Kim Vopni (00:00.878)
Welcome to another episode of Between Two Lips. I'm your host, Kim Vapni, the vagina coach. And in this week's episode, you've got just me and I'm giving you a five-year update on my rectocele repair. So it has been five years. As I'm recording this, I'm just shy of the five-year mark like by a couple of weeks, but I get asked a lot about my rectocele, about the repair, if I would do it again. So I'm just gonna give you a little update.
No intro, I'm just gonna jump right in. So short answer, I would 1,000 % do it again. I'm very happy that I did it. It really changed my life. I was struggling a lot with symptoms. I was starting to change the way I moved. I was starting to move less. I was avoiding certain activities.
It was really interfering with the quality of my life. So I thought about it for about four years. I booked and canceled twice before I actually went through with it. Part of the reason I did that was just because I knew I still hadn't addressed a couple of things. I was in perimenopause, not knowing I was in perimenopause. I was bleeding very, very heavily and I was also still struggling with constipation. So before I really had those in check, I knew it wasn't wise for me to go forward with the surgery. So I continued learning about
what the heck was happening in perimenopause. I had a thyroid component, an autoimmune thyroid condition that was contributing to the constipation, which, you know, I also had a rectocele, so chicken and the egg, I'm not sure which one really came first, but the constipation from the thyroid side of things and the hormone disruption was definitely contributing to the struggles I had because of the rectocele. The rectocele was just exacerbating the
dysregulation in the hormones and what have you. So it was a vicious circle. It wasn't fun. Perimenopause was a bit of a shit show for me. Partly because I didn't know what the heck was going on. Now, looking back, I and the world is talking about perimenopause and menopause a lot now, which is great. But I didn't know what the heck was happening at the time. I didn't know the term perimenopause. I just knew something was off and the doctor I went to said everything was quote unquote normal.
Kim Vopni (02:21.526)
And that's really what I knew I was not, what was happening was not normal. And that's where I started to investigate things. And the first book I read was called The Hormone Cure by Dr. Sarah Godfrey. That answered a lot of questions for me. And that just set me on a path of reading everything I possibly could about hormones and about the thyroid. And it was out of that then I, I didn't self-diagnose, but I checked all the boxes with Hashimoto's thyroiditis and went and asked my naturopath.
to have the test for that and I had the antibody markers for that. So that was my sleuth work. Unfortunately, in this day and age, I think we do really need to do a lot of our own sleuth work. But thankfully, we live in today's day and age where there is a lot of information out there. And I know that can be overwhelming and I know it can be confusing. But if you can find trusted sources, I recommend several people as a place to start. The book,
Estrogen matters is a great one. I just mentioned dr. Sarah Gottfried. She's a great resource. Her book was was very helpful. Dr. Anna, Rebecca the girlfriend doctor Karen Martel, she has just changed the name of her podcast. I believe it used to be called the hormone solution. I believe now it's called the midlife solution and Dr. Amy Horniman the thyroid fixer. Those are a couple of good places to start and to start learning and you'll go down your own rabbit holes
but at least it gives you some information to advocate for yourself when you are dealing with your specific care provider. I do also recommend working with a practitioner who is trained in menopause and menopause hormone therapy. went through, well, we're kind of on, we're dealing with the hangover of the two decades post-Women's Health Initiative where they're...
not only were there women who missed out, but there were a lot of doctors who were not trained. So there is a few different practitioners who, and certifying bodies who help educate. The Menopause Society is one, so menopause.org, you can find providers there. I'm not saying that everybody on there is magical, but they at least have taken the additional training.
Kim Vopni (04:39.913)
They have written the exam, they have become certified through the Menopause Society so you know that they have the up-to-date knowledge on menopause and menopause hormone therapy. Ishwish is another one, I-S-S-W-S-H, and they have a directory of practitioners. Dr. David Rosensweet, the Institute of Bioidentical Medicine, he has a list of practitioners. So those are a few places you could look for people in your area to see if you can find somebody to help you.
People typically who are informed in the menopause transition and hormone therapy are also more well-versed from a thyroid health because they're very interrelated. Dr. Amy Horniman talks a lot about this. So you hopefully would be supported from a thyroid perspective there as well with at least getting the right testing. The allopathic or conventional medicine model typically will check TSH, maybe T4 or maybe T3 one or the other, but
they don't do a full thyroid panel and there's a lot of information missed there. So that's just a bit of background. So I finally figured out what's happening. I got my thyroid in check. My bleeding started to subside finally and then I went ahead. when I finally said, okay, I'm ready. I've addressed all this. I've reduced inflammation in my body. I'm feeling good. I'm not losing half my body weight and blood. I'm pooping like a champ again.
And then actually when I did that, started my period started to normalize. and, and even they had stopped for a few months. have to look back on my exact, but I remember it had been, it had stopped for, I think it was a few months and then days before my surgery, it came back and I was really pretty angry with my uterus. But it, it, some people said, well, maybe it's your, uterus telling you not to go forward with the surgery. you know, so you have all the mind games that come with that. but really it just.
it helped confirm for me that I really, really was very prepared for the surgery and really wanted it. And regardless of what my uterus was saying, it was not something that was intermountable and it was not something that was going to stop me. So I went forward with the surgery in December of 2020 and, and now here I am five years later.
Kim Vopni (06:59.394)
The chance of recurrence is very high within that first five years. The chance of recurrence is highest within the first two years after a surgery. I remember feeling very anxious for the first six to 12 months after my surgery. I overanalyzed everything, every little thing that I felt. I was afraid that it was gonna recur. Once I got past that initial year, it started to subside and really after kind of
Definitely after two years, I felt I didn't have that same anxiety anymore. I also think I felt that because I share pelvic health with the world. And so I felt like a lot of people were watching and waiting and is it gonna fail? Is she gonna fail? Is the exercise, is what she does beneficial? There's lots of people, I felt my own, I was putting that pressure on me, on myself. But would I do it again? Yes, I 1,000%.
would do it again. I'm very happy with the outcome. I'm very happy that I poop awesome again. Like I, I, really like a good poop. I really do. And if I don't poop in a day, like if I go traveling, it just, it just, I don't know, nothing else is the same. So I really like pooping and I'm really glad that I do it well. Again, I'm very regular again, no issues.
The only time I have any sort of struggle is if I travel through time zones and I make sure I take a lot of stuff with me to help with that. But that's a normal thing when you travel through time zones, your system can get disrupted and your circadian rhythm is off. But I'm pretty dialed in. I'm pretty dialed in and I'm very grateful that I had that surgery to help me get back to that. In terms of what I do on a daily basis, as I was doing before the surgery,
I do a daily hyperpressive practice for about 20 minutes. I do that after I have had my morning bowel movement. So really in the morning, I am, I'm, I'm starting out in preparation for that next day's poop, really drinking lots of water, eating well throughout the day. I don't have a lot of, I don't consume a lot of things that are inflammatory in my body.
Kim Vopni (09:21.357)
I do things like yoga, red light therapy, I walk, I exercise. I do lots of things. I sleep well. I use hormone therapy. I am not on thyroid medication for those of you that may be wondering about that. I use something called low dose naltrexone, which is really helpful from a thyroid antibody perspective. It also helps reduce inflammation in the body. But I'm not on a thyroid medication. Just yesterday actually I had my annual blood work, so we'll see how my thyroid is doing.
But I do, so I wake up in the morning, I have some water, I wait to have a bowel movement that happens usually within the first hour. I then do my hypopressives and that's about a 20 minute practice. I then usually will eat something and then depending on my day, I will work out and my workouts are between three and four times a week, I'm doing resistance training. I do two days of
and usually sometimes it's on the same day as that resistance training. I do a sprint interval training on my stationary bike. It's like a spin bike. And I do one to two zone two 45 minute rides on my bike. Yoga right now is, I love hot yoga and I try to get there at least twice a week, but I will often be doing my own little mini practices at home. I'm also currently going through a yoga certification.
Not because I necessarily want to start teaching yoga classes, but I'm a movement person and I like movement for myself. I want to keep my body as able as possible as I age. And I also can bring that philosophy. I already do bring a little bit of yoga in from being a yoga practitioner, sorry, participant, but now I'll be able to bring in the knowledge I gained from the certification as well.
So doing that, and so I'm often practicing little movements and practicing cueing and that type of thing on my own. And then I'm working, depending on my day, sometimes I'm filming another movement practice throughout the day for my Buffmuff community. And I most days to get that, you know, seven to 10,000 steps in. So do some sort of a walk in there as well.
Kim Vopni (11:43.182)
And then at night, I am setting myself up also for the next morning. So I am drinking water throughout the day. And then at night, I am taking magnesium. I take a bunch of different types. I take kind of like a multi magnesium. It has a whole bunch of different types of magnesium. And I take an extra little bit of citrate. I take my Puforia probiotic. For those of you that don't know, I do have a supplement line at Rejuve, R-E-J.
EUVE.com and I have three key products. There's a probiotic probiotic called Pruforia. I also have Omega Muff, is an omega fatty acid product with sea buckthorn oil, which is really beneficial for the vaginal mucosa and can help with vaginal dryness. And I also have a muscle, a muscle support supplement called Buff Plus. And this has creatine.
and a peptide called Peptis Strong and fulvic acid. Fulvic acid helps our cells draw or like absorb more of what we consume. Peptis Strong is a research evidence-based peptide that helps with muscle strength and muscle recovery. Creatine, if you haven't heard about creatine, I think you might be under a rock, but the world is talking a lot about creatine right now, especially in females and postmenopausal women.
for muscle in particular. Bone, not so much that it's going to build your bone density, but that some evidence is showing that it could help with like slow the loss. But I'm taking it for bones, for brains, for energy. Higher doses is helpful from a brain health perspective. Anyway, so I'm dividing.
going off topic here. Those are supplements that I take on a daily basis and at night I am taking my magnesium, I'm taking my Puforia, I take my progesterone, I have estrogen that I take vaginally. I also have an estrogen gel so I am on hormone replacement therapy. I also have a testosterone cream that I take and I'm also using some sort of an external, so I use a Vagifem tablet inside the vagina twice a week.
Kim Vopni (14:04.757)
And I also use gelva cream. I also have a vaginal estuary, all cream. And during the day, also use most days I use a poise impressa. Now I have and did have when I went back to having my rectocele, when I was being evaluated before my surgery, the doctor said I do have an early stage bladder prolapse, which I knew about. And he asked if I would want to address that at the time I was doing the rectocele repair.
I chose not to. It was not bothersome. It was not symptomatic. And I didn't want additional scar tissue. I didn't want to, you know, quote unquote, fix something that really wasn't a bother. So I left it. I probably three years ago now. Two and two and a half years ago. It was two and a half years ago.
I hadn't been symptomatic, but one day I was walking, I was actually in Bali with my husband and was walking along and I sort of felt a little bit of a drop and immediately felt like I needed to go to the washroom. And so there was some sort of shift in my bladder that happened at that time. And so I'm not on a daily basis symptomatic from a bladder perspective. On occasion, I might feel a little, sometimes I feel a bit of urgency, but it really depends on the day.
Knowing that I have had a rectocele repair, knowing that I have had a uterine prolapse, knowing that I have a bladder prolapse currently, and knowing that I have a levator avulsion, which I found out once, well, it was when I went to a different physio before my surgery, she's the one that said, have anybody ever told you that you might have an avulsion? I'd never been told that before.
I didn't technically have it diagnosed or confirmed until after my rectocele repair, but she was the one that, you know, palpated and said, can you feel the difference? She was palpating with her finger inside. I could feel the difference just from her palpation, from her touch. But nobody had ever told me that before. So that was new knowledge to me. That was about 14 years after the birth of my second child. And then I did go and have imaging and did confirm that I do have a partial avulsion on my left side. For those that aren't familiar with that term.
Kim Vopni (16:25.133)
Part of the pelvic floor is called the levator of anii. It's a group of muscles. Levator means lift, anii, anus. So lift the anus. It's really a major element of support within the pelvic floor. And avulsion is where the muscles lose their attachment. And you can have a partial avulsion. You can have a complete. You could have one side or both sides. And so mine is a partial on my left side. So knowing that,
I know that I am at greater risk of incontinence and of prolapse in particular. So I do my buff them off exercises. I do my hyperpressives. I make sure I poop like a champ. I pay attention to my posture. I do all the things. And I also now am using a poison pressa because even though we don't really have any robust data to say that there's a prophylactic effect of pessaries makes me feel better.
Makes me feel better. It takes away any symptoms that I occasionally have. I feel like I have an extra layer of support knowing that I do have, you know, I could do all the muscle training in the world. It's not going to reattach that muscle. So knowing that I do, I use that, I would say prophylactically and I don't love that it's single use. I don't love that it's not organic cotton.
I've tried a few other ones. This one's is what's most comfortable for me currently. So that may change as my anatomy changes as things evolve over the years. I'm looking forward to the evolution that's happening in the pessary space for companies like Cosm and Femme Therapeutics, also REIA. There's some cool innovation happening in the space and I hope that there will be something that will
provide the comfort level that I have with the poise. I don't feel it at all, which, similar to when you have a tampon in, you should not feel it. Some of the other pessaries that I've tried, have felt, they haven't, they've, if anything, in my situation, made, just made me more aware where I didn't really have anything to, like I wasn't symptomatic per se. I'm using it for an additional layer of support, so it didn't seem beneficial or helpful for me.
Kim Vopni (18:51.809)
Whereas the poise I put it in, it just, I don't have to think about it. And, yeah, so that's, that's what I do. I hope one day that I can have something that's not single use and that provides the same layer. And that is better ingredients, I guess I would say. but I also make sure that I keep the vaginal mucosa healthy with my Omega muff. I use gelva cream, I use vaginal estrogen. so I'm
I'm doing all the things to make sure that my tissue stays healthy and can accommodate insertion and removal if I do end up going to a different type of pessary down the road as well. What else can I tell you? I think that's about it. If anybody has any specific questions, then please you can send me an email, kim at vagina coach.com. You could send me a DM on Instagram. The most common questions I get are, are you happy with it?
Would you do it again? And what type of procedure did I have? It was the posterior colporophy. I didn't use mesh. It was a native tissue repair. I do share more detail on my blog. I share the whole decision making process and leading up to, so my prehab, my rehab, and my return to exercise is all on my blog. I also, out of that, created a full program called Pelvic Surgery Success.
and that is housed with inside my membership. And it's a really comprehensive program that helps people understand the language of surgery, understand how to choose a care provider, what questions to ask, understanding your procedure, talks about some of the procedures. I have interviews with doctors in there, how to prepare your body for surgery, how to train for surgery, how to set yourself up for an optimal recovery, what I did in my recovery and how you can...
Like you have to get the clearance from your care provider for some of the things I did or not necessarily what my doctor recommended. So you would need to speak to your doctor about what they advise. And then how I then returned to exercise. was not a six weeks. You're good to go back to normal. And then I just went back to what I was doing before six weeks. I went to see my pelvic floor PT. was around seven weeks actually. And then I started the progressive overload. So started to add some.
Kim Vopni (21:18.795)
weight to my buff muff exercises, then I did the classic principles of progressive overload that I would do with any other muscle group. It wasn't till about six months post-op that I was doing what I had been doing before in terms of the amount of weight, the types of exercises, the explosive movement, that type of thing. So it's not a, I don't think that at six weeks we should just go back to normal. We need some pelvic PT in there. We need some retraining of
the core, the deep core system, and we need some progressive overload. I would say that for any type of rehab, not just pelvic floor. So if you have other specific questions that I haven't addressed, you can let me know on social media or send me an email. And other than that, I will sign off and we'll see you in the next episode. Thanks for listening.
