Overactive Bladder, Prolapse and Leakage…Is Our Vagina Aging Well with The Vagina Coach Kim Vopni

You Know That Moment When You Sneeze and Have to Cross Your Legs?

Let me ask you something: Have you started planning your entire day around bathroom locations? Do you wake up multiple times every night feeling like you need to pee? Maybe you’ve noticed a little leakage when you laugh, cough, or do that box jump at the gym—and now you’re wondering if black leggings are going to be your permanent uniform?

If you’re nodding your head right now, I want you to know something important: you’re not alone, this isn’t just “normal aging,” and you absolutely don’t have to live this way.

I’ve spent years studying hormone health, gut issues, and metabolic challenges in midlife women. And here’s what I keep discovering: no matter what health topic I explore, everything circles back to the same critical factor—your nervous system and your body’s foundational support systems. Today, I’m diving deep into one of the most overlooked yet life-altering aspects of midlife health: your pelvic floor.

I brought in Kim Vopni—also known as The Vagina Coach—because she’s revolutionizing how we think about pelvic health. Kim is a pelvic floor fitness expert who understands that what’s happening in your pelvic floor isn’t just about doing more Kegels. It’s about understanding the complex interplay of hormones, posture, breath, nervous system regulation, and yes, muscle function.

Why Should You Care About Your Pelvic Floor Right Now?

Here’s something that shocked me: according to recent research, 46% of women stop exercising entirely because of pelvic floor issues. Think about that for a moment. Nearly half of women are abandoning movement—which we know is critical for heart health, brain health, metabolic health, and mental wellbeing—because they’re dealing with bladder leaks or pelvic organ prolapse.

We preach movement and fitness, but if your pelvic floor isn’t functioning properly, you’re going to avoid the very activities that keep you healthy and vibrant. That’s not just inconvenient—that’s life-altering.

The Hidden Epidemic: It’s Not Just About Leaking

Most of us think pelvic floor problems are just an annoying side effect of having babies or getting older. We see the memes, we joke about crossing our legs when we sneeze, and we assume this is just part of being a midlife woman.

But Kim explained something crucial: there are multiple interconnected issues happening, and understanding them is the first step to solving them.

What’s Really Happening Inside Your Body

Your pelvic floor isn’t just one muscle—it’s three layers of muscles that have incredibly important jobs:

• Supporting your internal organs (bladder, uterus, rectum)
• Maintaining urinary and fecal continence
• Providing the foundation for your core stability
• Enabling sexual response
• Acting as a sump pump with your diaphragm for circulation

When things go wrong with these muscles, we typically wait an average of six and a half to seven years before seeking help. And when we finally do? Our doctors often tell us it’s “normal,” hand us a prescription for overactive bladder medication (which increases cognitive decline risk), or suggest surgery without addressing the root causes.

The Real Culprits: It’s Not Just Aging

Kim broke down the actual reasons your pelvic floor might be struggling:

Hormonal Changes: Loss of estrogen, testosterone, and progesterone affects muscle mass and function throughout your body—including your pelvic floor. The type two muscle fibers you need for quick reactions (like stopping urine flow when you sneeze) are declining.

Postural Adaptations: Chronic sitting, forward head posture, loss of lumbar curve—these all affect how your pelvic floor functions. Your posture and your pelvic floor are intimately connected.

Chronic Constipation: Straining on the toilet damages your pelvic floor over time. Yet nobody connects these dots.

Breathing Patterns: Your diaphragm and pelvic floor should work together synergistically with every breath. Most of us have lost this natural coordination.

Chronic Heavy Lifting: Not the intentional strength training kind—the carrying toddlers, transferring patients, or daily occupational lifting that never gives your pelvic floor a break.

Pregnancy and Childbirth: These are well-established risk factors, but they’re not the only ones, and having babies doesn’t doom you to pelvic floor problems.

The Cascade Effect: When Small Problems Become Big Ones

Here’s what really struck me during this conversation: pelvic floor dysfunction isn’t just an annoyance—it creates a cascade of other problems.

When you leak urine, you might start:

• Avoiding social situations
• Stopping exercise
• Reducing water intake (which makes things worse)
• Withdrawing from intimate relationships
• Planning your entire life around bathroom access

With pelvic organ prolapse (which is statistically more common than incontinence but rarely discussed), symptoms include:

• Heaviness and pressure in your pelvis
• Feeling like something is literally falling out of your body
• Complete cessation of impact activities
• Avoiding leaving the house

And the night waking? That’s disrupting your sleep quality, which affects literally every other aspect of your health—your hormones, your metabolism, your mood, your cognitive function.

What Your Doctor Probably Won’t Tell You

Kim shared something that honestly made me frustrated: Western medicine’s approach to pelvic floor problems is typically pharmaceutical or surgical.

The Standard Medical Approach:

• Overactive bladder medication (linked to cognitive decline)
• Birth control pills (can create dryness and irritation, especially in postmenopausal women)
• Surgical mesh for prolapse or incontinence

Now, sometimes these interventions are necessary and beneficial. But here’s what research actually shows: conservative management with pelvic floor physical therapy should always be the first line of defense. Yet most women never even hear about it.

The Truth About Kegels (And Why They’re Not Enough)

Everyone tells you to “do your Kegels,” right? But here’s the problem: most people don’t actually know how to do them correctly.

Kim explained that people typically think a Kegel is just “squeeze”—and they end up:

• Squeezing their inner thighs
• Clenching their glutes
• Holding their breath
• Sometimes even bearing down (the opposite of what you want)

What a Kegel Should Actually Be: A squeeze (hug), a lift (drawing up), and a release. It’s a coordinated movement that works with your breath—not an isolated squeeze.

But here’s the bigger issue: Kegels alone are like only doing bicep curls and expecting total body fitness. Your pelvic floor needs the same progressive training principles as any other muscle group:

• Endurance work
• Power training
• Hypertrophy
• Strength development
• Coordination with movement

The Game-Changing Solution Most Women Never Hear About

Kim’s number one recommendation? See a pelvic floor physical therapist. Not just when you have a problem—once a year as a preventive checkup, just like going to the dentist.

What Happens at a Pelvic Floor PT Appointment:

• Detailed health history
• External and internal evaluation (with your consent)
• Assessment of tone, symmetry, and organ position
• Checking for conditions like lichen sclerosis
• Teaching you how to properly activate your pelvic floor
• Identifying specific issues unique to your body

Many women walk out of their first appointment thinking, “How have I lived 50+ years in this body and never knew any of this?”

The Essential Action Steps for Every Midlife Woman

Kim outlined a practical approach that goes beyond just “do more Kegels”:

1. Hydration is Non-Negotiable Drink 2-3 liters of water daily. I know what you’re thinking: “But then I’ll have to pee more!” Actually, dehydration makes things worse. When you’re dehydrated, water runs right through you, and concentrated urine irritates your bladder more.
2. Address Constipation Immediately You should be pooping at least once daily with well-formed stool (Bristol Type 4). Straining damages your pelvic floor. Focus on fiber, hydration, and magnesium.
3. Retrain Your Bladder Normal is peeing every 2.5-4 hours (5-9 times daily) and not at all during the night. If you’re going “just in case” constantly, you’re training your bladder to signal you when it’s not actually full.
4. Vaginal Estrogen or DHEA is Essential Even if you’re already taking systemic hormone therapy, vaginal estrogen is critical. It’s the gold standard for preventing recurrent UTIs, dryness, painful sex, and supporting tissue health. There’s no link to any cancers with local vaginal estrogen—despite what the outdated black box warning says.
5. Learn the “Core Breath” Your pelvic floor is the foundation of your core and works with your diaphragm. On inhale, your pelvic floor relaxes and lengthens. On exhale, it contracts and lifts. This should happen naturally with every breath.
6. Progressive Pelvic Floor Training Start with foundational work (bridges, squats, lunges) incorporating the core breath. Then add load, resistance, and eventually power movements. Just like you’d never jump into Olympic lifting without building strength first, don’t do high-impact exercise without establishing pelvic floor foundation.

The Night Waking Mystery: It’s Probably Not Your Bladder

This was eye-opening for me personally. Kim explained that when you wake up at night, it’s usually NOT because your bladder is full. Something else woke you—a hot flash, blood sugar dysregulation, sleep apnea, a snoring partner—and then your anxious mind immediately focuses on your bladder.

The Retraining Process: When you wake up, do NOT automatically get up to pee. Instead:

• Recognize what actually woke you (probably not your bladder)
• Do some self-talk: “My bladder isn’t full. There’s no emergency.”
• Try toe scrunches, calf raises, deep breathing
• Calm your nervous system
• Go back to sleep

You’re retraining the Pavlov’s dog response your bladder has learned. Some people break this pattern overnight. Others take a week. But it works.

The Devices, Products, and Solutions: What Actually Works?

Kim addressed the sea of products marketed to women with pelvic floor issues:

Pelvic Floor Training Devices: Many are marketed as “tightening” solutions, but most women actually have TOO MUCH tension in their pelvic floor, not too little. These devices often make things worse because they encourage more squeezing.

Vaginal Red Light Devices: Tools like JoyLux and Fringe combine red light therapy, infrared heat, and vibration specifically for pelvic floor health. They help with:

• Tissue relaxation
• Collagen production
• Lubrication
• Pain reduction
• Muscle release

Pessaries: These are like orthotics for your pelvic floor—devices inserted into the vagina that provide 360-degree support. They’re great for symptom management and aren’t always offered by doctors.

Surgical Mesh: Can be effective for sling surgeries with few complications, but creates scar tissue and changes to the landscape. Pelvic floor training becomes MORE important after surgery, not less.

Prolapse: Can You Actually Reverse It?

Here’s the hopeful news: early-stage prolapse (stage 1 or 2) can often be reversed through exercise, posture correction, breath work, and addressing constipation. Even stage 3 prolapse can improve significantly—Kim has clients who’ve gone from stage 3 to stage 1 through conservative management.

Surgery isn’t mandatory, even for advanced prolapse. While it’s not physically life-threatening, it can be quality-of-life threatening because it stops women from living fully.

The Nervous System Connection (Again)

You know what’s fascinating? No matter what health topic I explore—gut health, thyroid, hormones, metabolic issues, and now pelvic floor—we always end up at the same place: nervous system dysregulation.

Kim’s approach includes:

• Hypopressives (low-pressure fitness that creates a suction effect and helps with posture)
• Walking in nature (barefoot when possible)
• Red light therapy and sauna (used mindfully, not obsessively)
• Touch therapy and bodywork
• Practices that allow rather than force

But here’s my caution from personal experience: when your nervous system is already overactive, adding too many biohacking devices and protocols can actually make things worse. Your body might not be able to eliminate what these tools are mobilizing. Sometimes the simplest approaches—nature, sunlight, circadian rhythm—are the most powerful.

What “Normal” Actually Looks Like

If you’re doing the right things and your pelvic floor is healthy:

• You can sleep 8 hours straight through the night
• You pee every 2.5-4 hours during the day
• You have no leakage with coughing, sneezing, laughing, or jumping
• You have no urgency (sudden, desperate need to go)
• You have no pressure or heaviness in your pelvis
• You can do high-impact activities comfortably

This isn’t an unattainable ideal—this is how your body is designed to function when everything is working properly.

Your Next Steps: Taking Action Today

1. Find a pelvic floor physical therapist in your area and schedule an assessment
2. Commit to hydration (2-3 liters of water daily)
3. Address constipation through diet, fiber, and supplements
4. Talk to your doctor about vaginal estrogen or DHEA (even if you’re on systemic hormones)
5. Stop going to the bathroom “just in case” and start retraining your bladder
6. Learn proper pelvic floor activation through Kim’s resources
7. Join Kim’s community at vaginacoach.com or follow her on Instagram @VaginaCoach

The Bottom Line

Your pelvic floor problems aren’t just “normal aging.” They’re not something you have to accept. And they’re not going to magically fix themselves with a few Kegels at red lights.

What’s happening in your pelvic floor is affecting your sleep, your exercise capacity, your social life, your intimate relationships, and ultimately your longevity. The good news? With proper education, support, and conservative management, most pelvic floor issues can be dramatically improved or completely resolved.

You don’t have to plan your life around bathrooms. You don’t have to wear pads every day. You don’t have to stop doing the activities you love. And you definitely don’t have to accept doctors who dismiss your symptoms as “just part of menopause.”

It’s time to stop joking about crossing your legs when you sneeze and start actually fixing the problem.

The contents of the Midlife Conversations podcast is for educational and informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider. Some episodes of Midlife Conversations may be sponsored by products or services discussed during the show. The host may receive compensation for such advertisements or if you purchase products through affiliate links mentioned on this podcast.