Rachel Gelman on How to Actually Maintain a Healthy Pelvic Floor... hint, it's not just Kegels.




We want you to meet Rachel Gelman, a pelvic physio therapist. She tells us all about what's key to actually maintaining a healthy pelvic floor. Hint: it's not Kegels. Enjoy!


Tell us about yourself! How did you become a pelvic physio therapist?

It was a speciality I discovered early on in physical therapy school and I just fell in love with it. I have always had an interest in sexual health and when I discovered this speciality existed it seemed like it was meant for me. I discovered pelvic floor physical therapy during PT school, thought it seemed cool, and after shadowing at a clinic, I knew it was what I wanted to do. I was lucky to do my clinical internship at a private practice in Austin, TX that focused 100% on pelvic health.


What tips do you have for someone looking to strengthen their pelvic floor?

Honestly, unless someone is experiencing symptoms and has been assessed and it’s determined they have muscle weakness, most people don’t necessarily need to work on strengthening these muscles. Instead, it’s important to work on maintaining good pelvic floor muscle coordination and health. Often, people’s pelvic floor muscles are in a guarded or tense state and they need to work on relaxing their pelvic floor muscles.


There are so many things to do: kegels, etc. What do we actually need to do to maintain a healthy pelvis?

The thing I always tell people about maintaining a healthy pelvic floor is to have better bowel movements. I know pooping isn't super glamorous, but it is important. Things like pushing and straining to defecate can put a lot of stress on the pelvic floor and being backed-up can put extra pressure on those little muscles. That can all be a recipe for pelvic floor dysfunction.

So I recommend using a toilet stool, like the squatty potty, which can get you in the optimal pooping position and make it easier to go. Staying well hydrated is also important for bowel and overall health!


What does our pelvic floor actually do? Where is it?

The pelvic floor is a bowl of muscles inside the pelvis that supports the pelvic organs: bladder, colon, prostate or uterus. It works with your deep abdominals and back muscles to provide postural support. It helps maintain continence and plays a role in sexual function.


Is it true that a stronger pelvis helps with people's sex lives? How so?

Not exactly. Instead, it’s important that these muscles have good coordination and range of motion. During orgasm, the pelvic floor muscles repetitively contract and relax, so if these muscles have more room to move and in theory a “stronger” contraction it can contribute to a more robust orgasm. However, MANY things play a role in sexual function and orgasm, so a person shouldn’t just focus on the pelvic floor for better sex because many things can make sexual health better.


Describe a typical day for you?

It really varies. My day is primarily filled with patient care. I spend about one hour with each patient. I typically use various treatment techniques with patients to address their specific issue, primarily using manual therapy to treat the external and internal musculoskeletal impairments that are contributing to a patient's symptoms.

Since I own my practice, I spend time managing all the aspects of the business.


How has your work changed since the beginning of the pandemic?

I actually opened my own practice during the pandemic. But in general my work hasn’t changed too much, other than I have more flexibility in my schedule since I decide when I see patients.


Check out more of Rachel here. If you enjoyed this, you'll LOVE Diem, download here.