What’s a pelvic floor occupational therapist vs physical therapist?

Oooh I have been asked this question more times than I can count! Furthermore, I have also been called a physical therapist maybe an actual billion times?

I’ve heard many opinions and perspectives on the difference between a pelvic floor occupational therapist (OT) and a pelvic floor physical therapist (PT).

Firstly: what’s an OT? Well, I have my masters’ degree in occupational therapy. In school, we worked alongside students in the physical therapy department for our anatomy class one summer, but that was the only overlap. I also have worked in hospitals and clinics alongside physical therapists and have been lucky enough to collaborate with them. Even better, I’m close friends with a few pelvic floor physical therapists.

Ok back to “definitions”: An OT tends to work with patients with the focus on understanding who they are and now what habits/roles/routines are impacted by the current “disability” or ailment. In pelvic floor therapy, the impacting situations tend to be incontinence/leakage, pain, pregnancy, constipation or postpartum “getting back into your body.” As an OT, my job is to learn what life looked like prior, and what’s different now. What is/was important to you? How can we get you back doing those things?

Also, a very fun side of OT is the figuring-it-out -ness. For example, I had a patient who was really struggling with nausea and “morning sickness.” She would be working at her computer from home and then have to rush to the toilet to throw up. Horrible! She was having pain with the urgency of moving quickly from her desk to the bathroom, and then the bending over was becoming problematic for her back. Also, no one really loves having to throw up in a toilet! So we problem-solved together and figured out that, unfortunately we couldn’t do much to change her nausea in and of itself, but we could make the act of vomiting less insane. So we got “emesis bags,” aka hospital bags meant for throwing up. Then, when the need to throw up occurred, she could contain it in that bag, without having to lean so far forward, and then she could dispose of the bag how she wanted. This took a lot of the physical pressure off her back and let her have less anxiety about the entire situation.

To me, the problem solving is the highlight of the OT lens comapred to the PT lens.

Ok, so then how is pelvic floor physical therapist different? Well, ideally, whether you have a pelvic floor physical therapist or a pelvic floor occupational therapist, your pelvic floor therapist will be able to address your concerns as they impact your life. The difference that I am aware of between myself and a physical therapist is the background training and the general lens of practice. Typically (and this definitely varies from therapist to therapist), a physical therapist focuses on the body mechanics, movement patterns, muscle systems and measurable changes in range of motion and strength. Generally, they may be less honed in on behaviors such as frequency of urination, food influence on bowel and bladder, the nervous system involvement. OR they may simply have less training in those areas.

As an OT, we have training in body mechanics, movement patterns, muscle systems, range of motions and strength. It just is in the context of the person as a whole and then the pieces individually.

I will say, though - any pelvic floor therapist who is worth your time and money is constantly learning to fill in any gaps they are missing, and also able to acknowledge when they don’t know something. The reality is - women’s health is an incredibly broad topic. Furthermore, physical therapy and occupational therapy are incredibly large disciplines. Even narrowed down to pelvic floor/pelvic health, we still have to decide where to point our focus. Pediatrics? Pregnancy? Postpartum? Leakage? Hormones? The mind/body connection? Diet/nutrition? Surgical interventions? Pessaries? Myofascial connections?

Many of us know quite a lot and also acknowledge that there’s ALWAYS more to learn. I’m grateful to know many pelvic floor therapists, OTs and PTs alike. I am constantly learning and constantly collaborating - with the explicit hope and goal to serve my patients the best I can.

Push like you have to poop!

Have you heard that? “Push like you’re having a bowel movement.”

Did you know that's incredibly dysfunctional?!

I know. Shocking.

When our body is operating with a good rhythm, we should having something called the gastrocolic reflex. This is where, when we wake up and eat a little something or have a little coffee, it stimulates our gastrointestinal system to start moving since it was resting through the night when we were asleep.

We start to feel an urge… maybe a rumble in the low abdomen or a pressure towards our rectum. We head to the bathroom, sit on the toilet (using our handy dandy squatty potty), relax and breathe.

We may do a slight nudge to get some input in the posterior pelvic floor region, and a nicely formed, relatively soft (not liquidy at all) bowel movement passes with the sensation of fully evacuating our bowels.

We do not have pain. We do not have bloating or cramping. We do not need to push or strain or hold out breath for this to happen. It isn’t rock hard pellets that come out and it’s not liquidy.

If this is not what happens for you, you actually would do well with a consultation to figure out what your specific situation is and to get you in a normal path! This will help you avoid other pelvic floor concerns down the road.

I have had SO many patients (men and women alike) who stare at me with this look of “…what are you even talking about..” when I explain this scenario. And -surprisingly- we get much closer to it with some tweaks in nutrition/supplements, body mechanics, stretching breathing, and relaxation techniques.

So, if your s*it don’t staaankk… or at least pass in the way I described - message me and let’s figure this out together.

The new “tummy time”

How many of us have been holding our tummies in since puberty? Maybe we were bullied, maybe we saw images online/in magazines, maybe we observed it in other people we knew… For a lot of women, having a small or flat stomach has been reinforced as a) aesthetically pleasing, b) prized, and c) the norm.

The challenging thing about that is .. it can make it hard for our abdominal muscles, organs, fascia, etc to operate at full “capacity” (if you will). We’re inadvertently creating a sort of suction or vacuuming effect by sucking in our stomach. Sometimes we may even notice or develop a line around the middle.

Here’s my challenge to you; Take time for the new “tummy time.” Spend time each day intentionally relaxing the muscles of your abdomen. You can even try this in a crawl position (like cat and cow, if you’re familiar). Honestly, a simple visualization I give is that you imagine you’re a happy mama cow in a field of wildflowers. Let those cute little udders hang low and relaxed, lean your head upwards slightly to breathe in the yummy air, and allow your booty to pop up a little (as long as this does not hurt your back).

Because this can be a really vulnerable or uncomfortable movement and position for you, try saying some nice words to your body: “Hey! You’re beautiful!” “You can take up space!” “You sustain me!” You keep me working and moving and digesting!” “I LOVE YOU!”

Try it out. You may be surprised with how it makes you feel.

Autumn is here! (…Almost)

It’s September. Which means it’s basically October. Which means it’s FALLLLL. What do I love during this season - my pumpkin spice lattes. If you’re in the same boat - or maybe you prefer the apple cider taste … or the year round vanilla or mocha flavors - you may notice that you seem to have to pee a lot more in the time after drinking said bevergino.

Did you know that caffeine is considered a bladder irritant? It makes your bladder more talkative and you may find yourself in and out of the restroom after enjoying those decadent sips!

I’m a firm believer in us being human and indulgences being lovely and necessary. If you are having a really hard time managing your bladder, or you’re in a context where getting to the toilet is tricky, you may consider decreasing or making those latte treats less frequent. However, we’re all human here and sometimes your taste buds are running the show! In that case, just pay attention to your bladder’s signals and make sure to “honor the urge.” If you have to go, and especially if you experience leakage, make sure to get your booty on the toilet when nature calls!

And maybe even comment with your favorite fall drink options! I’m always looking for recommendations!

Breathe Your Poop Out

A lot of people end up straining when they’re on the toilet and it can actually hurt to try to have a bowel movement! Unfortunately, what can happen in that case is that the muscles of the pelvic floor tighten to “protect” against this increased pressure which will make evacuating your poop that much more frustrating and difficult.

For most people, I actually recommend you relax your body on the toilet, focus on softening your tummy and pelvic floor, and “breathe” as you allow your rectum and the automatic muscle movement (peristalsis) to ease the poop out without much straining.*

*This will not work for all people and many times we must assess diet, hydration, and other variables that are impacting bowel evacuation.

Sleep: a pillar of pelvic health!

Are you having a hard time getting a full night’s sleep because your bladder seems to have a different plan? Waking up to see the clock read 3:09 am and your bladder telling you “Get up - NOW!” can really be a problem! And, although you may check with your girlfriends who say they have this happen, too - well, that doesn’t make it normal!

Here’s a few things I go over with my clients: How much water/fluids are you drinking throughout the day? Are you accidentally going all day without drinking water and - uh oh it’s 5 pm and I’m sooo thirsty! Let me fill up that Stanley cup I got after watching one too many TikToks and chug that down while I watch my favorite new TV show: Jury Duty (honestly, that show is hilarious!).

Unfortunately, by the time you feel thirsty, your body may already be a bit dehydrated. And, in drinking 30+ ounces of water/fluids in one go, now your bladder is getting filled to the max and you’ll be running to the toilet all evening and throughout the night.

Instead, I recommend my gals pace their fluid intake throughout the day (instead of all during the night), making sure to honor the urge to pee, as well, so that the communication between your bladder and your brain is on point! Then, hopefully, you’ll catch Zzzzs during the night and not “aahhhs” from running to the toilet in the night and stubbing your cute little toes!

Finally, some of us may wind down for the night with a little cocktail or alcoholic drink or some kind, or perhaps something bubbly. Alcohol and carbonation can also make our bladders speak up and be more urgent through the evening and night. So, if your sleep is disrupted, consider making some of these changes!

Your new favorite animals: Cat and Cow

There’s a simple exercise that comes from yoga that can make an amazing difference in your body.

Cat/Cow

Its focus is to bring spinal mobility and fluidity, but it also pairs breathing with specific movements, and stretching to the abdominal wall, back, and pelvic floor. Really, it gets the entire “abdominal canister” involved.

Your set up is on the floor on your hands and knees. Your hands are directly under your shoulders, and your knees are directly under your hips. Find yourself in alignment with your spine in a generally straight line.

Breathing in, allow your tummy to relax and gently descend towards the floor. Your chin raises so you’re gaze comes upwards, your shoulder blades pull down and together (away from your ears), and it feels like you’re sticking your booty out.

Breathing out, round your back like you’re giving space in between each vertebrae, rounding your shoulder blades away from each other, chin tucking towards your chest. You should feel a bit of heat/activation happening in your lower abdominals as you pull your tailbone under (like a scared dog).

Repeat this flow and allow the movement to be fluid and gentle.

I’m supposed to do what with my core?

So, you know when they say “breathe” and “engage your core” whenever you’re working out or… really doing anything forceful?

Do you know what that means? What do you end up doing? A lot of times, you might squeeze your abs, hold your breath, sink your belly button to your spine, squeeze your buns, or tense up just..everything! 

We have the abdominal muscle group that most of us know (rectus abdominis) that make our 6 pack abs - or 8 - or 10 if you’re #blessed.  But there’s also another muscle group called transverse abdominis. They are extremely important in engaging your core.

They are part of one “wall” of our trunk (if you imagine our middle is like a canister or soda can). This, along with the other muscles (diaphragm, multifudus, and pelvic floor muscles), are in charge of stabilization. They have to work as a team!

Engaging your transverse abdominis is extremely helpful for:

✨Stability

✨Strength

✨Co-engagement of your pelvic floor

✨Pressure management

When these muscle groups work together, we can prevent and often times resolve issues of leaking, pain, prolapse, constipation, and joint pain in this general area.

If we don’t engage these muscle groups well, we may see a “doming” effect along the abdominals, like it’s round like a barrel. This is an increase in pressure and force inside which pushes out on our abdominal wall and also down on our pelvic floor. This means that these itty-bitty muscles of our pelvic floor have to work extra hard to support and keep us from leaking. You might notice this when you laugh, cough, or sneeze!

Learning how to engage your transverse abdominis, as well as manage breathing are instrumental in pelvic floor health!

I thought it was just kegels..

Have you heard about Kegels? Where you just…squeeze? A lot of people - doctors included - often respond to any and all pelvic floor problems with a prescription of kegel contractions.

The challenging thing is that a lot of people aren’t really sure how to do a kegel properly! And - beyond that - sometimes kegels is the exact opposite of what your body needs.

Something important to know is that our pelvic floor muscles are meant to hold steady with enough tension that our pelvic organs are supported and we don’t pee/poop ourselves, but also have enough give and flexibility to them that they can relax and stretch for urination, bowel movements, sex, and birth. Sometimes, our muscles get offset in a way that they hold in an unbalanced tension - either very tense (like how your upper shoulders/traps might feel right now!) or more slackened.

Now comes the tricky part - if a muscle is holding really tense, we don’t want to teach it to keep tensing and contracting even more. This will simply exacerbate the issue. We want to learn how to lengthen, get back to a “normal” state, and then build strength from there.

This usually ends up being some combination of the following:

• stretching the surrounding muscles: inner thighs, hamstrings, glutes, quads

• learning how to breathe correctly so that the gentle movement can allow for an expanding and returning of our pelvic floor muscles

• use of a dilator or internal pelvic floor wand for massaging on the upset muscles

• figuring out what is happening emotionally that may be ramping up our anxieties and making our nervous system stay on high alert! This may mean therapy, putting boundaries up, self care, or medication (always follow up with your doctor).

• getting enough sleep - you’d be surprised how important this is

It’s a complicated thing, isn’t it!

That’s why I’m here. Shoot me a message for more information!

What is this nonsense about a pelvic floor?

Do you know that everyone has a pelvic floor? What the heck even is that? Well, our pelvic floor is the group of muscles at the base of the pelvis/torso.

They are in charge of: 

✨peeing

✨pooping

✨posture

✨positioning 

✨sex

✨stability 

There are actually a lot of things that can happen that can give you pain and problems “down there”.

Some people have leakage, pain with sex, difficulty sitting, a sensation of heaviness, straining with pooping, constipation, or many other things. 

Because this area of the body is something so “out of sight”, it can definitely become “out of mind”. Also, it can often feel straight up embarrassing and awkward to bring up any questions or concerns. And we have so few opportunities to get a clear idea of what “normal” is!

Although many of us are told: do Kegels! Did you know that not everyone knows how to do a Kegel correctly? And, furthermore, Kegels might actually do you more harm then good!

There are a lot of reasons that a person can develop problems with their pelvic floor, and I’m here to help figure out what those cause are and improve current symptoms! My approach is an individualized one, working with you to pinpoint specific causes and triggers that are leading you to have dysfunction. You should be able to live your life and I’m here to be by your side!