Why Occupational Therapists Are Uniquely Built for Pelvic Floor Therapy

When most people hear “pelvic floor therapy,” they picture a physical therapist. And while PTs

do excellent work in this space, there’s a quiet truth the public and even many referring

providers don’t know: Occupational therapists were trained for this work from day one.

Not as an add-on. Not as a subspecialty bolted onto our scope. It’s written into the very

document that defines what occupational therapy is.

A Note on Why I’m Writing This

In September 2025, I had the privilege of being the co- author of the New York State

Occupational Therapy Association’s official position statement on Occupational Therapy and

Pelvic Health is the first of its kind in New York, and only the second document of its kind in

the country.

So when I tell you that OTs belong in this space that we’re not just allowed to be here, but

uniquely built for it, I’m not speaking casually. I’ve spent significant time, alongside a team of

brilliant colleagues, helping our profession formally articulate exactly why.

This blog is the patient-friendly version of that argument. Here’s what it comes down to.

What the Profession Actually Says

The Occupational Therapy Practice Framework (OTPF-4) is the official guiding document of our

profession defines occupational therapy as the use of everyday life occupations to help

people participate fully in their lives.

When it lists the Activities of Daily Living (ADLs) we are trained to address, two of them stop

most people in their tracks:

• Toileting and toilet hygiene, including caring for menstrual and continence needs and

maintaining intentional control of bowel movements and urination.

• Sexual activity is explicitly named as an ADL.

These aren’t fringe concerns in our field. They sit alongside bathing, dressing, and eating as

foundational human activities that OTs are educated, trained, and licensed to support.

So when a woman comes to me, leaking on her morning run, dreading intimacy with her

partner, or planning her day around the nearest bathroom, she isn’t just experiencing a

“pelvic” problem. She’s experiencing a disruption in her daily occupations. That is precisely the

language and lens of my profession.

The Holistic Lens Was Already There

Pelvic floor dysfunction is rarely just a muscle problem. It lives at the intersection of:

• The body (muscles, fascia, nerves, organs, hormones)

• The nervous system (stress, trauma, breath, regulation)

• Daily routines (how you sit, lift, breathe, void, sleep, parent, work)

• Roles and identity (mother, partner, athlete, professional)

• Environment and context (your bathroom setup, your workday, your support system)

The OT models I was trained in PEOP (Person-Environment-Occupation-Performance) and

MOHO (Model of Human Occupation) doesn’t treat these as separate problems to hand off to

separate specialists. They treat them as a single, interconnected picture of a human being.

We’re trained to look at motivation, habits, roles, physical capacity, and environment together

and to design interventions that address the whole person.

That’s not a marketing claim. That’s the framework I was built on. And it’s exactly why pelvic

health belongs in occupational therapy’s hands.

Why This Matters for the Patient on My Table

When you walk into Pivotal Performance OT, I’m not only thinking about your pelvic floor

muscles. I’m thinking about:

• The way your nervous system has been bracing for years

• The bathroom habits you developed at age six and never questioned

• The C-section scar pulling on your fascia

• The meeting schedule that has you holding your breath for nine hours straight

• The intimacy you’ve stopped initiating because of pain or leaking

• The morning run that used to be your sanity, and now feels like a risk

All of that is occupation. All of that is in my scope. All of that is on the table.

You Were Never “Too Complicated”

So many of the women I see have been told some version of:

“Just do your Kegels.”

“It’s normal after kids.”

“Have a glass of wine before sex.”

“Wear a pad.”

If you’ve ever felt brushed off, fragmented, or sent home with a pamphlet, there is a reason a

holistic, occupation-based approach feels different. It’s because pelvic floor therapy through an

OT lens isn’t about isolating one muscle group. It’s about restoring the daily life you actually

want to live.

You deserve to MOVE Without Leaking. FEEL Like Yourself. LIVE Without Limits.

That’s not a tagline. That’s the OT framework doing exactly what it was designed to do, and

it’s the future of pelvic health care that I, alongside my NYSOTA colleagues, am working to build

across New York State.

Nicole Muriel, MS, OTR/L, is the founder of Pivotal Performance Occupational Therapy in Stony

Point, NY, serving Rockland County and the Hudson Valley. She is the co- author of the New

The New York State Occupational Therapy Association’s 2025 Position Statement on Occupational

Therapy and Pelvic Health is the first of its kind in New York and the second nationally. She

offers one-on-one, holistic care for women who are tired of being told their symptoms are

normal.

Read the full NYSOTA Position Statement here

Visit Pivotal Performance OT at www.pivotalot.com