The Difference Between Pelvic Floor Occupational Therapy and Pelvic Floor Physical Therapy

By Samone Jackson, OTR/L, CLT

Both Pelvic Floor Occupational Therapy (PFOT) and Pelvic Floor Physical Therapy (PFPT) play critical roles in treating pelvic floor dysfunction, but they differ in approach, scope, and focus. There are a lot of similarities between the two disciplines in this specialized area but also differences. Understanding these differences can help individuals seeking treatment for pelvic floor issues choose the best course of therapy suited to their needs.

Overview of the Pelvic Floor

The pelvic floor is a group of muscles, ligaments, and connective tissues that support the organs in the pelvis, including the bladder, uterus (for women), prostate (for men), and rectum. It plays a key role in controlling urination, bowel movements, sexual function, and childbirth. Dysfunction in the pelvic floor can result in various issues, such as incontinence, pelvic pain, organ prolapse, and difficulties during sexual intercourse.

Both occupational and physical therapists who specialize in pelvic floor therapy work to address these dysfunctions, but the way they approach treatment is influenced by the core philosophy of their respective fields.

Pelvic Floor Physical Therapy (PFPT)

Pelvic Floor Physical Therapy (PFPT) is focused on the musculoskeletal system and its role in pelvic floor function. PFPT emphasizes movement, strength, and coordination of the pelvic floor muscles. Therapists aim to restore the proper function of these muscles through specific exercises, manual therapy, and modalities.

Key Components of PFPT:

1. Assessment and Diagnosis: PFPT begins with a thorough assessment of pelvic floor muscle strength, coordination, and endurance. Physical therapists often use manual palpation and biofeedback tools to determine areas of weakness, overactivity, or imbalance.
2. Manual Therapy: PFPT may include hands-on techniques, such as internal and external soft tissue mobilization, trigger point release, and myofascial release to address pain and tension in the pelvic region.
3. Exercises: A key part of PFPT is the use of exercises designed to strengthen or relax the pelvic floor muscles. This includes Kegel exercises (contracting and relaxing the pelvic muscles), as well as core strengthening exercises that target the muscles of the abdomen, back, and hips, which interact with the pelvic floor.
4. Biofeedback and Electrical Stimulation: Some physical therapists may use biofeedback to help patients become more aware of how to control their pelvic floor muscles. Electrical stimulation may also be used to promote muscle contraction or relaxation.
5. Education and Posture: Physical therapists provide education on proper body mechanics, posture, and breathing techniques to reduce strain on the pelvic floor and improve overall function.

Pelvic Floor Occupational Therapy (PFOT)

Pelvic Floor Occupational Therapy (PFOT) also addresses pelvic floor dysfunction but with a focus on how pelvic issues affect daily activities, quality of life, and mental health. Occupational therapists take a holistic approach, considering both physical and emotional factors that impact the patient’s ability to perform daily tasks.

Key Components of PFOT:

1. Holistic Evaluation: Occupational therapists look at how pelvic floor dysfunction impacts the patient’s ability to engage in daily activities such as toileting, dressing, bathing, and sexual activity. They also consider the emotional and psychological effects of pelvic floor issues, such as anxiety, depression, or embarrassment related to incontinence.
2. Activity Modification: OTs focus on adapting daily activities and routines to accommodate pelvic floor issues. This might involve recommending assistive devices, adjusting toileting habits, or suggesting alternative ways of performing tasks to reduce strain on the pelvic region.
3. Behavioral Techniques: Occupational therapists may teach behavioral techniques, such as bladder and bowel retraining, relaxation techniques, and mindfulness exercises, to help manage symptoms like incontinence or pelvic pain.
4. Emotional and Psychological Support: PFOT often incorporates emotional and psychological support, helping patients cope with the embarrassment, frustration, or isolation that can accompany pelvic floor dysfunction. Therapists may work on building self-confidence, reducing anxiety, and addressing mental health concerns associated with pelvic health problems.
5. Sexual Function and Intimacy: OTs also address the impact of pelvic floor dysfunction on sexual health. They may provide strategies for improving comfort during sexual activity, including positioning techniques and relaxation exercises.

Similarities in Approach and Scope

While Pelvic Floor Occupational Therapy (PFOT) and Pelvic Floor Physical Therapy (PFPT) have distinct approaches, they share important similarities and often overlap in treating pelvic floor dysfunction. Both disciplines aim to improve pelvic floor health and quality of life for individuals dealing with issues like incontinence, pelvic pain, sexual dysfunction, and organ prolapse.

Common Goals

Both PFOT and PFPT strive to restore the function of the pelvic floor muscles and alleviate symptoms of dysfunction. They aim to enhance bladder and bowel control, reduce pain, and improve sexual function. Each discipline works to empower patients with tools to regain control over their bodies, whether through direct physical interventions or lifestyle modifications.

Holistic Focus

Although their methods differ, both occupational and physical therapists take a holistic view of pelvic floor dysfunction. They recognize that physical issues are closely tied to emotional, psychological, and social factors. Both types of therapy often include patient education on posture, proper breathing techniques, and muscle relaxation. They also emphasize the importance of lifestyle adjustments, diet, and exercise as part of overall pelvic health.

Manual Therapy and Exercises

In both disciplines, manual therapy and pelvic floor muscle exercises are commonly used to improve muscle tone and coordination. Whether it’s a physical therapist guiding a patient through strengthening exercises or an occupational therapist helping them adjust their toileting routines, both practices often incorporate some form of physical exercise to promote healing and muscle balance.

Collaborative Care

In many cases, PFOT and PFPT are used in conjunction, providing a comprehensive approach to treatment. Physical therapists may focus on strengthening and rehabilitating the pelvic muscles, while occupational therapists help patients integrate those improvements into daily activities and address any psychological effects. This collaborative care ensures a more well-rounded approach to healing pelvic floor dysfunction.

Differences in Approach and Scope

1. Musculoskeletal vs. Functional Approach: The primary difference between PFPT and PFOT is that physical therapists focus more on the musculoskeletal aspects of pelvic floor dysfunction, using exercises and manual techniques to restore muscle function. Occupational therapists, on the other hand, focus on the functional and behavioral aspects, helping patients adjust their daily activities and manage emotional challenges related to pelvic issues.
2. Exercise vs. Adaptation: PFPT often emphasizes pelvic floor muscle training and strengthening exercises. In contrast, PFOT emphasizes modifying activities and teaching strategies for living with pelvic floor dysfunction, incorporating mental health and behavioral changes.
3. Mental Health Component: While both disciplines may offer emotional support, PFOT is more likely to delve into the emotional and psychological effects of pelvic dysfunction and help patients manage these aspects more comprehensively.

Conclusion

Pelvic Floor Occupational Therapy and Pelvic Floor Physical Therapy are complementary approaches that address pelvic floor dysfunction from different perspectives. PFPT focuses on strengthening and rehabilitating the pelvic floor muscles, while PFOT looks at how pelvic issues affect daily life and emotional well-being. Both therapies can be highly effective, and in many cases, a combination of the two may offer the most comprehensive treatment for individuals experiencing pelvic floor dysfunction.