Your Pelvic Floor in Perimenopause: What Changed and What to Do About It with Christina Walsh

Your Pelvic Floor in Perimenopause: What Changed and What to Do About It

Graced Health Podcast

Amy Connell, Host

Christina Walsh, Tighten Your Tinkler, Guest

Amy Connell: Hey, Christina. Welcome, welcome.

Christina Walsh, Tighten Your Tinkler: Thank you so much for having me, Amy. I love talking to you as much as, more than, anyone.

Amy Connell: Well, we clearly love talking to each other because we are hitting record 34 minutes after this interview was supposed to start.

Christina Walsh, Tighten Your Tinkler: Oops.

Amy Connell: That's how much we love it. That's only because I was like, "We've got to hit record and do all of this." So no, you and your partner Jen are just some of my favorite guests to have on. You're so informed about what you do, and then we come on and we're always laughing and we always have a good time. So I'm really glad you're here. 

I have been a member—and we can talk about this here in a little bit—but I have been a member of your signature program. I've done it for my own pelvic floor, and you all had an email recently come out about cardio training you won't pee your pants while doing. And so I responded back and I was like, "Oh, you've got to come back on because this, as you know, Christina, this is an issue."

Christina Walsh, Tighten Your Tinkler: It is definitely an issue. I mean, look, and if you're a woman dealing with these symptoms, it's an issue for a lot more than cardio.

Amy Connell: Oh, so true as well. Yes, so true. And I want to take a quick break and say, if you have not listened to our first two episodes, I will link those in the show notes. But those give a really good foundation of our pelvic floor. But what I want to talk about today is our pelvic floor specifically as we're getting older. 

Much of my community is women in perimenopause and menopause. Because, you know, when you do one-on-one work and when you talk with people and you're a personal trainer, you get to know a lot about people. And I have heard a lot of various challenges with pelvic floor and just this ability to—yeah, I mean, we'll just call it the peeing when you sneeze and when you cough and all of that. And I know there's more than that, but I want you to start off, Christina, and help us understand what exactly is happening to our pelvic floor now when we didn't have this issue 10, 15, 20 years ago.

Christina Walsh, Tighten Your Tinkler: Yeah, I love this because it's not a wonder that many women find us in the stages of perimenopause. And so a lot is shifting, as you know, in our bodies. And one of the areas that has been impacted is our pelvic floor, because that pelvic floor is just soft tissue that is holding our guts in. Maybe not the most glamorous explanation, but it's simple, straightforward, and accurate. And it's soft tissue, so there's no bone holding all our organs in from below.

And when we're in that perimenopause change and the hormones are shifting—look, by the fifties, my numbers are that estrogen can decrease by 50%—and along with that, collagen is decreasing. And collagen makes up our soft tissue, right? And so with the estrogen decrease, collagen's decreasing, which is decreasing that strength and tenacity of those soft tissues and that muscle down there holding everything up and in. And then our skin can't hold and retain as much moisture, and so that leads to thinning. So all of this is happening. 

And just so you know, you're not alone if you're dealing with these sorts of pelvic floor issues. Look, and there's kind of two stages of pelvic floor issues. One is technically called pelvic floor dysfunction. It's kind of the milder symptoms. If we go beyond that, we get into what's called prolapse, which is where the organs actually start to lose their home and they start to fall and shift and move downward in that pelvic area. And that leads to worsening symptoms. 

And one in three women, whether or not you've had a child, will develop clinically significant prolapse over their lifespan. One in two for those who have given birth. And this is one more really impactful number: 20 to 25% of all women over 40 have at least early-stage prolapse. Okay? So you don't have to know you have it to be worthy of getting help. Okay? And that is why this shift is often much more noticeable. 

Most women are diagnosed with prolapse—if you're going to get diagnosed—most women, that happens in the fifties and beyond. And this is why: because these tissue changes are really creating problems that used to be maybe ignorable, like, "Well, that's just a little annoying, that little leak," or the urgency or the frequency or the waking up at night to pee, or the backache, or the—you know, maybe sex wasn't just as pleasurable, but now maybe it hurts. Okay, so things are ramping up. Now your life is being ruled by the bathroom. Now you're scared to go on a long trip. What if you can't find a place to pee? Now you're having to put a pair of underwear in your desk drawer. I mean, these are all real stories from women who've worked with us and that we've lived through versions of ourselves, which is why we do this now. But that is why at this stage of life, you know, your body's like white flag. Like, "No more." You can't kind of cope anymore. Your body is past that proverbial breaking point of being able to kind of work around the kind of dysfunction that's accumulated over all these years.

Amy Connell: If a woman has dysfunction or prolapse, is that something that when she goes to her gynecologist for her annual exam, is that something that a doctor would bring attention to? Or is it like so common that they're like, "We're not going to say anything if they're not saying it's a problem?" I mean, is that something—I guess I'm trying to think, are we going to be diagnosed by that, whether or not we want to be, or do we need to bring attention to that to our physician?

Christina Walsh, Tighten Your Tinkler: I could kiss you for asking this question because this is a soapbox I could stand up on all day long. Okay?

Amy Connell: Okay. You should see her face.

Christina Walsh, Tighten Your Tinkler: If you're on the YouTube channel, I'm serious right now. We laugh, but we're also serious because this is so—look, we like to keep it as light as we can because we know how heavy these issues feel. No pun intended. If you've got prolapse, it literally feels heavy. It's awful. I know from experience. 

Point is: No. Women often make the assumption, and understandably the assumption, that, "Well, I went to my OB-GYN annual. Of course they would have checked me for that." Well, your OB-GYN is really well trained to get you and baby safely through a pregnancy and a delivery and do your kind of annual well visit. But they're not actually given a great deal of training in screening and diagnosing for prolapse, and that is actually the realm of the urogynecologist. And all that being said, we have women—I mean, our most popular teaching on our YouTube channel is our in-depth bladder prolapse teaching. It has over 250,000 views. And go scroll the comments under that video. We personally reply to every single one of them because it is a litany of women telling all their heartbreaking stories of the ones that did get the courage to go seek help and ask their physician for help and report these extremely personal symptoms. And they got the courage to speak to their doctors, and they've been dismissed, they've been shamed, they've been invalidated, they've been turned away. Not all of them, of course, but the numbers of these stories are extremely heartbreaking. 

And here's the thing: So if you're one of these women, if you either don't want to go to the doctor and get a diagnosis, or you've tried and you've been brushed away, shamed, dismissed, and invalidated, first of all, sadly, you're not alone. Second of all, it doesn't mean there's not hope, and it is not in your head. This is the thing we hear in these—well, they kind of just told me it was this or it was that, and they're just brushing it aside. This stuff is life-altering. It is life-altering to walk around feeling broken all the time. And I have—I've lived it. So has Jen. That's why we do this now.

Amy Connell: Yeah.

Christina Walsh, Tighten Your Tinkler: It's not in your head. All the stuff you're feeling in your body from the pelvic stuff—the pee, the poop, the pressure, the back and hip, the impacts on the sex life—all of that is all connected. It's core and pelvic floor dysfunction, and it can be corrected. But here's the thing also: don't wait forever. Don't minimize the issue. It's just, "Well, it's not that big of a deal." You know, yes, to take action to solve a problem, it has to be bothering you enough that you're willing to do something about it. Okay? That's just a baseline threshold for all of us. 

However, the really heartbreaking stories are the ones of women who don't want to have surgery, but they've waited so long to get help. And I'm not shaming anyone for this because a lot of times they've tried to get help and they've been brushed aside and dismissed and turned away and shamed by their doctors. But please don't wait any longer to address this stuff because it's not going to heal on its own. And those hormonal changes, as we just discussed, are only going to exacerbate things. So if you are a woman who values a non-invasive approach or a holistic approach or a non-surgical approach, don't wait any longer. 

You know, honor your body with the dignity of seeking help before it gets to that place. And I only say that after, you know, a decade of reading comments under these YouTube videos and the emails in our inbox and going, "So many women, if only I'd found you sooner." You know? So honor what your body is trying to tell you. I just read a post on Instagram I love today that was talking about your symptoms are not the devil. The symptoms are not evil, right? Symptoms are our body's messages, and it's our bodies going, "Hey," you know, tapping you on the shoulder, like, "Can I get a little help here?"

Amy Connell: Right.

Christina Walsh, Tighten Your Tinkler: And—

Amy Connell: It's your way of communicating, or it's your body's way of communicating with you.

Christina Walsh, Tighten Your Tinkler: Yes. And so when we honor it with dignity and listening to that and taking compassionate action for our body to support our body so it can be there for us for the long term, it really can start an upward spiral of healing. And when we heal at our center, ladies—that's like, we're nerds for this stuff. So it's like, we're healing at our center. It's literally our center. From a biomechanical standpoint, from a physics standpoint, your center of gravity is in your pelvis. But it's so much more than that. It's the center of where we create life. It's—I mean, I could start—I could cry. This is so emotional.

Amy Connell: Yeah.

Christina Walsh, Tighten Your Tinkler: It is our energetic center as women. So when you start to heal there, it ripples outward, both physiologically and emotionally. It changes your posture. It changes your confidence. It changes how you show up as a mom and a wife. And that is why it's worth taking care of.

Amy Connell: Totally. Yeah, totally. Okay, so I want to back up some. You've mentioned prolapse, you mentioned dysfunction. Can you kind of line-item out what would be considered prolapse, what would be considered dysfunction? Because, you know, you talked a little bit about it, but if someone's listening, they're like, "Huh, this is kind of ringing a bell. Where would I fall in this world?" Give us some guidance with that.

Christina Walsh, Tighten Your Tinkler: I love this, and this is—it's complicated. If anyone tells you they can tell you, give you a line-item checkbox to diagnose whether it's dysfunction or prolapse, they're lying because it's not possible. But what I can offer—and here's why: because so many women, prolapse is so under-reported and underdiagnosed. But after a decade or more of doing this specific work, what we've learned is that, you know, mild prolapse can look very much like pelvic floor dysfunction. Pelvic floor dysfunction can get really severe and women still not be diagnosed with prolapse. 

But all that being said, there is one symptom, other than just all the leaks and all that, that is highly correlated with prolapse specifically, and that is that feeling of pressure and heaviness.

Amy Connell: Okay.

Christina Walsh, Tighten Your Tinkler: You can have a lot of leaks and back and hip discomfort and pain with sex and still not have prolapse. Maybe it's still just pelvic floor dysfunction, or all of the other stuff can kind of fall into different buckets. But the pressure and the heaviness is a hallmark of prolapse. 

And, you know, this is the next tricky part. So many women we work with—it's not a wonder they find us—either don't want to go through the invasive exams and invasive procedures, or they've gone that route and not gotten the help they were looking for. And that's when they find us. And we do have a specialized diagnostic tool that we can offer. Now, it's not going to give you a medical diagnosis, but it is a free quiz that is an assimilation of the research-validated questionnaires we used when we conducted medical research on our protocol, because we're nerds like that and we love data as much as you do. And so we assimilated those assessment quizzes and turned them into an online quiz, and it's five minutes. And it will tell you—we took the data and compared it to the women who did well with our conservative, non-invasive approach to healing all this stuff. 

And that quiz not only does it help you quickly connect the dots between a lot of these issues—you're going to be like, "Oh wait, that's related. Oh wait, she did say something about that. That's part of this problem too"—it'll give you a scoring zone. You're going to fall green, gold, or red. Green and gold, you are highly likely to benefit from a conservative approach to treatment. That could be with us, that could be with someone else. That doesn't matter. You know, if you feel called to work with us, that's great. If not, you can still have confidence if you score in that green or gold zone on that free quiz that you can reasonably expect to benefit from a quality conservative treatment approach. 

However, if you fall in that red zone, we still do offer as much care as we can, and we let you know this has probably progressed beyond what we or another conservative approach can manage. You're going to really need to seek some in-person care, and we direct you to a page of resources of the types of providers we would refer you to and the type of care we recommend that you seek at that point. So no matter which zone you fall in, you're going to get validation. You're going to get a lot of light bulb moments, and you're going to get a type of diagnostic to help guide your next steps.

Amy Connell: You also mentioned that one in two women who have given birth will have prolapse or dysfunction. Does it matter if they've given birth vaginally or via cesarean?

Christina Walsh, Tighten Your Tinkler: This is such a great question, and the answer is no. So there are probably statistics that—you know, vaginal birth is probably the strongest risk factor for developing pelvic floor issues and prolapse. That makes sense.

Amy Connell: Mm-hmm.

Christina Walsh, Tighten Your Tinkler: This statistic of the one in two for those who've given birth will develop clinically significant prolapse over a lifetime—that does not say how they gave birth. And the thing is, like, right when we've—anybody who's been pregnant knows that feeling of that last trimester, right? You can feel that pressure and that heaviness. I mean, your—and your body still stretches, and relaxin is still flowing. Your body still prepares to birth vaginally because that's by design, whether or not you're going to deliver vaginally or not. It does not—neither here nor there. 

So your body does all that prepping and stretching, and your pelvic floor still carries that weight. It's like carrying that bowling ball on your pelvic floor for that full-term pregnancy. So, and then not to mention, if you do end up having a C-section, that creates a different host of tricky things to recover from with scar tissue and interrupting that connection with those deep abdominals, which, when functioning well, work in coordination with the pelvic floor and the outer hips. So it creates a different set of unique challenges when it comes to rehabilitation from all that with the C-section. But it does not eliminate your risk of developing these issues. 

And many women who've never given birth—you know, as the other statistic shows—still end up developing these issues because, you know, our body tells our life story. And so if you've had a history of chronic constipation, if you've had a history of chronic asthma or coughing, if you've been a victim of either birth or sexual trauma, if you played certain sports, if you just have a chronic high-stress background—there's a lot of guarding and tightness. All of those things are risk factors for developing these issues. 

So pregnancy and birth, certainly the highest—and no matter how you give birth, still the highest risk factor—but a lot of other things contribute to this over a lifespan. So I hope you hear validation in that, right? Like, if you're listening, going, "Oh wait, I did have asthma as a child. Oh wait, I was constantly constipated when I was little." Maybe the stage was being set for this stuff long ago. You know? And so the good news is it's not too late to start making small changes to move that needle in a positive direction. But all those things are a part of this puzzle.

Amy Connell: Christina, one of the things I wanted to ask you is—and you may have answered this, but I just want to make sure that this is covered—is how perimenopause and menopause affects our pelvic floor. So you had mentioned the estrogen decline. Is that the answer to the question, or is there more?

Christina Walsh, Tighten Your Tinkler: That's the bulk of it. That's the meat of it.

Amy Connell: Okay.

Christina Walsh, Tighten Your Tinkler: Aside from that, it's just an accumulation, you know, of what we ask of our body over many, many, many years. So, but specifically, the changes that most women note getting worse during perimenopause and after are related to that estrogen decline, which, you know, again, the tissue can't retain moisture as well, and then the collagen simultaneously decreases, which decreases the kind of bounce-back ability—

Amy Connell: Mm-hmm.

Christina Walsh, Tighten Your Tinkler: —and stretchiness and tightness of our connective tissue, which is what the pelvic floor is made of. Yeah. So that's the meat of why things tend to exacerbate and get that much worse at that stage of our lives.

Amy Connell: I know this is not going to be a magic wand that cures everything. So having said that, what are your thoughts on taking collagen to help with the elasticity of our pelvic floor?

Christina Walsh, Tighten Your Tinkler: Absolutely. Why not? Yes.

Amy Connell: Okay.

Christina Walsh, Tighten Your Tinkler: And I would trust you to recommend an excellent collagen. My partner Jen also loves to do deep-dive research on supplements. I would trust her recommendation and I would trust yours. But that's a great idea. And we've had some women find—report good results also with estrogen creams that they receive from healthcare providers.

Amy Connell: Hmm.

Christina Walsh, Tighten Your Tinkler: So those are great auxiliary things to do.

Amy Connell: Yeah, well, there's a lot of new discussions, or I guess I don't know if new is the right word, but there are a lot of discussions right now about the estradiol vaginal cream. You know, that FDA just had a great panel on removing the black box from that and how the safety and the efficacy of that. So I'm glad you brought that up because that's something we haven't talked a lot about on this show, but that is something that providers, in particular, are feeling more and more comfortable prescribing. That can really help in a lot of ways in our pelvic floor.

Christina Walsh, Tighten Your Tinkler: Definitely. And—

Amy Connell: Okay.

Christina Walsh, Tighten Your Tinkler: —tune into your intuition when you're making treatment choices for this stuff too. So we—

Amy Connell: Totally.

Christina Walsh, Tighten Your Tinkler: —love the data, but we want to lean into our women's intuition as well about what's the right fit for you. You know, it's—

Amy Connell: Right.

Christina Walsh, Tighten Your Tinkler: —that's a great option that's becoming more readily available, and I didn't even know that news that you just shared, so that's really cool.

Amy Connell: Yeah. Yeah, it was a good panel. It's funny, they had it on YouTube for a while and then they took it down, but it was an hour long, maybe two hours long, with some really great providers who knew a lot about women's health. And I really liked it. I thought it was really good. 

And as far as the supplements for the collagen, my community knows this, but the biggest thing I would say is just make sure it's third-party tested. So look for that NSF, you look for the USP. Look for something that says that someone else verifies that whatever they say is on the label is on the label. So that's really—and beyond that, you do whatever you want to do. Just make sure that it's third-party tested. That's my personal, that's my personal-slash-professional opinion. 

Okay, so we understand now about how the perimenopause and the menopause, primarily the estrogen, also the elasticity with reduced collagen, the thinning skin—if women are listening and they're thinking, "There are some things that Christina is saying that are making me suspect that maybe this is something that maybe I can do something about, rather than just say, 'Peeing while I am—you know, when I sneeze is super common and I'm just not going to, you know, whatever,'" like, that's because so many of us do it. And you have said—it was either you or Jen, I think in the first episode—like, it's common, but it's not normal. And I love that saying because yeah, I mean, we all talk about it so much that you think, "Okay, well, it's not going to be a problem." 

And so I'm wondering if you can talk to us about, specifically for the women who are wanting to get that breathless state—like, I love doing some sprints, which I know is really weird of me, but I love—there are elements of cardiovascular work that I love doing and it's good for my heart, it's good for my lungs. There are a lot of—it's good for my HDL cholesterol. Like, there are a lot of compelling reasons to do that. However, if women don't feel comfortable going out and running because they don't want to pee their pants—and I know that there's a lot more than running—but where would you recommend that they start that is a more gentle approach to taking care of our pelvic floor while we are training our heart and our lungs in a more intense way?

Christina Walsh, Tighten Your Tinkler: This is a great question, and it brings me to another soapbox topic. But this is not the most glamorous reply. You know, sometimes the right answer isn't the sexy one, and in this case, that's going to be true. You really want to stick with walking. You know, higher impact and higher load is not going to be a gift to your body. It's not going to be a gift to your pelvic floor if you are lacking the foundational strength to support against daily activities, which includes laughing, coughing, sneezing, jumping, you know, or if you're dealing with that sense of urgency, that "gotta go now" leak. It's not going to be a gift to your body, you know, and therefore it's going to make things worse. And now only you can determine what that threshold is, you know.

Amy Connell: Mm-hmm.

Christina Walsh, Tighten Your Tinkler: Is it bad enough or something you don't want to make worse? But walking is the answer as far as getting your heart rate up. And, you know, that—again, sometimes the right answer's not the one you want to hear.

Amy Connell: Yeah.

Christina Walsh, Tighten Your Tinkler: But you—

Amy Connell: Yeah.

Christina Walsh, Tighten Your Tinkler: It would be like—I love some—you're so great at analogies. It would be like trying to build your house—

Amy Connell: Mm-hmm. Mm-hmm.

Christina Walsh, Tighten Your Tinkler: —trying to add load before you've got stability at your center. And it's not going to end well.

Amy Connell: Christina, that makes me wonder—this was not something I planned on asking you—but when I go for a walk in my neighborhood, and, you know, I live in this enormously large master-plan community, I cannot throw a stone without hitting a woman—I don't really do that—but wearing a weighted vest when she walks. And I did an entire episode on "Should I wear a weighted vest?" But for women who may have pelvic floor dysfunction, that makes me wonder if that is an appropriate thing for them to be doing. But maybe it's a different distribution of weight. I don't know. Tell us.

Christina Walsh, Tighten Your Tinkler: No. As not—no one will be surprised, you were onto something. We have just been sharing content on our Instagram page about this, and one of the last slides was "weighted vest to add weight." You know, it's exactly what we just talked about. It is not a gift to your body. It's, again, it's like trying to build your house on a foundation of sand. So if you're adding load, whether that's impact or, you know, weight, to a center, a core, a foundation that's not able to even, you know, have the strength for basic function, it's not going to end well. 

We did a poll on our Instagram stories, you know, explaining why it's not a good idea for women dealing with these issues to add that weight. And we said, "Hey, have you experienced this? Have you tried the weighted vest and had an uptick in all your issues?" Seventy-five percent said yes.

Amy Connell: Wow.

Christina Walsh, Tighten Your Tinkler: And, you know, I even gave the option of "No, I haven't tried a weighted vest." It was like, "Yes, I've tried it and it caused problems. Yes, I tried it and it worked out fine. No, I haven't tried one." Seventy-five percent: "I tried it and it made things worse." So—

Amy Connell: Okay.

Christina Walsh, Tighten Your Tinkler: —feel validated in that if that's your story. But also don't give up hope, you know.

Amy Connell: And it, again, it goes back to we've got to use our own discernment about our own body and what makes sense. And yeah, I mean, I just see blanket—everyone is wearing a weighted vest and I'm sitting there going, "I don't know." Like, I don't wear one because it's really hot where I live.

Christina Walsh, Tighten Your Tinkler: Mm-hmm.

Amy Connell: And I don't want any more weight on me when I'm outside. And also I happen to know through a DEXA scan my bones are fine, and I strength train, and my mother—and so I'm like, "I don't see a need for me." I think that there is a time and a place for it, but just because some people are saying to wear it doesn't mean everyone needs to wear one.

Christina Walsh, Tighten Your Tinkler: It reminds me of your—not rant, you don't ever rant—but it reminds me of your recent episode about, you know, not leaning into all the doggone trends without looking into it yourself, using discernment, paying attention to your body. Don't pick it up just because everybody else is doing it. Yeah. And same thing where I live. I mean, the weighted vests are everywhere. And oh, this is a great hot tip: if you want to do something low-impact that will help wake your muscles up, improve your lymphatic return, and improve bone density without adding impact—vibration plate.

Amy Connell: Okay.

Christina Walsh, Tighten Your Tinkler: The data is amazing.

Amy Connell: People have been asking me about it.

Christina Walsh, Tighten Your Tinkler: Yeah, the data's amazing. We actually have women doing the exercises in our signature program on their vibration plate because that is like multitask central in a good way. Multitasking, you know, holistic care for the body, and it's incredibly functional. And it's improving all of those aspects. It's improving lymphatic return. It's improving bone density. The data is there now on that, which is phenomenal. And it's helping with muscle activation and sensory stimulation in the feet, and all of this stuff is connected and it's all getting stimulated at once that way. And so, yeah, invest in a vibration plate. We've got our favorite ones on our Favorite Things page, right on our website. That is your answer.

Amy Connell: Okay, so if you are new to Christina and Jen with Tighten Your Tinkler, you may not know that these girls look at the research, they look at the data. I am really surprised to hear you say that that's something that you support because you are not women who just jump on the train of whatever is out there. I mean, like, if you're giving it your green stamp of approval, that means a lot.

Christina Walsh, Tighten Your Tinkler: The data's there. I mean, it's what you said. We're not—and that's why we did our research on the protocol we teach in the program, because the anecdotal results were so good and it helped us so much that we were like, "We want to get this out into the world to help all the women who need it." But we were like, "We didn't feel ethically good about doing that unless we had more than testimonials," and, you know, we thought that doing the research was going to be the way it reached women who needed it. 

But what we found was that when we started presenting the research to the Western medical community, it was actually rejected. It was rejected for being too progressive. It was rejected for—I mean, I hate to sound like a conspiracy theorist. You know, if you take a non-invasive approach to a surgeon, they're going to reject it. What do they want with that?

Amy Connell: Sadly.

Christina Walsh, Tighten Your Tinkler: And so it was heartily rejected, and that's why we put the program online. Because we thought we were going to reach women by doing the research and putting it out into the world that way. But that didn't work, you know. So here we are with the digital program because we felt it was incumbent upon us—you know, when you know better, you do better. We found a non-invasive way to treat these issues and we figured out who it works for, and we're like, "We have to get this out there now" because the cog wheels of the Western medical system slowly turning was not going to work.

Amy Connell: Mm-hmm. Yeah. Okay, so let's talk some about your signature program because you and I were talking offline, and one of the reasons I wanted to have this conversation today was because of this email that you sent about cardio and working our way into, you know, doing some cardiovascular stuff with your pelvic floor. And you said, "Yeah, but this is not something that we offer unless they've already gone through the signature program." 

So tell us—I understand why—but tell us about your signature program, and then I want you to talk to us about the cardio and how that can supplement what you do. And so this is kind of your time to help us understand what it is that Tighten Your Tinkler can do to help those of us who have—and I've got to say too, like, I've done your program just as an anecdotal testimony. I mean, it is so much better. It's not perfect, but you know what? I'm not perfect about doing it. And it's definitely better. I mean, like I have—I'm allergic to the entire environment and universe, and when I sneeze, like, I'm not peeing as much. When I cough, I'm not peeing as much. So things are definite—I pull all-nighters sometimes, you know, where I don't have to get up and pee in the middle of the night. It's great. But anyway, so tell us some about the Signature program. Tell us some about the cardio program, why you need to—why you guys are so adamant about, like, you can't do the cardio without the signature.

Christina Walsh, Tighten Your Tinkler: Well, and it's exactly—so the Signature program is just one option that women can choose to get help for these issues. If you don't choose that, if you're dealing with these and you're listening to these issues and you're listening, please know that there are lots of options out there now. You know, we are just one of them. And, you know, take that quiz first if you're like even a little bit interested. You have nothing to lose and everything to gain by first starting there. 

And then if you feel called to work with us in the Signature program, it works best because it is a whole holistic approach. We're going to teach you relief techniques that you use simultaneously with the activation exercises. So this is getting to that deep place of turning the muscles on again, but we're doing it without inserting anything into your body. We're doing it without having to take our clothes off. We're doing it through functional movement, and that's it. That's the gold. We're turning the muscles on again. Then we're adding a little strength as we work forward, but while also adding relief at the same time. So we're going to walk you through all of that. 

And it also comes with membership in our private community. You know, so you've got coaching, you've got interactions with us and other members walking that same journey. And it's lifetime access. There's an app, all that cool stuff. You know, it really is the best fit for women who value a holistic approach and who value a non-invasive approach because you're not going to get that if you work through the Western medical system. 

That being said, know yourself. If you're like, "I'm a girl who wants—you know, I want to go through my doctor. I want to do it that way," do it that way. You know, you have to feel aligned with what choice you're making, as with any healthcare decision. But that's what the Signature program does. 

And we don't offer those—the kind of exercise progression programs that we filmed after the Signature program—women were coming back to us going, "I feel so much better. What can I do next?" And then some were saying, "I went out and I did my own thing next, and now I'm having terrible flare-ups and I feel like I've undone all my progress." Now, you didn't undo all your progress. If you reset that foundation, you know, good is good enough. Come back to it, you know.

Amy Connell: Mm-hmm.

Christina Walsh, Tighten Your Tinkler: It just takes like a week on the wagon again of your 10-minute-a-day routine to really start to notice those improvements again. But we don't even offer those progression programs because it doesn't feel ethical to offer a progression program to someone who hasn't restored their foundation first. That's just asking for trouble. So we've got cardio and strength progressions, but we don't even put those forward to women who—you know, we're attracting women who are dealing with problems in this area, and we want to help. But we're not going to offer them something that's only going to hurt them and not help them. 

And so that's why we recommend all members start—all women start with that quiz and then seek help to restore your foundational strength functionally, which is what our signature program's doing, and then think about progressing from there. Your body will let you know. Listen to your body. It's going to let you know if the activity you've chosen is a good fit for you right now or not. And if it's not, you're going to have a flare-up in the issues that led you to seek help in the first place. And that's the time to pull back again, try to reset again, and then try to slowly ramp things up after that. And that's your recipe for success. And your body, depending on the level of injury you've been through in that region, your body may or may not be able to tolerate what it did 40 years ago. That's also pretty normal.

Amy Connell: That's a good point. Yeah, that's a really good point. Christina, so we've talked a lot about this, you know, pelvic floor and all of that kind of stuff. But if women are thinking, "This is me," or "These are some of my symptoms," do you have anything beyond your programs that you can say, you know what, start here, try these?

Christina Walsh, Tighten Your Tinkler: Girl. Yes. This is one of my favorite questions because small steps move the needle. Okay? Absolutely. There's so many things you can begin doing today. Some of them are going to be like a no-brainer, like, "Well, I'm already trying to do that for something else," but no. Now it's also going to help your pelvic floor. 

Hydration. Okay? Get enough water and put some electrolyte drops in there if you feel like you're not actually absorbing the water you're drinking, because a hydrated, soft-tissue pelvic floor is a happier one. And you're not saving yourself anything by dehydrating yourself because concentrated urine is a bladder irritant also. So you're not winning—

Amy Connell: Okay.

Christina Walsh, Tighten Your Tinkler: —by doing that. So drink enough water. And along with that, get enough fiber. You just had such an amazing episode on fiber. Listen to Amy's fiber episode. She details all the reasons, especially important in this stage of life, but it's also important for your pelvic floor. If you are not having, you know, not-too-hard, not-too-soft stools on a regular basis, if you are constantly straining to have to empty your bowel every time, that is doing no favors to your pelvic floor. You're pushing, pushing, pushing. 

And to that end, if you're not already, get thyself a Squatty Potty. Get a toileting stool. Put yourself in that ergonomic emptying position where you don't have to strain as much. And if you're not sure—a lot of women with pelvic floor issues are dealing with incomplete emptying of bladder or bowel. So exhale as you go. Rock side to side, rock in circles. Exhale. Have your knees higher than your hips, and do not push your pee out. This is supposed to be a passive affair as much as possible, whether it's peeing or pooping. 

All of these are micro gifts to your pelvic floor that you can give your pelvic floor multiple times a day. This is starting to move the needle in the right direction. 

Now, stop bracing. Do not Kegel. We do not like Kegels because they lead to hypertonicity. They lead to an overtight pelvic floor, which is also just, you know, an overtight muscle is still a weak muscle. It's just a different type of weak muscle. So we don't want an overtight, guarded pelvic floor because that's going to make your symptoms worse. We want functional strength. So Kegels are not your friend. 

Do the opposite. Get in our free 90-90—

Amy Connell: Mm-hmm.

Christina Walsh, Tighten Your Tinkler: —position at home, and Amy will have those links. This is a gift to your pelvis, your pelvic floor, your back, your hips, and your nervous system all at once. Put on Amy's podcast, put on Graced Health, lay in your decompression position for 10 minutes. If you wake up stiff, do it in the morning. If you've got heaviness and pressure before you go to bed or you're spun up, do it before you go to bed. This is a gift. I call it "rest multitasking" for my Type A go-getters. You are doing so much good for that 10 minutes, so—

Amy Connell: Mm-hmm.

Christina Walsh, Tighten Your Tinkler: —adding that. It's, you know, active rest you could call it. I've also heard people say that.

Amy Connell: Yeah. Yeah, I can attest to that. That's a really wonderful movement. Yes. Sorry to interrupt.

Christina Walsh, Tighten Your Tinkler: No, no, no, no. Look, I could go—I'm on a roll. I just want to make sure women hear all these tips, but I really appreciate your testimony on that because it's more important than just hearing me yammer on. Okay. And so also don't wear compressive clothing. Your body's probably already going to let you know that that's not a gift anymore at, you know, in our age group in other ways. But if you notice increased pressure or heaviness or bowel or bladder discomfort or issues when you're wearing any kind of compressive garment—this can even be jeans—if you're like—we always talk on our team about how if you're on a travel day, you're going to be in the car a long time or at your desk sitting for a long time, if you have something pressing into your belly all day, it's adding downward pressure again. It's not a gift to your pelvic floor, and you will feel the unpleasant effects of that. Pressure, heaviness, bowel, bladder symptoms getting worse. And it's not all in your head. Size up. Wear something loose if you're going to be sitting all day. 

Definitely avoid heeled shoes as well, because that tips your pelvis forward, puts everything at a bad angle, and leaves you vulnerable to compression and dysfunction in that area getting worse. 

And choose low-impact exercise. If you're dealing with these issues, again, what does—what's a gift to my body right now? How can I meet my body where it is right now with the compassion that I would show to a friend or that I would offer to a friend struggling with these issues? Well, you wouldn't tell her to push through. This is not the right time—

Amy Connell: Right.

Christina Walsh, Tighten Your Tinkler: —to push through. So all of these things are simple things you can do to really pour into taking care of yourself at your center—

Amy Connell: Mm-hmm.

Christina Walsh, Tighten Your Tinkler: —and start to move the needle in a positive direction.

Amy Connell: Okay, those are really good. Thank you for that. And Christina, you guys have been super generous and have offered my community $50 off with the code GRACEDHEALTH. So all caps, all together, G-R-A-C-E-D-H-E-A-L-T-H. That'll be in the show notes along with the link. So if you're interested in it, I will tell you, you guys, I have used it. I like it, I recommend it. I hope you know this about me by now: if I don't have—if I'm not 100% behind it, it's not coming on my show. I'm just too protective of you guys. So I do highly recommend it. So it's an option. It's an option. Just like Christina said, if you feel led, if you feel called, it's an option for you.

Christina Walsh, Tighten Your Tinkler: And reach out to us. You know, there's no bots answering our emails. Okay? So—

Amy Connell: Yeah. Yeah.

Christina Walsh, Tighten Your Tinkler: —you are—we answer everything, you know. You can ask us the things you're afraid to Google, and we will be straight shooters and honest with you. We will meet you with compassion and authenticity at every turn. I promise you that.

Amy Connell: Yes.

Christina Walsh, Tighten Your Tinkler: And we don't waver from that. So if you're not sure or you need some clarity or you don't know—whatever it is, whatever you're wondering—pop it in one of our inboxes. Email hello@tightenyourtinkler.com. Look us up on YouTube. We have teachings on all the stuff that is, you know, all the wormholes and rabbit holes—

Amy Connell: Yeah.

Christina Walsh, Tighten Your Tinkler: —you know.

Amy Connell: And I will say too, like, go take that assessment, see where you are. Yeah, the quiz. Yes.

Christina Walsh, Tighten Your Tinkler: When in doubt, start with the quiz. Light bulb moments await you.

Amy Connell: Yes. Yeah. And we'll put that in the show notes as well. Okay, so Christina, tell me really quickly—and I say really quickly because hopefully listeners will be none the wiser—but you and I have had a few technical issues here, so we feel like we are going against the clock on the recording. So if you sound rushed right now, that's why. But tell people how they can connect with you. Where's the very best place to reach out and connect?

Christina Walsh, Tighten Your Tinkler: Just hop to our website, TightenYourTinkler.com, and there you will find links to our email address, our Instagram page, and our YouTube. All of our freebies are organized by symptom on our Resources page there also, so a wealth of resources and links to relevant teachings depending on which symptom you're dealing with. And again, we're always in our inbox, so it's our YouTube channel, our Instagram—it's Tighten Your Tinkler everywhere.

Amy Connell: Okay.

Christina Walsh, Tighten Your Tinkler: There isn't another one. We got it trademarked. So.

Amy Connell: Good for you. Good for you. Okay, last, and again, once more, I just can't recommend this program enough. I can't recommend Jen and Christina enough. You guys, I love you. I mean, you used the word "heart-centered." I love that about you all, and you care. You care so much about the women, every single person who comes through. So thank you for that. And thank you for giving women the time and the attention and the knowledge that we need in an under-discussed and kind of—it can be kind of embarrassing as well. It doesn't need to be, but for a lot of women it is. So thank you for what you're doing. Yeah.

Christina Walsh, Tighten Your Tinkler: Thank you so much, Amy. We love those same things about you very much.

Amy Connell: Well, thank you. Okay, you get the last word. No rants, no soapboxes. Just one small, simple thing that you want people to remember about our conversation.

Christina Walsh, Tighten Your Tinkler: Oh. Honor your body by listening to your body. It is trying to tell you what it needs and what it wants, and try to honor that with dignity and compassion as you would a friend so that the two of you rage on together into old age in wonderful fashion.

Amy Connell: Oh, so good. Amen. Okay, that is all for today. Go out there and have a graced day.