.939)
This is from Randy. What is the relationship between lifting weights and prolapse? I'd like to understand the physiology better. I can't make the connection in my mind to why it increases my prolapse. How do you recommend taking care of the weight lifting needs for osteoporosis when there is also a prolapse?
Prolapse is when the bladder, the uterus, and or the rectum, those are the three most common, those organs start to shift out of their proper anatomical position. Let me just make a little sidebar. They're always kind of shifting. They're not cemented in place. There's always some movement that happens with our internal organs. But if they are starting to descend or bulge into
the wall of the vagina or into the vagina from the top down in the case of the uterus, this is considered prolapse. And there's different stages. Stage one is often asymptomatic. Many people consider stage one normal for postpartum people. There's stage two where it's starting to come down a little bit lower. Stage three, there's a bulge visible at or can feel the bulge at the opening of the vagina.
Stage four would be where there's a bulge outside. It's not falling out, but you can see the tissue outside of the opening of the vagina.
Over 50 % of women who've given birth have some degree of prolapse and many don't even know it because early stage prolapse is often asymptomatic. Things that can contribute to the development of prolapse are chronic coughing, chronic constipation, heavy occupational lifting, pregnancy, childbirth, connective tissue disorder. And so,
Kim (22:17.346)
The research with heavy occupational lifting can sometimes be associated. People interpret that as heavy lifting is bad for the pelvic floor. And as Randy had stated, she's concerned about osteoporosis and her bones. And she's told to lift weights, but many people often say, don't lift weights if you have a prolapse, because it will make it worse. She is feeling herself that she feels more symptomatic when she's lifting weights. So.
To that, I would recommend you see a pelvic floor physical therapist and have an internal evaluation, ideally in standing as well, maybe even standing with a couple of movements like a lunge or a squat. So she can feel and you can understand the strategy you're using that might be contributing to some symptoms. So if you're holding your breath and bearing down while you lift, that could contribute to
more symptoms. And playing around with different breadth strategies is one way to help. I am not of the belief that you can't lift anything and that you can't lift quote unquote heavy. If you have a prolapse. One interesting piece of research from Dr. Laurie Forner in Australia looked at was close to 4000 women in this study and there was a subsection of women with prolapse and they looked at that group.
and had them lift weights. There was a light, medium, and heavy weight category. Weight that they were lifting, not weight of the person. The heavy weight lifting group was greater than 50 kgs. So what is heavy to one person is not necessarily heavy to another, and that's, I'm gonna get to that point in a second, but over 50 kgs is a heavy load. And in that subset,
group of people with prolapse, the women who were lifting the heavier amounts of weight had the fewest prolapse symptoms. It wasn't looking at is my prolapse worse or better, but from a prolapse symptom perspective, the heavier lifters had fewer symptoms. The advice to not lift or not lift quote unquote heavy
Kim (24:40.159)
is trying to, like the intention behind it is reducing intra -abdominal pressure. We all have intra -abdominal pressure. We all need intra -abdominal pressure. And things we do throughout the day, increase and decrease intra -abdominal pressure. Me standing up from the chair that I'm sitting in right now would increase intra -abdominal pressure. Coughing is one of the biggest increases. Jumping.
But things like, as I said, standing up from a chair, downward dog in yoga, crunches, even just lifting something off the counter. It's a constant change, dynamic, it changes dynamically throughout the day with what we're doing. Generally speaking, the harder something is, the more likely it is that we will hold our breath or bear down.
or exert a higher force that would increase the amount of pressure that we generate. In the pressure studies, there was a huge variance. So in the same exercise, there could be, you know, some people that there wasn't a huge increase and some people where there was, and this is accounting for the fact that it's kind of about the effort required. So somebody who is well -trained in, let's say, lifting laundry baskets, somebody who's
lifting laundry baskets of say 20 kilos frequently, that's probably not gonna feel like it's that much effort compared to somebody who has not lifted a laundry basket or anything weighing that amount for a long period of time and then they all of a sudden need to do it. The effort required in that person would be greater than theoretically, we don't know. Again, there's other reasons why pressure can change.
But generally speaking, if something requires more effort, it's going to increase inter -abdominal pressure more. So if we tell people not to lift at all or not to lift quote unquote heavy, we are deconditioning them in that activity. And if that activity ever presented itself where they had to do something, the amount of effort required arguably would be much higher. So instead of a limiting approach of
Kim (27:03.771)
You can't lift, you can't jump, you can't run, you can't all of these things. Let's retrain the pelvic floor, coordinate it into movement, increase sets and reps, add resistance, add dynamic training and build resilience and capacity in that group of muscles. Rather than saying or thinking we can't do something. Maybe it's the strategy that you're using.
Maybe it's the, like what are the variables you could change? How you breathe? How often you do it? How much weight you're lifting? How many reps? How long your rest period is in between the reps? The time under tension, like how fast are you moving that weight? So there's lots of variables that you can change there, but I wouldn't say.
in that, you know, say there's one exercise you've done and you felt symptoms when you're doing your resistance training. Let's see what we can change. Get an evaluation ideally in standing ideally with movement if you can build capacity with my buff muff exercises. And I also recommend the hyperpressive method. So hyperpressive, we had a quick little introduction a couple of questions ago. hyperpressive is a pressure management technique.
It's a lot more than that, but it can help us build more resilience from managing pressures and can help even change the position or the bulge of some of those organs depending on which organ and at what stage. So I am a believer in building resilience and capacity in the pelvic floor so that you can do all the things that you want to do. And if you feel symptoms in a movement, play around with what can you change?
And sometimes it's maybe a different exercise, maybe it's a different position, maybe it's a different breast strategy. In that exercise, there's again lots of different variables that you can play around with.
Kim (29:09.978)
Okay, this is from Rhonda. I'm 65 and I want to know if I should be taking HRT. Where do I begin? Do I start with my family doctor or should I try to find a different kind of doctor? If so, what kind? And by the way, I live in Edmonton, Alberta. So Rhonda, it has historically been thought that as we get closer to, well, it was 10 years past menopause or age 65 that all of a sudden hormones
dangerous. And just like I was always confused with how we have hormones and estrogen all throughout our life. And all of a sudden, just because we reach our menopause estrogen all of a sudden becomes dangerous and we can't supplement with it. Now, of course, that's a bigger conversation. But the the general consensus is still a bit of like what you're saying people will tell you you can't because you're 65 or older.
And a lot of that is still the hangover from the women's health initiative. But another article which I can tag into the show notes is about menopause hormone therapy over the age of 65 and all of the benefits to that. So I'll share that in the article. I myself am not a hormone specialist. I am a trained menopause support practitioner, but I am not, I can't prescribe. I don't know anything about your health history. So
Definitely would be recommending that you work with somebody who is knowledgeable as it pertains to menopause as it pertains to hormone therapy. So I've listed off a few people before because you're in Canada, Karen Martel may be a good place for you to start. You can also work with a naturopathic physician. You could also ask your medical doctor, have they received any training in menopause? Are they familiar with the up -to -date guidelines as it pertains to menopause hormone therapy? And if not, I would find somebody else.
You can go to menopause .org and they have a listing of practitioners there who have undergone additional training and are certified through that organization. So that's a couple of places to start, but I would just because you're age 65, I can't say that yes, you should be, but there are very well established benefits to menopause hormone therapy. Even if you are, you know, past the
Kim (31:35.222)
what's generally recommended, which is at the start of your menopause. So I would stay curious. I'd read the book estrogen matters. I would also check out Kristen and Maria from wise and well. I also love Dr. Sarah Godfrey. I love hot flash Inc. She is a friend and colleague who she herself is not a medical doctor, but she does share all of the research and has amazing conversations on her newsletter and podcast.
So again, planting some seeds of what you can ask for and question your care providers with and how you can advocate for yourself.
Kim (32:15.766)
Alright
Kim (32:24.373)
Steph, how long after starting exercises might it take to be able to stop the flow of urine? A pelvic PT told me five years ago that I have minimal muscle tone and I was unable to do a strong squeeze or hold it at all. Until I found this program, I have not done anything. Generally, when people come and start working with me, it can depend a little bit on their symptoms, but you've talked about stopping the flow of urine, so stress urinary incontinence. That might be...
you might be dealing with a little bit of urgency in there as well. And when you feel that urge, you may not be able to stop the flow. I'm just speculating you haven't said that, but.
From an incontinence perspective, stress urinary incontinence perspective, most people around two weeks of doing consistent buff muff exercises will notice a change. Not everybody, but that is fairly common. By about the four to six week mark, people will often notice a very close to complete reversal, often a complete reversal. The challenge is when like the symptoms we experience are like little reminders.
do our exercise. We don't always listen to those reminders but generally the symptoms are kind of a reminder. When the symptoms are no longer there, people think they're cured and while we may have intervened and helped the situation, a full lifelong cure is not the case. And so the four to six week mark most people are symptom -free.
everybody. There are some people that it can take you know three, four, sometimes even six months. But generally speaking from a stress urinary incontinence perspective, generally around four to six week mark but you still need to be consistent beyond that point and that's a huge part of what I say is it consistency is key to overcome symptoms. It's also key to keep the symptoms at bay. So when you're
Kim (34:33.876)
Pelvic PT said that you had minimal muscle tone.
I guess I would go back, this is five years ago, but if you go to another pelvic PT or even that same one, is the tone, generally they do an internal evaluation and they will feel for the tone at rest. And if there's high tone, that could be indicative of overactivity, low tone, then maybe underactivity. But sometimes people have not a lot of tone, but still have tension. So I'd wanna,
that ruled out a little bit. But she said that you were unable to do a strong squeeze. So usually that's more on the under active side. But that's very trainable. And with consistency, again, applying the principles of posture and breath, releasing tension, activating, and then building up endurance by being able to, first of all, make the engagement happen, but then hold it there. That's how you get stronger. And kind of back to the point where
we were talking about exercise. Stopping exercise or avoiding certain things, thinking that it will make things worse is not going to strengthen or build capacity.
Basically, experiencing load and responding to that and doing it over and over is what contributes to the adaptations of the muscles. So I would get consistent, I would recommend that you see a pelvic PT again. Depending on how close to menopause you are, I would recommend vaginal estrogen. I would recommend that you focus on making sure you have good quality protein, about a gram per pound of body weight because
Kim (36:20.017)
is what helps us build muscle. And when we're talking about pelvic floor exercise, we're talking about pelvic floor muscles. They benefit from the same principles from a diet and a movement perspective as our other muscles. Taking your pelvic floor exercise into whole body movement and then adding progressive load as well is is another way to help build strength and capacity in that group of muscles.
Ummm...
Kim (36:58.097)
from Sigi. I had a visit with my guy and we talked about what is bothering me the most. I said it must be stress incontinence I deal with. He gave me medication for it with some samples that he had. I tried them for two weeks. They do a good job and I almost feel normal. I'm using Estradial cream two times a week. My bowels are working well. I am still keeping up with exercises most of the time. What is your opinion of taking meds to pee less?
So I'm not opposed to medication. I would say they can play a role for people that have true overactive bladder. And usually to get that true diagnosis, there is some protocols that you go through from a testing. But many people who go in and say, I pee all the time, or I feel like I have to go to the bathroom a lot and I'm leaking a little, some people will self -diagnose themselves as overactive bladder, or sometimes the doctor will.
of apply that label with it out actually being true overactive bladder and provide a medication and sometimes the medication will work but root causes still need to be investigated. So usually what I recommend is if you have done all the things for about six months, you've seen a pelvic floor physical therapist, you're drinking adequate water, you're having a really great bowel movement at least once a day without straining,
you're using vaginal estrogen, you've reduced inflammation, you've taken out bladder irritants, you've been consistent with pelvic floor exercise, you've done all of those kind of the basics, the fundamentals, and you still haven't moved the needle as much or there's still some symptoms, that's when we come in and say, all right, maybe we need medication, maybe we need a therapy like a laser, maybe...
some e -STEM, some electrical stimulation. Maybe some people go for surgery, maybe a laser, like there's, I think I said that twice, but those are all we are lucky to have. We're fortunate that they exist devices or protocols or therapies, but they wouldn't be my first line of defense. So depending on how long you have done and if you have done all the other things,
Kim (39:20.721)
then if medication is now helping you, I'd say great. The challenge is also though, sometimes those medications will also dry out other tissues, including the vagina. So glad you're using vaginal estrogen, but just keep an eye on that and making sure that it's not drying out other parts of your body as well. So I guess keep you posted on that and see how you carry on. Some people notice that the medication works at least initially and then it starts to lose.
of umph as they go. But sometimes it's like we're talking about with symptoms being good reminders. When we take medication now we don't have the bothersome symptom, we forget that we should be doing our pelvic floor exercise at the same time. So stay consistent with your pelvic floor exercise, see your pelvic floor PT, stay with your vaginal estrogen, keep pooping well, drinking water, doing all the things, and then see how that works for you by carrying on with the estrogen.
Okay, I am going to do one more question and then we will wrap up for the day.
Uhhhh
Kim (40:29.521)
So this is from Debbie. Am I correct that you squeeze the pelvic floor muscles when you exhale? Yes, physiologically in our body, if you take the Kegel exercise out of it, when we exhale, there is a contract and lift. There's an upward kind of close and lift motion of the pelvic floor. And then when we inhale, there is
lengthening and an expansion of the pelvic floor. So this is what ideally is happening throughout the day without us even thinking about it. Things can come in and interrupt that and maybe people have been told that when they do a Kegel they should inhale and sort of suck up. Some people naturally do that because they think that they should be sucking up. So different reasons why that
normal physiological response could become hindered. So the principles that I teach is about going back to what's happening in the body normally. How can we harness that? So the core breath, we inhale, we think of blossoming the vulva, we think of expanding the sitz bones and the pubic joint and the anus away from one another. We think of creating space in the pelvis. And then when we exhale,
we think of those four points, the pubic joint, tailbone, and two sit bones closing. We could think of a jellyfish kind of contracting and propelling up to the surface of the ocean. There's different cues and different visualizations, but generally speaking, on the exhale is where the pelvic floor contracts and lifts, even without us adding the voluntary component. But when we do add the voluntary component, we want to add the voluntary activation when the pelvic floor is naturally.
already contracting and lifting. Okay, so that wraps up this episode of the community questions, questions from my community. I will send you on your way. Fantastic, have a fantastic day. I appreciate you listening. Would love if you could leave a rating and review. Share this with anybody else you feel would benefit from pelvic health knowledge. And I will see you in the next episode.
