Interview with Rachel Gelman: Pelvic pain, hormones, birth control, & the squatty potty
Pelvic pain during sex, pain from the pelvic region generally, incontinence, prolapse – these do NOT have to be your “new normal.” There are treatments out there to help you manage, even solve, many of the issues related to pelvic floor dysfunction.
One solution might mean taking a long look at your choice of birth control ….
Rachel Gelman DPT is a clinical specialist and branch director at the Pelvic Health and Rehabilitation Center in San Francisco. She specializes in the physical therapy management of numerous pelvic pain disorders, including bowel, bladder and sexual dysfunction. We talked with her about some of the sources of pelvic pain, including the surprising news that hormonal birth control may be part of the problem.
1:27 What’s your approach to pelvic pain?
Rachel says she deals with pain from the “ribcage to the knees,” specifically focusing on the internal muscles of the pelvic floor. We asked her exactly what that meant. The list is surprisingly long – clearly this part of the body is responsible for a heck of a lot and needs proper care and attention.
3:13 How do hormones impact our pelvic health or cause pelvic pain?
Rachel also focuses a lot on the impact of hormones on that part of the body. Given that midlife and menopause are a time of enormous hormonal changes, we wanted to understand that better. Rachel explained to us how the sensitive tissue of the vagina and surrounding area are affected by estrogen, progesterone, and testosterone.
(Here’s a fun way to increase pelvic health: get yourself an Elvie)
6:06 “No good birth control method” – what do you mean?
So, what does that mean for women who take hormonal birth control? Especially women who’ve been on the Pill for a long time? Rachel says there’s no truly perfect birth control; oral contraceptives are effective, but it increases sex hormone binding globulen. The take away: the Pill can negatively impact some very sensitive tissue, so if you have a choice, consider carefully when choosing it as your contraceptive method.
8:44 Please explain pain in the vestibular tissue?
So, what exactly is vestibular tissue, and why is it so impactful if this area is inflamed or otherwise unhealthy? Rachel gives us a sort of private-area map and explains the consequences of hormone imbalance here and what can be done about it.
10:52 How can you tell where pelvic pain comes from?
So, we asked, how do you know when pain is caused by hormonal imbalance as opposed to some other concern? You have to look at all the puzzle pieces, Rachel says; she takes us through how she puts them together to figure out what’s going on and how to fix it.
14:43 How do patients find you?
How do patients find you? Is it mostly by referral? She gets a lot of referrals, Rachel says, from ob/gyns, urologists, etc., but a lot of patients simply find her on the Internet. So, shortcut Dr. Internet: if you’re having a particular problem and not getting a solution from the doctor you’re seeing, ask for a referral to a specialist.
15:50 Is age a factor in pelvic pain?
Do you see more older women, or do you see these patients more often? Her practice is pretty evenly distributed, Rachel says, because pelvic issues aren’t limited to age, but yeah, no surprise: age does have impacts as hormones change. So if you’re getting older and have never seen a pelvic specialist, it might be time: avoid problems in the future by being proactive!
17:29 What should patients be doing between visits? Is there anything they can do?
What kind of self-care should women be doing between visits to a specialist like Rachel? It depends on where you are, Rachel says; are you already in pain and need help relaxing or releasing? She gives her patients things to do between visits to help them learn to treat themselves, and that’s a Very Good Thing.
18:19 So … about that Squatty Potty ….
“We as humans were not meant to sit on the toilet to have a bowel movement.” Ooooookkaaaaaay. Not giving it up. Just sayin’. Fortunately, says Rachel, there are ways to adopt the optimal BM position without resorting to squatting in the woods. Phew! She explains why not excreting correctly can actually be pretty bad for you.
(speaking of toilets, do you know how much urination is normal for you?)
20:10 Before we let you go, what else should we know?
“Kegels are not the answer to everything,” Rachel says. They can be good for you, but they don’t solve every issue. Best not to self-diagnose a kegel deficiency – if you’re having problems with painful sex, incontinence, bowel dysfunction, there’s help, there are resources. Seek them out and get your standard of living back.
If you’ve had issues with pelvic pain or other issues related to pelvic dysfunction, would you share with us how you managed it? Let us know in the comments below, or hit us up on Gennev's Facebook page or Midlife & Menopause Solutions, Gennev’s Facebook group.
More about Dr. Rachel Gelman: Rachel is a Bay Area native who received her bachelor’s degree in Biology from the University of Washington in Seattle and her Doctorate in Physical Therapy from Samuel Merritt University. As you heard in the podcast, she’s passionate about women’s and men’s health and strives to promote quality education regarding pelvic health both in the clinic and in the community. We appreciate her sharing her wisdom and expertise with us!
You can follow Rachel directly @RachelgDPT on Twitter.
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