Kim Vopni (00:01.592)
Dr. Sarah Reardon, you have been taking over the world lately with your book, Lord, which I have right here. Thank you for sending me a copy, first of all. And I have followed you in your vulva costume for a really long time. Obviously, a lot of us in the pelvic health space follow one another and we root for one another. And at some point, somebody had created the term pelvic mafia and I don't see it used as often anymore, but I hope one day that that...
that kind of gets reinvigorated because we are, think, all fighting the same fight and trying to get the awareness of this kind of taboo topic out there. And you have now come out with a really glorious, incredible book and you have been making, you've been on like podcast after podcast. I'm sure you are absolutely, well, we were just talking exhausted by the process. And I'm really glad that you took some time to join me. So thank you for being here.
Dr. Sara Reardon (00:38.04)
Yeah.
Kim Vopni (00:55.234)
Before we jump into questions, can you just take a moment and tell us who you are, how you became the vagina whisperer, how you got into pelvic health really, and then what prompted you to write this book?
Dr. Sara Reardon (01:06.835)
Well, thank you, Kim, so much for having me. feel similarly I followed you for so long before you were even the vagina coach. I can't remember what your previous handle was, but I was like, I feel like we've been Instagram friends for so long. So I am a board certified pelvic floor physical therapist. I live in New Orleans, Louisiana. I've been practicing for about 18 years and I really started out sharing on Instagram under my account, the vagina whisper about pregnancy and postpartum tips and resources.
Kim Vopni (01:12.77)
Yeah.
Dr. Sara Reardon (01:33.4)
when I was pregnant and postpartum and over the years it's really grown to include everything about pelvic floor health and prolapse and now perimenopause and menopause and you know the growth of my Instagram account I really attribute to I think the need that so many women have to learn more the lack of understanding they have about their bodies and this part of their body in particular and really just a community that women are looking for to feel like they are less alone in their symptoms that they're
getting kind of evidence-based helpful resources instead of being gas-lit or dismissed. And you know, that it really is a testament to how much women want and need this information and they're not getting it and now they're really searching for it. So it's been an exciting time to be in this field. I have two kiddos, two boys, and you and I were just chatting about boy mom life and I also am in the process of creating an app. I have a kind of online workout program now called the V-Hive, but I'm creating an app to just...
Kim Vopni (02:21.761)
Yeah.
Dr. Sara Reardon (02:30.947)
help make pelvic floor exercises and education more accessible and more affordable for women everywhere.
Kim Vopni (02:37.633)
Yeah, yeah. So where did did you just come up with the term vagina whisperer? And then where did the vulva costume come in?
Dr. Sara Reardon (02:45.347)
So I wish it was, know, sometimes these things happen that you don't really know where they're gonna lead. And I think you probably have the same, the similar mindset. It's like, sometimes you're in the shower and you're like, that's really funny, you know? And so it's just like our kind of weird thoughts that happen when we're in isolation. But I started my Instagram account when I was pregnant and I was sharing a lot of pregnancy and birth tips with my group of girlfriends at the time.
Kim Vopni (02:55.414)
Yeah.
Dr. Sara Reardon (03:08.077)
And I started that Instagram account really for them because they were like, how do I do perineal massage and what's the best pregnancy belly support? And so I just was like, let me put this on Instagram because I'm writing the same email over and over and then you'll have a place to refer back to it. And they are the ones who called me the vagina whisperer. I had already been a pelvic health therapist for 10 years. And so they just kind of had that nickname for me. So.
Kim Vopni (03:19.607)
Mm-hmm.
Dr. Sara Reardon (03:30.586)
I started that account and, you know, again, everybody kind of started just joining and their friends and it just kind of grew really organically. And then when I hit 10,000 followers, which was maybe 2018, I, my sister who's in marketing was like, we need to do something really funny. You 10,000 was like a really big number back then. And so we just kind of started playing around looking online and we found this Volvo costume and we're like, let's do a video. And so I put on this Volvo costume and I floated in this big pink
Kim Vopni (03:49.57)
Mm-hmm.
Kim Vopni (03:55.949)
Yeah.
Dr. Sara Reardon (04:00.026)
pool float and they just took a video and we were like, yay! And that's where the Volvo costume was born and it was 150 bucks, you know? And so was like the best investment ever and they unfortunately don't make them anymore but if they did there would be a huge market for them I think.
Kim Vopni (04:15.305)
1000%. Yeah, I know, Betsy, Dr. Betsy Greenleaf has, she has one and she shows up to some conferences sometimes with she's a urokinologist and has has it on sometimes. I don't know where she got hers or maybe she made it. I'm not sure. But anyway, I love it. It's like your signature and it's awesome. And I so love what you do. And, and it's been really cool to watch your story and your your growth, like watch your channel grow.
I've had other pelvic floor physical therapists on the show and I talk about pelvic floor PT ad nauseum. Everybody knows that I refer to everybody to it, but there's still some people who I've been talking about it for 21 years. I'm still shocked that people still have never heard of pelvic floor PT. So can you tell us a little bit about what is a pelvic floor physical therapist? What's what makes you different from a regular physical therapist?
Dr. Sara Reardon (05:07.245)
You know, physical therapists are trained to specialize in the treatment of muscles and tissues and nerves to, you know, optimize movement and function. That's kind of like what we do. And pelvic floor physical therapists really specialize in treating the area of the pelvis, which includes your pelvic floor muscles, which help support your pelvic organs. They assist with core stability and strengthening. They, you know, contract and relax with breathing, but they also help, you know, control bowel movements and urination and...
play a role in menstruation and vaginal birth and vaginal intercourse. So, you know, we're using these muscles all throughout the day with every movement, with every pee and poop, you know, during every life transition we have as women from periods to post-menopausal, they're changing and yet we're so rarely educated on that. And we don't even know they exist until we start experiencing a problem. And so as pelvic health therapists, we really kind of help diagnose if there's a muscle issue, help
guide you on treatment options. And you know, there are occupational therapists who are doing pelvic health therapy now too. So it's OTs and PTs who are kind of in this space. you know, we're just dealing with different muscles than say your traditional physical therapists. And we do internal examinations through the vagina or anal opening to assess the muscles. So that's probably a pretty big discriminator as well.
Kim Vopni (06:25.355)
Yeah, can OTs do internal evaluation?
Dr. Sara Reardon (06:29.217)
As long as they are trained, they totally can. you know, OTs are really becoming much more well-versed in pelvic health education and therapy. There are training courses out there, and I love it. I mean, I think we just don't have enough therapists available to help the, you know, 40 million women in the United States and then, you know, however many, or 40 men, women who are giving birth every year, let alone how many women are, you know, exist.
So I think it is the more the better. They come at it with a different lens. They don't necessarily have the anatomy background that a, a PT would. But I think that they have a lot of what we call ADLs, like activity of daily living, education for peeing and pooping and bowel movements and things like that that we don't have. So it's really a different kind of pathway they take. But I think that it's a great thing that more people are getting into this field to help more women.
Kim Vopni (07:21.357)
Yeah, thousand percent. And you said something as well that when you started, you were pregnant yourself and that was the phase of life you're in. And now being 18 years into the practice, there's other phases of life. And that was exactly the same as myself starting in pregnancy, then started Belly's Ink postpartum recovery, and then started my own perimenopause and thought, OK, here's a whole other new chapter. And my career really has.
Dr. Sara Reardon (07:27.779)
Yeah.
Dr. Sara Reardon (07:35.97)
Yeah.
Kim Vopni (07:47.96)
kind of just evolved with my life, which sounds like that's the same with you. And the more that we need more practitioners, we there are so many people that need help. And I think and I remember I haven't had this confirmed, but I remember somebody saying that in the UK they are starting to teach it as part of grade school, pelvic health. Why not introduce it? And I've always thought that that should be when we're learning when they're teaching us about our menstrual cycle and about sexual
Dr. Sara Reardon (08:11.171)
Yeah.
Dr. Sara Reardon (08:16.664)
Yep.
Kim Vopni (08:17.345)
health in our bodies, why aren't we planting the seed about pelvic health? What's your thought on that?
Dr. Sara Reardon (08:22.403)
I mean, I 100 % agree with that. And I've talked to some kind of research assistants and students now who are starting to teach pelvic health education in schools. I think one, all gender should have this education. I don't think it's specific to people with vaginas. Like I have two boys and they can tell you what a vulva is and like where pee comes out of and what a tampon does. And I think that's important because this part of our body has been shamed, hidden.
Kim Vopni (08:41.634)
Mm-hmm.
Dr. Sara Reardon (08:50.425)
You know, really so mystical for us for so long and something that we feel really embarrassed and ashamed about often that I think if we just make it like a body part like anything else, it will help us get better care for it. I think it's incredible. Unfortunately, in the United States right now, we're in a place where I think we are doing less education for women. We, depending on where you live in the country or what schools you go to, like we're not even getting sex ed anymore. And so I think that
My hope is that that can shift, that pelvic health education becomes part of health education, just like I hope pelvic health care becomes part of health care for women.
Kim Vopni (09:21.645)
Mm-hmm.
Kim Vopni (09:25.249)
Yes.
Kim Vopni (09:28.801)
Yes, yeah, 1000%. In your practice, what would you say are like, what are the most common things that you see in terms of women coming in? And I guess I'm going to back that up. Another question I have, when people come to see you, how have they heard about you? What brought them there other than their symptoms? But is it somebody telling them? Was it another care provider referring what's happening there?
Dr. Sara Reardon (09:53.636)
You know, I think a lot of that is based on where you live and what your practice looks like. I would say the majority of people who come in to see me or any of the other therapists at our practice, they find out about us from social media. They find us on the internet doing a Google search going down a rabbit hole, like looking for help for their issues, or it's a referral from a friend. Unfortunately, it's not a lot of other medical providers, like physicians or nurse practitioners.
you know, even it's much more from acupuncturists or chiropractors or lactation consultants or even pediatricians are referring moms. But I would say, you know, OB-GYN practices, urologists, urogynes, colorectal surgeons, it's just not as much as I think it could be. And they're not often assessing the pelvic floor muscles, which is our job. But I think if there was a way to kind of educate providers, medical providers, on how to just do kind of a quick assessment or even a quick screening to know if somebody should have a referral.
to PT or OT, it would be helpful. you know, I really applaud women because I think we're at a point, and I think you and I both saw this one, you know, 10 years ago, we were pregnant and postpartum and going through all this where it's like, we deserve better care and we've been denied it for so long that now we're pushing for it. And if it's we're not getting it from our medical providers, we're going to go find it ourselves. And we're kind of backed up against the wall, which is unfortunate that we have to be in that position. But women are saying like, no, I want this. I deserve this. I need this.
and we really do deserve that care.
Kim Vopni (11:22.763)
Yeah, thousand percent. I feel like the explosion of the conversation around perimenopause and menopause has indirectly really fueled the conversation around pelvic health because we have the whole, you know, the GSM category and, and menopause itself was taboo, right? And so that's being unleashed. And I would say that's a little easier for people to talk about for some people. And as a result, because it's now a
Dr. Sara Reardon (11:32.856)
Yeah.
Kim Vopni (11:51.337)
category of symptoms and signs is GSM. We can talk a little bit more openly about that. So kind of back to that other question I asked who is coming to see you? What like what are they presenting with most commonly?
Dr. Sara Reardon (12:02.573)
You know, historically, I would say over the past five years, it's really been a lot of women during pregnancy, particularly those who want to prepare for birth, because we did a lot on like, hey, nobody's taught you how to push or, you know, if you want a certain type of birth, you should really prepare for it or your body's going through a major transformation and leakage and prolapse and pain are not like just things you should have to deal with it. There's actually research and therapy to help support you. So a lot of it's pregnancy. A lot of it is postpartum. We try to see everyone at six weeks postpartum.
after they go see their medical providers. Again, there's no education or rehab given to women after their bodies have just been gone through, you know, 10 months of pregnancy and then vaginal birth or, you know, surgery and they're just like, see ya, you know? And so I think we need, we're just, we're really not taking care of women during that timeframe or moms during that timeframe. And so a lot of postpartum, we're starting to see more perimenopause right now.
women feeling really lost on how to navigate symptoms like frequent urination at nighttime or painful intercourse or even prolapse. And so kind of starting to see more of those. But historically, it's been things like leakage, urinary leakage with everything from coughing and sneezing to know, wetting your pants when you're running or, you know, can't make it to the bathroom. Painful intercourse has also been a common one, whether it's a young...
student or young, you know, person who's really starting to become sexually active or it could be kind of a menopausal postmenopausal woman who's, you know, got, you GSM and now she's having discomfort with intercourse. So leakage, painful sex, prolapse, we see a lot and the research is mixed about whether therapy is helpful prior to prolapse surgery and afterwards, but I'm like, it's certainly not harmful, you know? And so like, why can't we really help give women
a better understanding of what can contribute to prolapse and exercises to help post surgically to help, you know, improve their function and their exercise and their quality of life. So, you know, those are a lot of the things that we see. And, you know, I think just going back to what you mentioned about GSM and symptoms during perimenopause and menopause, I think that this explosion of conversation in that space is awesome. I love what you are doing as well by really like saying like, hey, don't forget the pelvic floor because
Dr. Sara Reardon (14:22.637)
We talk a lot about osteoporosis and wearing weighted vests and getting your protein and brain fog, but I'm like, if your vagina is not functioning, it will affect every aspect of your life. And we're not still talking openly about pelvic floor symptoms during perimenopause and menopause. And so we can talk about menopausal hormone replace or therapy and vaginal estrogen, which again, I'm a big fan of, but we need to talk about exercise.
Kim Vopni (14:50.187)
Yeah.
Dr. Sara Reardon (14:51.107)
Vaginal estrogen is not gonna like give you strong pelvic floor muscles or functional pelvic floor muscles. So it's a big piece of the conversation that's missing. I love what you're doing and being so vocal about it. And I think all of us are really trying to like, hey, don't forget about the muscles. Don't forget about exercise too.
Kim Vopni (15:06.154)
Yeah, yeah, yeah, I want to come back to your surgery point, but following along with you just ended with there, it's like many things in social media. There's of course the there's the extremes and you must have this supplement and you must do this exercise and you must, you know, all these and we start to feel very overwhelmed, very confused, very now thinking you aren't doing enough. And the menopause conversation again, I agree. It's awesome. It's people are talking about it, but
people are being asked to jump for their bone health and do heavy resistance training, like lift very heavy shit. then there's, know, we can, some people define heavy as, as, you know, something you can lift four times. You have to do four sets of four reps and have basically like hardly any reps in reserve. And so now this population that we work with has historically been either they're self removing themselves from jumping or lifting heavy, or they might've been told not to do it.
or maybe they feel symptomatic doing it. And then they look at these and say, okay, well now I'm screwed now because I can't jump and I can't do heavy lifting. I, yeah, and so both of us are sort of sharing that thing. Well, hold on, like you can, we just have to, let's build up your tolerance. Like, and also even if you have no pelvic floor dysfunction, you still have to build your way up to heavy lifting, right? Yeah.
Dr. Sara Reardon (16:23.544)
Yeah.
Dr. Sara Reardon (16:27.577)
Right, right. You're totally right. I think that or, you know, people are experiencing these issues and they're just pushing through it and like, and not realizing that, you know, there is actually a way to improve it. so or they're not talking about it. So it is it's really kind of interesting to me to see all the information coming out. I'm like, OK, the pelvic floor stuff is like not getting enough attention in this space because
We're post-menopausal, perimenopausal, post-menopausal for probably half of our lives. And you're like consistently losing urethral sphincter strength, collagen support every year that we age. And I'm like, okay, let's talk about collagen for like our face, but like, what about our vaginas? You know, like, let's talk about that too. So I think that's where you and I really come together and we're like, all right, let's like bring it back to the pelvis. Like, don't forget about that, you know.
Kim Vopni (17:10.24)
Mm-hmm. Mm-hmm.
Kim Vopni (17:18.218)
Yeah. Coming back to what you said about surgery, I wholeheartedly agree. So when I went through my surgery, that was first of all, I experienced the shame and the taboo in making that decision. I would say because I work in the field, maybe I felt it a little bit more because I felt like you're supposed to be invincible because you're the pelvic floor person. But anyway, you make the decision and
And I very intentionally did train for it. I very intentionally did recover from it. And I absolutely, 1 million percent, even if we don't have evidence or research, believe that we should be training for our surgeries in many different ways. And if you look at the research on prostate surgery, there's actually lots of research about doing pelvic floor muscle training before prostate surgery improves it. Where's that same research for pelvic surgery? it right? It's crazy.
Dr. Sara Reardon (17:52.931)
Yeah.
Dr. Sara Reardon (18:04.387)
Yeah.
I know, I know, I know. I totally agree. It's crazy and it's like, do we really? I think for, you know, people going through prostate surgery, it's like we didn't even need research to like have start implementing that. We're like, they have these symptoms. Let's just send them to therapy and like hope that'll help. Like we're not doing that for women because it's for so long. The narrative has been like, this is normal. just deal with it. it's part of aging or whatever. Yeah.
Kim Vopni (18:24.308)
Yeah. Yeah.
Kim Vopni (18:30.196)
Or PT or exercise doesn't work. It won't fix your problem. Yeah.
Dr. Sara Reardon (18:34.169)
You know, it's so funny what you mentioned too about your surgery, because I was kind of following along when you were going through this and that I started playing tennis maybe two or three years ago. And, you know, at the ripe old age of 40, I was like, let's learn a new sport. It was like post-COVID, I just want to be outside a lot and get exercise. So, you know, a couple of months ago I was playing and it was a night match. And I don't remember where I was in my menstrual cycle, but I like took a quick step and then I leaked and I was like, oh, shit, I just.
I I peed my pants and I had on of course these like hot pink leggings where you could see everything and I'm in New Orleans which is like everybody knows who everybody is and I was like my gosh like Sarah you can't leak you're the vagina whisperer like this is not good for your brand do you like you have a workout program about this you know and so but it was one of those realization points it was everybody is susceptible to these issues no matter how much you do or exercise or prevent like these things can happen
Kim Vopni (19:14.496)
Yeah.
Dr. Sara Reardon (19:29.005)
I think the difference between you and me is like we have the tools to help prepare our bodies to address symptoms. Most people don't. And so it was just really eye open. It was like, OK, you have to kind of drink your own juice here. Like you have to do the things that you tell everybody to do. I'm aging. I'm in perimenopause. I'm trying a new sport. Like I haven't trained for this. Like you got to. And I did. And it's gotten so much better. And it was one of those things that it was like, OK, there's no immunity to pelvic health issues. It's just we have.
Kim Vopni (19:47.712)
Mm-hmm.
Dr. Sara Reardon (19:57.656)
the education expertise to address it, where I think a lot of people don't even know. Again, they might have stopped tennis or they might have just started wearing liners and not known that there was help available.
Kim Vopni (20:07.424)
Yeah, totally. So I want to narrow in on incontinence and then we'll come to prolapse. And there's, excuse me, a few tips that you share from an incontinence perspective. One tip that I've learned from you is peppermint oil in the toilet bowl. Can you tell me what that is helpful for? Who should be putting peppermint oil in their toilet bowl?
Dr. Sara Reardon (20:25.197)
Yeah.
Dr. Sara Reardon (20:31.225)
Well, this actually started with a midwifery tip that I gained from, I think it was either a class I took or something like that, but a lot of my postpartum clients or patients would come in and they'd say like, can't, I couldn't pee after I got my catheter out, you know, after my C-section or after my birth. And so they were sent home with a catheter. They were in urinary retention and got UTIs. They were extremely uncomfortable.
And it was a really stressful experience for them. And so I learned this tip that if you put peppermint oil in the toilet water, you know, 10 to 20 drops and you just sit over at the toilet like you normally would and just take some big deep breaths, that kind of fumes from the peppermint oil can come up and kind of stimulate your urinary sphincter to relax. And it's such an easy trick. And I think so many people don't know about it. So many hospitals aren't using it as an option.
When your other option is to get sent home with a catheter and you've got a newborn baby to care for, I mean, that's pretty distressing. So again, it's these kind of things that I think like, aren't we trying, like what's the harm in trying this? Why aren't hospital systems, and there actually is research to support this practice where I'm like, okay, why aren't we doing this and we're just sending people home with catheters? So it's something I share that I think is a really cool tip that I'm like, at least try it, you know?
Kim Vopni (21:33.782)
Totally.
Kim Vopni (21:47.309)
Yeah, yeah, yeah, I love that tip. think that was so cool. What are some of the reasons why somebody would have urinary retention? Because we see a lot and I talk about we we have talk about leakage. We talk about stress urinary incontinence. And there are other people who think, well, I can't even I can't even get the P to come out. So what would be the causes of urinary retention?
Dr. Sara Reardon (22:10.019)
So I think, you and I go through this in the bladder chapter in my book, it's called Taming the Tinkler, but I was like, most people don't understand how urine is created and how it exits our body. And so when you start understanding that process that urine's made in the kidneys, it's filtered waste from the kidneys filtering blood, it travels down your ureters into your bladder and your bladder is like a deflated balloon.
that as it starts to fill with urine, it stretches. And that stretch signal sends a message to your brain that's like, hey, I'm getting pretty full down here. Like, I'm to have to go soon. In response to that message to your brain, your pelvic floor muscles, there's two layers, an internal sphincter and external sphincter. They tighten up, and they're like, chill out, bladder. I'm on a Zoom call. I can't go just yet. So the urge kind of goes away. And then as your bladder keeps filling, it gets stronger and stronger until you can make it to the bathroom.
When you go to the bathroom, your sphincter should relax and then your bladder, which is a muscle, contracts. So that balloon should kind of contract and push the urine out. When you can't get your urine out, it can be because those sphincters are too tight or tense, that external sphincter is too tight or tense and it can't relax well. It could be that your bladder is one, not full enough, that you're going pee all the time. You have the urge to pee, but then you go and you're like, there's actually like not that much in there.
or that your bladder can actually be overstretched and it can not have that ability to kind of push the urine out. Like the muscle's like weak and tired. And so that overstretching of the bladder happens when people delay the urge to urinate a lot of times. Like their bladder's just getting overly full. The normal frequency to pee is every two to four hours. So when you don't go that often and your bladder gets really full, it kind of just gets weaker and it can't push the urine out. Or when you also have pelvic floor tension,
either from delaying the urge or just in general, that sphincter's not relaxing well so that your urine can empty. And so it's actually interesting, one of the first things, you know, people can go get urodynamic testing from a urogynecologist to see, but if those sphincters aren't relaxing, then like that's where the pelvic floor therapy comes in of like, let's work on relaxation of these muscles so that you can empty more urine.
Kim Vopni (24:19.275)
Yeah, yeah. What role would prolapse play? Like, would it add an additional layer of complexity? And could that be a contributing factor to retention for some people?
Dr. Sara Reardon (24:29.955)
Totally. So I'm glad you brought that up. So prolapse, as a lot of folks know, is when, you know, that bladder, if say it's a bladder prolapse or urethral prolapse, isn't as well supported by that kind of anterior front vaginal wall. And it starts to kind of push or droop into the front vaginal wall. Now, urine can pocket in that. Think about a balloon that's just kind of hanging out and urine can pocket in there. So when you go pee, you're like, I know I have pee in there. But you start pushing it out. You start moving your hips. You're leaning backwards and forwards.
you're pushing on your belly to try to get it out, but it's the position of the bladder that's like urine's kind of still hanging out in that little pocket because of the position of the bladder. And so sometimes people find that, I mean, there could even be things like when somebody uses a menstrual cup, it like pinches the bladder a little bit and they feel like they can't like get it all out. So there are some tips and tricks we try for if they have prolapse to, I think sometimes people, if you use a pessary or an internal bladder support that can help kind of reposition the bladder.
kind of moving your hips forward and back, side to side, leaning forward, even sometimes again pushing kind of right over the suprapubic area. The challenge is that people who don't empty their bladder and even their bowels, they start pushing to get it out. And that pushing and straining causes more prolapse, decreased support of the bladder, kind of more weakness. So you're in this cycle of...
kind of adding more weakness and the weakness adds more retention. So it's a tricky thing, but it is a common symptom with bladder prolapse as well.
Kim Vopni (26:00.959)
Yeah. When you're working with people with prolapse and I often get asked, you know, what are the exercises for a bladder prolapse? What are the exercises for erectus heel? And really at the end of the day, it's all the same. We, we, we're, you're going to have the same approach when you're working with somebody who has prolapse, let's say, one compartment fairly early. one type of prolapse catching it fairly early.
Dr. Sara Reardon (26:15.715)
Yeah.
Kim Vopni (26:30.015)
And then if you compare that to somebody who maybe has maybe two types of prolapse that are a little bit more advanced, does anything change with your treatment? Does anything change with regards to how that person would manage it at home?
Dr. Sara Reardon (26:43.353)
So, you know, I've really become, this is a great question, the majority of people, of women in particular, especially if you've given birth, have some degree of prolapse, which is kind of surprising, I think, for folks to heal because if you look it up, it sounds and here it looks pretty scary, but most of us have some degree of prolapse. And so that's kind of a given, like what do we do in that situation? I think a lot of it depends on muscle tension, muscle function, so I kind of always am based on like what are the symptoms and what am I finding?
And for lot of people with prolapse, you'd start thinking like, strengthen, strengthen, strengthen, but a lot of people actually have tension in their pelvic floor muscles. Because when you feel like something's falling out or that you're gonna leak or you have pressure or heaviness, you start tensing up in response to that. And so if you just go tell somebody like, do a bunch of Kegels, like they're tensing and tightening muscles that are already tense and tight. So sometimes it's like relaxing the muscles and getting them out of that over kind of tense state.
I've also become a really big fan of internal supports because when those tissues are exhausted internally in the vaginal canal and they're kind of almost dragging, it's hard to get any lift when you're trying to strengthen. So using different internal supports, whether it's a pessary or, you know, uresta or revive or a tampon or whatever the case may be to kind of just give those tissues a little bit of a rest.
and then performing, if it's strengthening, your contractions, you know, often in a gravity lessened position, lying down, hands and knees, sideline, whatever, and then progressing them forward. I also work a lot on pressure management with breathing to make sure that folks aren't like holding their breath or bearing down. And then I, you know, there's even some things that I'm like, listen, you may be more fatigued later in the day. So if you are gonna like exercise, you may want to do it earlier in the day when those postural muscles aren't as fatigued or.
you know, work on your longer hold contractions, because those are your endurance muscle fibers versus just like the quick ones, which are kind of easy and like, we just want to check the box and building it into function, you know, like you can do Kegels till the cows come home, but if you're like straining when you poop or like, you know, holding your breath every time you like lift your kiddos up and then it's putting pressure down, really looking at not just what's happening and how can we like strengthen or coordinate the muscles, but
Dr. Sara Reardon (28:56.749)
Like what are you doing throughout the day that could also be contributing when you're peeing, pooping, lifting, breathing, all these things that may make a difference as well.
Kim Vopni (29:05.909)
So many people come and want the magic exercise. I'm here for the exercises. And there are so many other things that when, if people take the time to understand the role of breath and not straining when you poop, not pushing to pee, then they, lot of people have these light bulb moments and those sometimes can be the bigger change in their symptoms. Not so, like the exercise helps, but oftentimes it's so much the lifestyle that
these behaviors that people have, that sometimes even compensatory. You mentioned the guarding that happens when you think something's gonna fall out. We don't necessarily know we're doing it. And then when we are, when we have the awareness, it's so helpful. The piece about the pessary is, I think it's shifting now, but so many people used to think like, pessaries are just for, and I've even heard doctors say this, pessaries are, you're too young. Pessaries are for older people. And I think, my gosh, like that couldn't be more further than the truth.
Dr. Sara Reardon (29:43.948)
Right.
Dr. Sara Reardon (30:04.067)
Yeah.
Kim Vopni (30:04.266)
I'm super excited about the innovation that's happening with pessaries. A lot of people in my community use the Revive or the Uresta or the Poise. I use the Poise myself. The Rhea Pessary I think is amazing and unfortunately not available in Canada as of yet, but there's two companies in Canada doing 3D printed pessaries where you have a pelvic ultrasound of your anatomy.
Dr. Sara Reardon (30:19.235)
Mm-hmm.
Kim Vopni (30:32.18)
And then a 3D printed pester specific to your anatomy, I think is just so cool because we were sort of stuck in this. We'd been we'd had the same menu of pester ease for thousands of years. Not really, but yeah.
Dr. Sara Reardon (30:42.211)
Yes. Yeah. It feels like that. We wish it was thousands of years, but you are so right and I agree with you. Like, I mean, ultimately we want options and we don't want to be have a gatekeeper to these options. And in the United States, pessaries are prescription only. Now therapists can start fitting for them. But for so long it was like you had to go see a urologist and you had to get fit and you could only try one and then you had to pay for it and then you have to go back and...
And when you look at a pessary, it's like you're asking me to put like a cube or a giant ring inside of my vagina and that feels really scary and sometimes uncomfortable. And when you've got, you know, low estrogen tissues that can be like frail or sensitive and then you're like putting it's like just this combination of like, what are we really doing here? You know? And so I think giving people a variety of options. And I have some folks who will wear the poison presa day to day. But if they're going hiking on the Appalachian Trail, they're going to wear like a more rigid pessary. And so
I think we want options. also think that I am a huge fan of internal supports because it's this. It used to be like physical therapy and exercise or you have surgery and I think that passers have provided an amazing in between of what can we do to help women be functional to be active to have be less symptomatic help them work on their pelvic floor when their tissues aren't so exhausted and yet we may not. You know we're either preparing for surgery or you want to prevent it or whatever the case may be. So I almost wish that a lot of.
postpartum women were on pessaries or internal supports because that is when we are breastfeeding or pumping and we have low estrogen. And I'm like, these are the people I'm like, girlfriend, put a tampon in. Like if you feel like your bladder's falling out, like put something in there and support it because you need something, you know? And it's just not standard of care. And I hope that at some point we know how to integrate that into postpartum care. And again, all pelvic health care more seamlessly.
Kim Vopni (32:10.091)
thousand percent.
Kim Vopni (32:19.04)
Yep.
Kim Vopni (32:30.453)
Yeah, yeah, yeah, I think that I totally agree with you. think that would be amazing. just, you know, I think about, I talk a lot about how I joke, you know, like people in France don't pee their pants or many parts of Europe, right? Because they have their standard of, that's their standard of care. You get six to 12 visits. Now, it's not as robust as the PT that is, that you provide or that the PT's provide here. A lot of it is.
biofeedback or ultrasound, but it's better than nothing. And at least it's planting the seed about the importance of pelvic floor care. part of that, think, could be, as you say, some sort of a pessary designed specific to postpartum to provide support to those tissues. Well, because we both have experienced it. We see it all the time. Women are sent home with zero guidance. A baby, have to keep alive. Their hormones have changed. They have no sleep.
They've just either had a surgery, maybe they've even pushed and then had surgery and there's been a lot of disruption and so the support system is not working very well at all and so we need extra care and I wholeheartedly agree. I think that would be such an amazing way to just an additional way to provide some support and take away the symptoms and make those. That's a rough time. It's not easy and you know, and yeah, the panic of, sorry, go ahead.
Dr. Sara Reardon (33:26.125)
Yeah.
Dr. Sara Reardon (33:32.108)
Yeah.
Dr. Sara Reardon (33:46.707)
I mean, I was. Yeah, I mean, I remember looking back and know you. I mean, you bring up such a great point about the people and women in France on Peter Pan's and that's hysterical. I love that so much. But it's also like, you know, their health care system is recognizing that women do need some support. Postpartum moms do need some support. Is it, you know, is it pretty kind of a protocol that they're run through? Likely.
However, it's acknowledgement like, OK, we understand you need support. We're going to give you something to help, at least kind of in the early stages. And you know that this exists should you continue to have problems. Like, there's none of those aspects built into what we experience here. I just think that there's so much that needs to change. I don't know how it is in Canada, but I mean, we could go on and on about all the things that are just like totally messed up for parents and women in this country.
But I think I always say like when you don't function well, you can't perform well, whether that's as a mother, as a friend, as in fitness, as an employee. We can't perform well. And we're asked to go back to work so soon here in the United States and have all of these hats that we're wearing and exercise because it's good for your mental health and make sure you're connecting with your partner because relationships get fragile and play with your kids because, you know, all of this stuff and then go back to work. it's like
But if we can't even function well in our pelvic health arena, then it's so hard to do any of those things. And like even the tennis match I played in, like I couldn't think about anything else for the rest of that match is like, are my pants wet? Am I leaking? Is it gonna go again? What if I did like, it was so consuming. I lost the match, but it was very eye-opening for what people experience. And it's just, you can't think about anything else when something is affecting your body in that way.
Kim Vopni (35:23.254)
Mm-hmm. Yeah. Mm-hmm.
Kim Vopni (35:38.828)
It's the distraction and it really it is consuming. It takes away. You've just mentioned all of them, you know, your your work suffers your social out your French circle your intimate relationship. If you have one everything has this, you know, we were talking earlier before we started recording about this visa process. going through with my son and it's like this. It's an exciting thing. However, it's got this heaviness this veil that's hanging over it because of this process that we have to go through and that it's just I don't know if that's right.
comparison but when you have something that is taking away your attention you're never fully present you're not performing as you say you're not doing you're not giving your best because you just have this little voice here or worry or shame or embarrassment and I like I often say that the the pelvic floor or symptoms of should be kind of like vital signs like there's nobody asking how often do you poop do you strain to poop do you have any pain with sex.
Dr. Sara Reardon (36:14.445)
Yeah.
Kim Vopni (36:37.363)
Are you leaking when you this and those can be very quick questions and yes with and I think your health care system similar in some regards. We don't have a lot of time with the doctor and yet that's usually the first place that people are going for help when they finally do seek help. So within that period of time they can't really explore that conversation and we can't really get or if somebody does ask those questions you feel pressure you're like no no no no I'm fine. Yep I'm fine. Right. Yeah. So it's.
Dr. Sara Reardon (36:37.528)
Yeah.
Dr. Sara Reardon (37:02.925)
Yeah, yeah, yeah.
Kim Vopni (37:06.187)
It's a challenge and pelvic PT, it is my sincere hope that at some point in my lifetime, I see it being that we remove the cost barrier, that it's more accessible for people. So there's some sort of government subsidies and also that it is recognized as that's your first line of defense. Medical people can be on your care team, absolutely, but we really need a care team and that this is one person, one important part of your team.
Dr. Sara Reardon (37:28.75)
Yeah.
Dr. Sara Reardon (37:32.954)
Totally. And I think it's also that, you know, if we can integrate these things a little bit kind of along a continuous model versus like, okay, you have a baby and then you have one visit. It's like, are we seeing, you know, folks prior to birth during pregnancy so they're established or and giving them kind of proactive tools for postpartum? Are we checking in with them in the hospital? Like we have PTs come in when you have a hip surgery, a knee surgery, when you're been in the hospital for a couple of days and just need to mobilize. Like, why isn't that happening for
post-c-section moms for every mom. So it's like, if you've got more touch points, you don't feel like you have to cover everything in one visit because you're trickling in information and support along the way. And I think that what we see is there's actually a huge health savings cost to that. People end up leaving the workforce. They end up having surgeries. end up buying tons of incontinence pads or whatever the case may be. So there's not only just
kind of a benefit of like, women can feel better and function better, but it's also there's a cost savings perspective because so many resources are put towards managing problems later down the line instead of kind of having touch points where we can integrate it continuously.
Kim Vopni (38:45.887)
Yeah, thousand percent. So before we wrap up, what would you say, you you're you've gone through pregnancy yourself. You're starting to now you're in perimenopause. You're starting to see more of that population in your practice as well. If you were to give a couple of couple of tips that you think like these are vital for optimal pelvic health as we go through these stages, what would they be?
Dr. Sara Reardon (39:11.011)
You know, I think so much of this is kind of learning what our normal is. Like, you should know that your normal should be to pee every two to four hours during the day, to wake zero to two times at night, to not push when you pee, to, you know, sit down, try not to hover if the toilet's not too yucky, take deep breaths, don't do Kegels when you pee, just like sit, chill, and breathe. So I think if we know like, that's our normal, then if we start waking multiple times at night, then we're like, hmm, something's changing or...
We feel like we can't start our stream and we have to push. Hmm, something's changing. Like know your normals. The same thing for bowel movements. You should be going anywhere from three times a day to three times a week. You should be, you know, bearing down and exhaling using a squatty potty underneath your feet, but you shouldn't be straining or holding your breath. also, I always say like poop should look like soft serve yogurt coming out, like soft and smooth. I don't know anybody that really has that, but that's like the dream poop to have.
And you know, it shouldn't be painful. Hemorrhoids, fissures, all of these things are kind of signs of pelvic floor issues. Even like fecal staining, skid marks in your underwear. These are pelvic floor issues that we just kind of ignore and don't really address until they become full blown, you know, kind of big problems. And the same thing with intimacy and sexual activity. Like sex should not be painful. I don't care if it's your first time, if it's after giving birth, if it's with aging, like there are tips and things to help. And...
I think just helping people realize that like if we know our normals, we can know when something's abnormal and that no pain or no amount of pain or leakage is normal. Like these are this is information from our bodies that something's not functioning the way it should be and that there are resources and therapy available to help. And I have a lot of patients go into, you know, prolapse surgery and sometimes they're like, I just feel like if I would have done more exercise, I'm like, listen, like this is
gonna happen. mean this is we can't PT is not a cure-all for everything but what we do want is we want you to feel informed, empowered, educated, have a good recovery plan, be supported so that we get the best optimal result from this surgery. And I think that those are really the things that we want is just helping women feel really empowered in this part of their body. So whether it's peeing or pooping and you know a lot of what I go over in the book Florida is like what is normal because we've never talked about it.
Dr. Sara Reardon (41:31.159)
And so here are some like really easy things that you can look at and start doing now if you're experiencing issues at home.
Kim Vopni (41:38.155)
Yeah, I always am saying go to see your pelvic floor PT once a year for a checkup like you would go see your dentist. Do you agree with that?
Dr. Sara Reardon (41:45.528)
Yes, totally. We go through transformations every year of our life, and especially when we're menstruating, pregnant, postpartum, perimenopause. so, just like the dental model, it's like if we go in every year and get it checked, then we can know that issues are happening, we can address them sooner. I think the biggest challenge to that is we don't have enough pelvic for therapists. There's just not enough for us to see
women annually, I think that that can change. My hope is that it changes because we've got plenty of dentists out there. But I think that, you know, we also we need kind of a top down and bottom up approach where we're like we need more therapists, we need better insurance coverage so more therapists can go in network. We need, you know, just a lot of pieces to kind of make this more accessible for women. But I think we have options in health care now, whether it's like an online program like you do or a book or
you know, in person, we've got a menu of options to help women, so it doesn't have to be just in-person care because not everyone can access that. But that would be, like, that's the gold standard, the dream, but there are a lot of intermediate steps you can take.
Kim Vopni (42:56.276)
Yeah, 1000%. So where can people find your amazing book? Where can they learn more and follow along on social media so they can see your Volvo costume?
Dr. Sara Reardon (43:05.209)
I am on social media as the vagina whisperer on Instagram and I'm on TikTok as the vag whisperer because TikTok doesn't like the word vagina and my website is thevaginawhisperer.com where I've got tons of blog posts and free guides and kind of an online workout program where you can check out some workouts for free for a week and then my book is called floored a woman's guide to pelvic floor health at every Asian stage and
It really starts from like menstruation to postmenopause and peeing and pooping and sex. Even if you're like, I'm postmenopausal, I don't really need this. And like, if you're raising daughters, if you pee, if you poop, like there's so much in there that we've just never been taught. And I really hope that you can either read the chapters that are interesting to you or kind of go through the whole thing. But you can find it anywhere you like to buy books.
Kim Vopni (43:55.742)
Yeah, amazing. Thank you so much. I so appreciate this conversation. Thank you for your work and for joining us for today.
Dr. Sara Reardon (44:02.532)
Thanks for having me, Kim.
