Do Pelvic Health OTs Only Work With Pregnant People? 13 Populations You Can Serve
OTs in Pelvic Health Podcast · 11 min listen
When I first learned about pelvic health, the field seemed narrow and specific. And most of the OTs I talk to assume the same thing: that to work in pelvic health, you mainly work with pregnant or expecting people.
I understand why. Most of my own stories and points of reference are prenatal and postnatal. The Functional Pelvis was the first private practice in Manhattan owned by an OT, and that community was my sole focus, so naturally it became my frame of reference for everything.
"Basically, if you have a pelvis, we can support you."
But it isn't the whole picture, and it isn't close. You can use fundamental pelvic health techniques across a wide range of communities and settings. It isn't an all-or-nothing choice.
After all, we're OTs. We're only limited by our ability to problem-solve with our clients — and we can problem-solve with every single one of them.
In this episode:
- Thirteen communities pelvic health OTs serve, well beyond pregnancy
- Why hormonal transitions — puberty, lactation, perimenopause — share a common thread
- What genitourinary syndrome of menopause is, and why you'll meet it constantly
- What actually happens in a birthing rehearsal, and the myth it corrects
- The blend of approaches that keeps this work from ever being cookie-cutter
Who pelvic health OTs actually treat
This is not an exhaustive list, but it's a wide one. There are a few ways to look at the subspecialties of pelvic health, and the one I find most useful is by the communities we serve.
1
Puberty and pre-puberty
A period of enormous hormonal change, and a group that rarely gets anyone's attention around pelvic function.
2
Prenatal
Birthing rehearsals that prepare someone for an optimal delivery, including how to use the uterus and abdominal wall to push the baby out.
3
Postnatal
The ADLs of being a new parent, and everything that comes with them. This is a vastly underserved population and the one my heart is in.
4
The mother-infant dyad
Many OTs specialize here, caring holistically for both — whether the baby is in the NICU or home with needs that OTs are well equipped to address.
5
Lactating people
During lactation, estrogen declines in a process very similar to menopause, though temporary. It affects how buoyant, responsive and supple the pelvic floor can be.
6
Perimenopause and menopause
Another period when hormones are in flux and the tissue changes directly affect pelvic floor function.
7
Men's health
A community with real need and very few practitioners addressing it.
8
Pediatrics
Where many OTs are already working, often without realizing how much pelvic health shows up in their caseload.
9
Oncology
Treatment affects pelvic function in ways that frequently go unaddressed.
10
Older adults
Where pelvic floor dysfunction is common, often assumed to be inevitable, and rarely treated as something that can improve.
11
LGBTQIA+ clients
Including gender-affirming care, where informed and respectful pelvic health support is badly needed.
12
Athletes
Where pressure management, loading and performance meet pelvic floor function.
13
Ostomy care
A group whose daily lives are profoundly shaped by what we address, and who rarely get OT support for it.
Basically, if you have a pelvis, we can support you.
The thread running through several of these
Look at puberty, lactation, and perimenopause together and you'll notice the same mechanism underneath all three: hormones in flux, and that flux shaping pelvic floor function.
With both lactating people and perimenopausal people, estrogen is typically in decline. That affects the pelvic floor's ability to be buoyant, responsive and supple.
Worth knowing
During the menopause years specifically, these tissue changes and the symptoms that come with them are often grouped under the term genitourinary syndrome of menopause, or GSM. Telltale signs include pain with sex, vaginal dryness, and urinary incontinence.
Some providers still use the older term vaginal atrophy instead of GSM. A very similar process happens to people who are lactating, though in that case it's temporary.
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The OT Practitioner's Role in Pelvic Health
Where pelvic health sits in OT scope of practice, plus simple interventions you can use with clients tomorrow.
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The OT's Guide to Pelvic Health Practice Settings
Nine settings where OTs are already doing this work, from hospitals and SNFs to living rooms and L&D units. No private practice required.
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Sign up for freeWhat prenatal and postnatal work actually looks like
Since this is where most people assume the whole field lives, it's worth being specific about it.
For prenatal clients, we can offer birthing rehearsals that prepare the birthing person for an optimal delivery — including optimizing the uterus and abdominal wall to help push the baby out.
That's worth sitting with, because most people believe the vagina pushes the baby out. It's quite the opposite. The vagina relaxes and gets out of the way for an optimal delivery.
Postpartum care helps with the ADLs of being a new parent and everything that comes with them. Many OTs specialize in the mother-infant dyad, caring holistically for both, whether the baby is in the NICU or home with needs that OTs are well equipped to address.
And our background in mental wellness helps with all the feelings that accompany role changes. OTs are so well rounded and equipped to address the biological, psychological and social aspects of a person's life.
The approaches we blend
Just as the populations vary, so do the methods.
What we draw on:
- Trauma-informed care
- Neuromuscular re-education
- Behavioral re-education
- Sexual health
- Mental health
- Manual skills
It's truly a blend, and it's never a cookie-cutter approach.
I can see two clients back to back with the exact same set of symptoms, and their sessions and home exercise programs can look wildly different. That's one of the many reasons why, after more than a decade in this field, it's still fulfilling and intellectually fascinating. Every client is a puzzle, and we meet them where they are.
For newer OTs, that can feel overwhelming. But I can tell you with real confidence that taking the individual factors into account is exactly what moves the needle. Things like:
- How much time the client realistically has to do a home program
- Their sleep hygiene and stress levels
- Whether they have community support in place
- The specifics of their home environment — a walk-up or an elevator building made a huge difference for my Manhattan clients
- Their own goals and struggles as the basis for their therapy
That's what gets results for the client, and it's what will keep you fascinated by this specialty for life.
Get out there and serve your people
The world of pelvic health is yours for the taking.
Every one of the communities above is vastly underserved, and most of them aren't getting the time or the education they need from traditional healthcare — not from their GP, not from anyone.
We have the time with them. We have the expertise: task analysis, and models like Person-Environment-Occupation to guide us.
They need us.
