Kim (00:01.708)
All right, question number one. I get this question multiple times a day and the question is, usually somebody has seen one of my ads or one of my posts on social media and I am talking, I'm the vagina coach, I'm talking about pelvic floor, I'm talking about buff muff exercises, the buff muff method and the question is, can this help men too? And,
Most so that's that's the general question. Sometimes people will elaborate and say, will this help men with prostate issues or my husband is struggling post prostatectomy? Will this help him? Can he do these exercises too? So short answer 100%. The principles of alignment, posture, breath,
coordinating the pelvic floor into movement, all of that is the same whether you have male or female anatomy. The difference is with regards to the cueing or the ways that we activate the pelvic floor. So the pelvic floor, whether you have male or female anatomy, is a group of muscles we can't see and it helps to use visualization and imagery so that we can access this group of muscles that we've never been taught about.
And it's often not until we face a challenge with our pelvic floor that we now have to start paying attention. Ideally, we should have received this information much earlier in life so that we could be proactive and know how to intervene earlier and how to mitigate risks that we face as we're aging. it's even if we did, there's a lot of people that don't necessarily take action until there is a problem to fix. And prostate issues in men is definitely a challenge. So they will they can experience pain.
they can experience incontinence and they need to improve their pelvic floor muscles, just like women who are struggling with incontinence or pelvic pain or pelvic organ prolapse would need to as well. And that can be a blend of the same principles of releasing tension in the muscles, using visualization and imagery to activate and relax the muscles voluntarily, hypopressives potentially.
Kim (02:16.883)
scar tissue, especially if there's been a surgical intervention or radiation of some sort. And so that's so again, short answer. Yes, absolutely. This can help men too. And many people participate together. So husband and wives, partners, some men have purchased the program. And as as of yet, they don't necessarily join the coaching calls. But I will also be recording male content.
for the program going forward as well because this is such a common question and because so many people in my community have husbands or partners or family members who are struggling. absolutely men can do this program. The most common from a visualization or a cue perspective, what was shown in research to be the most effective for men to activate their pelvic floor was actually to shorten the penis.
And that has been kind of renamed to pull the turtle into the shell. That doesn't mean that that is the best cue for everybody, just like the an anal cue for women was shown to be the best, but it's not always the best for everyone. So I like to provide a bunch of different cues and let people try, ideally try in the presence of a pelvic floor physical therapist who can assess your interpretation of that cue and see how that actually plays out in your
the response of your muscles. So shorten the penis, pull the turtle into the shell, imagine lifting your bits or imagine walking into a cold lake, imagine pulling your scrotum away from a pin or a flame, make your penis dance. Those are all male or intended for people with male anatomy as a way to activate the pelvic floor. And then of course we want to make sure that we can relax as well.
imagining the attachment points of the pelvic floor, the pubic joint, tailbone, two sit bones opening or spreading or widening apart from one another, imagining the sits bones spreading apart from one another, the inhales lengthen the pelvic floor. So all of the principles still apply whether you have male or female anatomy. Next question is again people have seen some sort of an ad or post that I've made talking about the importance of pelvic floor muscle training.
Kim (04:41.896)
the importance of it being a whole body approach and the question is is this important or what about after a hysterectomy? So some people think that if they have had a hysterectomy they therefore would not need or would not benefit from pelvic floor muscle training and I argue the exact opposite. Hysterectomy or any type of pelvic surgery I argue that it is even more important that you are paying attention to the pelvic floor.
So again, I am hopeful that going forward, women will receive education and information about the importance of the pelvic floor much earlier in life, ideally in school. That then can translate into all the different phases that we go through in life. We would have the education and the knowledge about the importance of pelvic floor, what the pelvic floor is, what are the common signs and symptoms of challenges, who we go see for help.
Ideally planting the seed that this is a once a year visit just like we see the dentist for our teeth for a checkup We should be seeing a pelvic floor physical therapist for a checkup as well, but post surgery There is scar tissue. There's a change to the landscape It is a controlled trauma to the body which can influence the way the the pelvic floor or the whole deep core system works so we need a retraining I Started out saying this from a postpartum perspective
And that was way back when I was working primarily with pregnant women and new moms. The need to retrain the pelvic floor postpartum, given all of the changes and adaptations that have happened to the body, including all the hormonal influences. And there's been a birth, whether it's a vaginal or cesarean birth, we need to come in and help mitigate these now changes and the risks that we face for pelvic floor dysfunction. The same applies to post-op. And when I was going through a rectocele repair four years ago now,
I recognized that just like I talked about postpartum period as being overlooked and no one talks about it and it's so important. Nobody was talking about the post-op period and the two of them are very, very similar. We need to train for birth. We need to train for our surgery. We need to recover from our birth. We need to recover from a surgery. We need to retrain after pregnancy and birth. We need to retrain after our post-
Kim (07:05.773)
period and gradually progress back to all the things that we want to do. The three top reasons for a hysterectomy are prolapse, fibroids, and heavy bleeding. And heavy bleeding and fibroids are often due to low progesterone. However, again in the mainstream medical kind of sick care system, not many people are sent down the path of investigating that. And for heavy bleeding they are offered ablations,
or hysterectomies, especially if the person is no longer wanting or has finished having babies, maybe they've never even given birth, they're offered a hysterectomy. Over 600,000 of them are done in the US alone every single year and most of them are for benign conditions. I have a whole workshop that I'll post a link to about hysterectomies. There's no shame in needing one or choosing one or having had one. I just wanna make sure that you understand
the risks associated with it from a pelvic floor perspective. There are changes to our anatomy as we mentioned, there is scar tissue, there's this controlled trauma, and we have an increased risk of incontinence and pelvic organ prolapse. There's even some evidence to show that we have a change to our overall support structure. So when we have the ligaments cut within the pelvis, some people notice widening of their hips, they notice that the torso will start to
collapse almost that is going to alter the relationship between the diaphragm and the pelvic floor from a core a deep core system perspective. So there's there's so many parts in there. And especially if the person has had a hysterectomy because of prolapse the risk of incontinence and prolapse is even greater and the type of prolapse afterwards obviously it couldn't be a uterine prolapse because that would be removed but it could be the bladder.
most commonly it's the rectum, erectocele. It could also be the vaginal vault where the walls of the vagina start to kind of cave in and collapse on one another. And also the intestines and enterocele that starts to descend into the space where the uterus once was. So I argue that buff-muff exercises, whole body pelvic floor muscle training, pelvic floor physical therapy is even more important after surgery. And so many people are
Kim (09:29.357)
are told, especially if it's for a symptomatic thing like a prolapse, they are told, you don't need to do it anymore after I've fixed the problem. I've removed what was causing the issue. So you're fine now. And a lot of people believe that. And when the symptoms are gone, that kind of reminder to do pelvic floor exercises is also gone. So a lot of people just kind of carry on. But we need to really be careful with our posture and our pressure management. And that comes with
Pelvic or muscle training, pelvic or physical therapy, hypo-pressive is one of my favorite techniques to help offset this increased risk that we have post-hysterectomy. So short answer, will this or is this essential or is this important post-hysterectomy? 1,000%. Third question, how many Kegels should I do in a day? I use the term core breath. This is something that when I had my other company called Belly Zinc,
When we were starting to create a postpartum recovery program, we knew the evidence about Kegels and we wanted to honor the fact that Dr. Kegel had worked with a group of postpartum patients and created an exercise called the Kegel, but we wanted to expand on that. It was not just about isolated, contract and relax exercises. We wanted it to be more robust. We wanted it to be more dynamic. And so we came up with the term core breath to highlight that the pelvic floor is part of the core. And it also works in synergy with
breathing with our diaphragm. And so that's where that's kind of the term that I now use. I use Kegel sometimes, but I'm essentially wanting people to understand that Kegels are misinterpreted so often and Kegels are an isolated exercise. They don't train the pelvic floor dynamically with movement. So I want to expand on what Dr. Arnold Kegel started. So the core breath is the foundation. When people come into my program, they learn the core breath.
then I teach them how to layer that into movement and I've chosen specific movements, a variety of them, but definitely including the ones that do activate the pelvic floor the most even without the core breath. But we want to harness the fact that they're very powerful from a pelvic floor perspective already. And then now the core breath and people then think that, okay, they come into my program and they start to do, let's say the 28 day buff muff challenge.
Kim (11:55.254)
And they think that they also need to do Kegels as well. So I am asked all the time in my community, how many Kegels should I do? And my response is, if you look at literature, it'll say three sets of 10, 10 second holds three times a day of Kegels, but just, just the static voluntary contract lift and let go. We know that most people do Kegels incorrectly, not their fault. They've never been taught. They've never had their pelvic floor evaluated.
And so most people think that Kegels don't work. However, we have evidence to show that they work when they're done correctly and consistently. However, a shortcoming I think is that it is not training the pelvic floor dynamically. So somebody could do three sets of 10, 10 second holds three times a day, but we know that compliance is really low. Not many people are going to remember and choose to do that three times a day. And it's also really boring. So my bias is to take
core breath or take your Kegels and put it into dynamic whole body movement. And we now have evidence literature to support my bias that shows that Kegels or in my case, the core breath done prior to resistance training is more effective and also some evidence to show that when they're combined. So Kegels with resistance training in the literature, you will not find the term core breath as of yet. Maybe one day you will find the term Kegels or pelvic floor muscle training. And so
My program is if you are doing the core breath combined with the whole body movement in the workouts that I provide, which is typically 10 to 15 minutes a day, that's all you need to do. You don't need to do an additional three sets of 10, 10 seconds whole Kegels. My general practice, my own routine in the morning after I've pooped, I do hypo presses for about 20 minutes.
At the end, I usually start my hypopressor practice in standing, I work my way down, I'm on my back at the end, and I will do some just some general core breath just to kind of connect with my pelvic floor. Make sure I expand and relax and release tension on my inhales and then I do some gentle activation. I'll do that with some pelvic tilts. I'll do it with some bridges. I do it with some cat cows.
Kim (14:15.205)
then I do a couple of mobility movements and stretches and that's kind my normal routine. It takes about 30-ish minutes with hypopressives and that little routine at the end where I do have just some core breath coordinated with a couple of movements. Then depending on what my day is I do resistance training three to four times a week and during my resistance training that's my workout where I bring my buff muff methodology into those workouts and I'm activating and relaxing the pelvic floor with
my resistance training with cardiovascular activity. So I do high intensity intervals on the bike. sometimes I will do, either Hills or steps outside. I, there's no core breath. There's no Kegels. I'm just, I'm just breathing how I, and it's very heavy side intensity, but I have trained my pelvic floor to be able to manage those loads. A lot of people will say that they have symptoms.
when they run or symptoms when they do high impact or symptoms when they do high intensity lifting their bum off the bike seat in a spin class. That doesn't mean those exercises are bad. It means that currently the pelvic floor is not able to manage that load for some reason. Is it the number of sets, the number of repetitions, the intensity, the frequency that you do it, your posture doing it, your breast strategy doing it, the footwear that you have? There's a lot of different variables that could contribute to why you may be symptomatic in a specific movement.
So usually I guide people to pull back a little, come back to the basics, reestablish the alignment, the breath, the coordination. So doing the core breath, making sure you've got your good alignment, and then layering it into whole body movement, progressively load that and add in more dynamic movement, add in more impact, add in prerequisites for high intensity, such as the return to run program by Dr. Granyidhanali.
that the return to run postpartum guidelines, which I think applied to pretty much everybody, especially those who are symptomatic with movement and, that's the plan. So Kegels alone is not going to do a whole heck of a lot for things like high intensity exercise or progressing to heavier lifts and loads, or the people that may be symptomatic during those activities. need to incorporate it into resistant training, into more dynamic movement, into impact in ways that will allow us to be able to do all these things. So
Kim (16:36.084)
I don't recommend just a Kegel practice. I recommend a whole body approach, which is what I teach in my buff-muff method. question, why do I need to see a pelvic floor physical therapist? A lot of people come into my program and one of the very first lessons I have, it talks about pelvic floor physical therapy and why I recommend every single woman see one at least once a year, even if they have no symptoms, but especially if they do. And some people come in and they say, well, what?
Why did I buy this program then? Why are you telling me to see a pelvic floor physical therapist? I thought you were going to help me. I thought this program was all that I need. And my program will absolutely give you a ton of information. I often hear from a lot of people who've been to multiple pelvic floor PT appointments and they say they've learned more in the first Pelvic Health 101 section than they have in, you know, five, six, seven, eight sessions with a PT. But that doesn't mean that there's not value in seeing somebody in person.
and seeing somebody who is licensed to evaluate and treat beyond the opening of the vagina. I'm a personal trainer. I am not a physical therapist. I even if I was a physical therapist, I am not trained in internal evaluation and treatment. So pelvic floor, physical therapists, pelvic floor, physiotherapists, women's health physiotherapists, there's many different names will have taken their regular physio or physical therapist. Then they've taken additional training in the pelvic floor.
and they are then licensed to perform the internal evaluation and treatment. And there is so much value from that internal assessment. It happens with your consent, of course, so not everybody will have one at all. Not everybody will have one, especially on the first appointment. But I do truly believe it is the most underused women's health resource that we have. And I've been talking about this for 20 years and I still every single day hear people
tell me that they have never heard about this? Why hasn't my doctor told me about this? Why hasn't my urogynecologist told me about this? And people learn so much about their body after seeing an in-person pelvic floor PT. So they will do a health history. They talk a lot about the same things that I talk about alignment, breathing, coordination. They look at your health history. They look at your symptoms, but they also can can look and see in front of them the status of your tissue. Is it in a low estrogen state?
Kim (18:58.378)
Is there any changes to the tissue? Is there any scar tissue? Can they feel a balance in tone of the muscles? Can they feel that there's tightness? Can they feel there's laxity? Can they feel an imbalance? Can they feel or see the descent of any organs and assess for pelvic organ prolapse? They can assess so many things and they can also treat so many things.
What I want to say though and plant the seed of is a lot of people will also say to me when they've come into the program, I did X number of rounds or I saw pelvic PT for X number of months and it didn't work. And I want to say that the pelvic floor PT is yes, they can do the internal evaluation. Yes, they can provide some treatment, but the person, we, the patient, we need to do the homework. We need to be consistent with the exercise protocols that either they have prescribed or that maybe I'm
teaching in my method or they may have learned from somebody else. We can't rely on the PT to quote unquote fix us. They are a valuable, incredibly valuable part of our pelvic health team, but we still need to take responsibility and put in the work. It's a collaborative process. So why should I or why do I need to? I also equate it to our teeth.
We've been told from a very young age to brush our teeth, to floss and see the dentist once or twice a year, even if we have no toothache, even if we don't have bleeding gums, we just go for our checkup. And I think we should be doing the exact same thing with our pelvic floor. The brushing and flossing is the buff muff exercises and the hypopressives and our posture alignment, all the things, the lifestyle hacks. And the dentist is now the pelvic floor physical therapist. They are going to screen for...
incontinence, pelvic organ prolapse, things that might be contributing to pain changes in the tissue. They ideally assess you in a lying down position as well as standing. And they can help reduce these ongoing risks that we face by nature of just aging and of going through pregnancies or childbirths or car accidents or falls or perimenopause and postmenopause. They are an essential part of our care team.
Kim (21:18.291)
Even if you are in my program, even if you are in somebody else's pelvic floor fitness program, I still absolutely promote that you see a pelvic floor physical therapist once a year as part of your overall overall health care. The pelvic floor is so central to so many things that we do, and it is often the root. So our, our root being the pelvis is often the root cause of other challenges. We may have insulin resistance because we aren't exercising.
We may have diabetes, we may have osteoporosis, we may have cardiovascular disease, we may have muscle loss because we're not exercising as intensely as we should or at all, either because we're symptomatic with our pelvic floor or because we've been told that we shouldn't be doing it. So it's vital that we address
the foundation, the pelvic floor, so that we can do all of the other things that will support our overall health and longevity and so that we can age powerfully. So that's wrapping up the top four questions that I see and I hope you found this helpful. See you in the next episode.
