pelvic-floor-occupational-therapy

What Is It Like Working in Pelvic Floor Occupational Therapy?

If you’re interested in working in pelvic floor occupational therapy, I’m very excited to share this very informative interview with Anjana Aluri Boyanapalli, OTS, and her advisor Tiffany Ellsworth Lee, MA, OTR, BCB-PMD, PRPC.

In this interview, Anjana and Tiffany explain everything you need to know about pelvic floor occupational therapy. They also provide you with actionable tips and certification criteria to help you get started in this specialty.

But first, about the interviewees: Anjana Aluri Boyanapalli is a graduate student of Occupational Therapy from Stanbridge University, Irvine. Her clinical practice interests include geriatrics and mental health with special interest in women’s health.

Anjana-Aluri-Boyanapalli

Tiffany Ellsworth Lee holds a BS in Occupational Therapy from the University of Texas Medical Branch, and an MA in Health Services Management from Webster University. She has worked as an OT and a manager in a variety of rehabilitation settings for the past 23 years. In 2004, she received her board certification in Pelvic Muscle Dysfunction from the Biofeedback Certification International Alliance (BCIA).

Tiffany-Ellsworth-Lee

She is the owner of a continuing education company, Biofeedback Training and Incontinence Solutions and has a private practice in San Marcos, Texas, exclusively dedicated to treatment of urinary and fecal incontinence, and pelvic floor disorders. She is on faculty at Herman and Wallace Pelvic Rehabilitation Institute. She also offers clinical consultation, training workshops, and mentors health care professionals working toward their BCIA certification.

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First, a case study to get a feel for a typical patient one might see working in a pelvic floor occupational therapy clinic:

Mrs. Smith is a 61 year-old high school teacher with urinary and stool leakage. She leaks small amounts of urine on the way to the bathroom. She has 1-3 urine leaks a day. She reports nocturia (getting up at night to void) 2x a night. She voids every 1-3 hours. Her daily fluid intake consists of more than 8 cups of plain water, and 2 cups of milk.

She reports when she voids urine she does not strain to completely empty her bladder. When she voids urine, she reports very slow stream or dribbling. She wears 2 pads for protection against leaks, and with larger accidents washes her underwear in the bathroom at school. She does void “just-in-case” for fear of leakage.

She reports being “distracted” at work, and is “terrified a student will smell” the urine or stool
leakage.

This is a typical case that a pelvic floor occupational therapist will treat.

A goal for the client would be: To strengthen pelvic floor muscles to stop leakage, and to be able to work without “fear.”

For those who have not heard of pelvic floor occupational therapy, this interview will take us into the details and the technical know-hows of being a pelvic floor therapist from an occupational therapy perspective.

What does your graduate research entail?

Anjana: My research initially began with working on a critically appraised topic (CAT) to submit to the AOTA evidence exchange group. CAT is a short summary of the best available evidence created to answer a specific clinical question like a PICO with a list of systematically reviewed peer reviewed articles.

Occupational Therapists are known to work with a myriad of orthopedic and neurological conditions such as stroke, brain injury, TBI and Alzheimer’s. For my research, I wanted to focus on a topic that is relatively newer, challenging, and an unexplored area of practice which still falls within our domain of practice.

After much discussion with my advisor and internet searches, I chose pelvic floor dysfunction since it is yet an underdeveloped area of rehabilitation in occupational therapy. My research focused on understanding the role of occupational therapists in pelvic health. What can we do? What is our scope of practice within the realm of this speciality? What level I evidence is currently used by OTs working in pelvic health? Most importantly, what are the different avenues of getting into this setting of practice?

On performing an extensive literature review for three months, we gathered that Surface EMG biofeedback treatment is currently the most widely used intervention that can improve incontinence symptoms and sexual functioning in males and females with pelvic floor disorders.

I gathered seven Level I ( randomized controlled trials), two Level II and three Level III studies to support the efficacy of biofeedback in patients with pelvic floor dysfunction and its associated symptoms. For more details on what these levels mean, please refer to this EBP article.

The purpose of our research was to assist occupational therapy practitioners specializing in chronic pelvic floor conditions in enhancing their developing body of knowledge to guide the process and utilize evidence-based interventions using surface EMG biofeedback techniques with their clients.

Since pelvic floor disorders come with a host of symptoms such as an urgent need to urinate, painful urination or incomplete emptying of their bladder, constipation and muscle spasms, in our research we wanted to focus on how biofeedback could be the answer to many of these problems in pelvic floor occupational therapy clients.

Critical review of available evidence showed that although the basic intervention includes assessing and training for deficits in functional self-care skills that may be contributing to the incontinence, pelvic floor OTs can use their clinical, technical and psychosocial skills to specialize in evaluating and intervening with functional approach using surface EMG biofeedback.

Within the literature, there is strong evidence that links biofeedback-assisted pelvic floor muscle training (PFMT) as an effective therapy compared to PFMT alone for well-motivated females with mild to moderate pelvic floor dysfunction. Randomized control trial studies done ascertain by training the client to use his/her muscles to quiet the sensation of urgency, one can prevent urinary incontinence.

Systematic review of at least seven studies showed that treatment groups that use biofeedback have better outcome measures as indicated by an increased score on QOL (Quality of Life Questionnaires) and lower depression and anxiety scales as compared to treatment groups using medication and/or placebo.

The evidence we gathered in our research could be considered by practitioners as a therapeutic strategy for pelvic floor muscle re-education specifically related to clinical conditions that include urinary incontinence, fecal incontinence, pelvic organ prolapse and sexual dysfunction (dyspareunia and vaginismus in women and erectile dysfunction in men), secondary to pelvic floor dysfunction in both men and women.

Within the realm of pelvic floor occupational therapy, what is Surface EMG Biofeedback technique?

Anjana: “Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately “feed back” information to the user. The presentation of this information — often in conjunction with changes in thinking, emotions, and behavior — supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.” (Definition adopted by BCIA, AAPB, and ISNR (May 18, 2008).

Tiffany: Biofeedback provides visual and auditory feedback of muscle function. It is a non-invasive technique that allows patients to adjust muscle function, strength, and behaviors to improve pelvic floor function. The small electrical signal (EMG) provides information about an unconscious process and is presented visually on a computer screen, giving the patient immediate knowledge of muscle function, enabling the patient to learn how to alter the physiological process through verbal and visual cues.

This mechanism allows the patient to assess muscle resting tone, creating an environment that teaches how to down-train a tense pelvic floor while providing the means to teach coordination of muscle function.

Patients are able to see signals (similar to what an EKG of the heart shows) with contraction or relaxation of the pelvic floor muscles being monitored. Therapists can work with the patient to increase endurance, coordination, and an isolated contraction without co-contracting surrounding muscles. Muscles are monitored using external electrodes, or internal sensors (self-inserted similar to a tampon).

In short, biofeedback treatment/training using the proper instrumentation provides the precise information necessary to change behaviors associated with tensing the pelvic floor for control, or proper relaxation of the pelvic floor for release of urine or stool.

What is the typical role of a pelvic floor occupational therapist?

Anjana: While a variety of experts will treat pelvic floor problems, and often, the approach is multidisciplinary in order to provide the best outcome for patients, occupational therapists are one of the best suited health professionals to treat pelvic floor issues.

Occupational therapists are in the right place to treat patients with pelvic floor symptoms, not only because they are trained in the biomechanical aspects of providing care like knowing the anatomy and physiology of the pelvic area, but in addition, they possess the expertise and knowledge in the psychosocial realm of disorders associated with a multitude of problems arising from pelvic floor dysfunction, such as depression, social anxiety and fear.

According to the Occupational Therapy Practice Framework (OTPF): Domain and Process, 3rd ed., (Framework-III], AOTA, 2014) “Occupational Therapists (OTs) can be involved in numerous aspects of pelvic floor rehabilitation that impact our activities of daily living such as toileting, rest, sleep, and sexual activity.”

What is “Pelvic Floor Therapy?”

Tiffany: Pelvic Floor Muscle Dysfunction is a term used to describe bladder, bowel, pelvic pain and/or sexual problems related to restrictions or malfunctioning of the muscles and nerves of the pelvic floor. For more than 15 years, I have offered pelvic floor therapy for women, men, and children.

Many of my patients have suffered with pelvic floor muscle dysfunction for years and consulted numerous physicians in a variety of specialties, without relief or a clear understanding of their condition. When primary care physicians and specialists cannot find anything wrong on “the inside,” they may consider the “outside” or the muscles of the pelvic floor which act as the gatekeeper to many internal organs and urinary and bowel elimination.

However, many medical providers tend to be less familiar with how muscles, connective tissues and joints can cause pain and disruption of the pelvic floor, as compared to therapists whose primary focus is studying and managing dysfunction related to those structures.

In recent years, it has been the field of physical and occupational therapy that has discovered that tight, weak, overactive, uncoordinated muscles of the pelvic floor, lower abdominals, lumbar spine and even hips are the primary cause of a wide range of pelvic floor symptoms.

Experience with hundreds of patients has produced data that demonstrates that highly specialized pelvic floor therapy provides understanding, education, effective treatment and relief of pelvic floor issues.

Women of all ages may experience symptoms of pelvic floor dysfunction. Urinary issues include leaking, urgency, frequency, hesitancy or retention; bowel issues include constipation, incontinence, and rectal pain; sexual issues include painful sex, vestibular pain (pain outside of the vagina), and erectile dysfunction or perineal pain in men. Even persistent hip pain can have an underlying condition related to the pelvic floor muscles.

Pelvic floor muscle dysfunction is an embarrassing subject for people to discuss with physicians, family and friends. I believe that the best outcomes are achieved when patients are fully informed, invested partners in the rehabilitation process. I listen closely to their concerns and then work to plan treatment strategies which are individualized for each patient after a thorough evaluation.

The treatment strategies may include (and are not limited to) biofeedback (computer assisted exercise) for the pelvic floor muscles, retraining of uncoordinated muscles, and strengthening, postural training, stretching and restoration of muscle length and function through manual treatment techniques.

Incontinence is not a normal part of aging despite what the public is all too often led to believe. Incontinence can be treated successfully!

Pelvic organ prolapse is another common example of a challenge many women face after childbirth or as they age. Think of prolapse as a hernia that mostly affects women. When the muscles that hold the pelvic organs become weak or stretched, the organs – the bladder, uterus, small bowel, rectum – can drop from their normal location and push against the wall of the vagina. Strengthening or stretching the appropriate muscles, altering behaviors around the symptoms, and empowering someone with prolapse to understand how to keep the problem to a minimum is all part of the treatment strategy.

While incontinence (urinary or bowel) is often the primary reason for treatment, there are many other factors listed below that warrant evaluation and treatment. Most people think these challenges only apply to older patients. In fact, many conditions affect men and women alike, young and old.

More than 25 million Americans have urinary incontinence and the experience can leave them feeling ashamed, socially isolated, and depressed. Patients need to know that there are options other than pads or diapers, medications or surgery.

By teaching how to change behaviors surrounding toileting concerns, strengthening and changing muscle function through biofeedback, altering bladder signals with muscle stimulation, and empowering patients with knowledge to alter the negative effects of this problem, people gain control and successfully resolve their problem.

Incontinence symptoms can accompany other problems associated with the pelvic floor muscles such as those listed below.

The Pelvic Floor Program successfully treats these relatively common problems which include, but are not limited to:

• Urinary incontinence
• Urinary urgency and frequency
• Urinary retention
• Frequent night time voiding and/or bedwetting
• Interstitial cystitis or painful bladder syndrome
• Pelvic organ prolapse
• Vaginismus
• Vulvodynia
• Dyspareunia
• Post hysterectomy
• Post-partum
• Pregnancy
• Pelvic pain
• Lichens sclerosis
• Endometriosis
• Pelvic congestion
• Constipation
• Rectal prolapse
• Fecal incontinence
• Anal fissures
• Hemorrhoids
• Irritable Bowel Syndrome
• Diarrhea

Can you tell us about how treating patients with bladder, bowel, and pelvic pain dysfunctions is within an OT’s scope of practice?

Anjana: This is also one of the reasons I wanted to explore this area of practice and check to see how many occupational therapists have specialized in pelvic floor. Our framework defines occupations as “…various kinds of life activities in which individuals, groups, or populations engage, including activities of daily living (ADL), instrumental activities ofdaily living (IADLs), rest and sleep, education, work, play, leisure, and social participation.”

We are predominantly seen for the work we do with ADLs at different settings. However, with pelvic floor complaints we see women and men equally suffer in their IADLs section which can be sleep participation (sustaining sleep without disruption, performing nighttime care of toileting needs) and achieving full participation in work, play, leisure, and social activities that requires one to be able to maintain continence in a socially acceptable manner in which they can feel confident and comfortable to fulfill their roles and duties.

So yes, all these client factors that directly influence their performance factors are well within our scope of practice as we act as the bridge between facilitating a change and growth in these client factors for our patients.

What does a typical pelvic floor occupational therapy treatment session entail?

Anjana: There is a host of techniques and interventions that pelvic floor occupational therapists can use. While there is a huge amount of research pointing to the use of biofeedback in conjunction with traditional pelvic floor rehabilitation, there are list of other interventions such as kegel exercises, self-regulation techniques, progressive muscle relaxation, behavioral modification, mindfulness education and environmental modifications that can be implemented as part of the OT treatment regime.

Clients are evaluated on a case by case basis, and a formal treatment plan is prepared by experienced therapists. Treatment plans are entirely customized to the needs and symptoms of the client and since occupational therapists use a client-centered approach, their recommendations and interventions are transferable functionally into the client’s everyday occupations which will be one of the important clinical outcomes for the OT.

Improving functional ability is our main goal and hence from day one. Occupational Therapists tend to incorporate that into the heart and soul of the treatment planning process by taking into account what the client wants the most out of the session. This is what differentiates us from other health professions and is our unique USP as we understand the link between well-being and occupation.

What are the most common diagnoses pelvic floor occupational therapists see?

Anjana: Pelvic floor dysfunction causes a host of symptoms when patients are unable to control the muscles that help them have normal bowel and bladder function. Full relaxation of the pelvic floor muscles is required for complete elimination, and good pelvic floor tone and strength that will help patients maintain continence. The muscles may be weak, tight, or there could be an impairment of the joints, low back, coccyx and hips. Pelvic floor dysfunction can affect women, men, and children.

However, there is a higher incidence of dysfunction among woman which often keeps them from achieving full participation in work, play, leisure, and social activities due to their inability to maintain continence in a socially acceptable manner ultimately hindering their participation in occupations.

In addition, pelvic floor dysfunctions can have a negative impact on clients’ lifestyles and occupations. These include BADLs and ADLs such as toileting, sexual relationships, social engagement, psychological, mental and physical wellbeing.

While we as Occupational Therapists are well trained and equipped to address activities of daily living (ADLs) such as toileting and grooming, our education goes beyond the usual norm as we can easily cross match our skill set with other professions that will allow us to address other areas such as sexual health, social participation, health management and preventive education that offers personalized training to clients from all age groups.

Some of the typical symptoms may include:

• Constipation, straining and pain with bowel movements
• Urinary and Fecal Incontinence
• Unexplained pain in the lower back, pelvis, genitals or rectum
• Pelvic muscle spasms
• A frequent need to urinate
• Painful intercourse for women

How long do clients undergo treatment? Do you see any recurrence rate after treatment?

Tiffany: Clients would usually benefit from OT services 1x-12x over a 90 day time frame. Education is provided about pelvic floor anatomy and dietary bladder/bowel irritants; E-stim is given if indicated along with computer assisted neuromuscular re-education (surface EMG biofeedback), including cuing and visual feedback.

Therapeutic exercise and activities and manual therapy along with a home exercise program is provided in this time frame after the goals and treatments are discussed and agreed upon with the client. Clients are usually treated 1 to 12 sessions depending on their diagnosis, age, ability to follow HEP plan and insurance regulations.

The goal is for them to continue the HEP for life to maintain a healthy pelvic floor with good strength, tone, coordination, and free from pain or dysfunction. Clients are taught to manage their symptoms and pain through manual therapy techniques, behavior modification, biofeedback, neuromuscular re-education, therapeutic exercise/activities, and dietary and lifestyle changes.

In terms of the recurrence rate, it will usually depends on the client. If they continue with their home exercise program, then their symptoms usually resolve. If they are not getting better, they are referred back to the pelvic floor clinic by the doctor.

What is a “day in the life” like as a pelvic floor OT?

Anjana: Like in any setting, occupational therapy practice begins with a referral, screening, and evaluation. Evaluation process consists of generating the occupational profile of the client. This will review the client’s occupational history, prior level of function, any comorbidities, understanding the lifestyle dynamic of the client and occupations that are most affected by their current condition.

Typically in a day of a pelvic floor OT, they would see on an average 7 patients a day. Usually it is customary to schedule 1 hour evaluations and 45 minute treatment sessions in an outpatient rehab setting.

Tiffany: After the evaluation, the very first task on the agenda is explaining anatomy and physiology of the bladder and bowel to the client. Pelvic floor OTs will educate clients using PF anatomy cards and 3-D models so he/she can understand why there is PF weakness, and how to properly perform a PF contraction (Kegel).

In addition, the therapist will show the client to sit properly on the toilet to void (Squatty Potty for bowel movements), the importance of not straining, and if he/she is constipated, review dietary recommendations (proper fiber/water intake). He/She receives an in-depth education packet addressing:

• Bladder Irritants and Substitutes
• How Diet Can Affect the Bladder
• Caffeine Chart
• Bowel Health
• Fiber Facts
• Pelvic Floor Muscles (Anatomy)
• Bladder Retraining (Timed Voiding, Urge Suppression)
• Instructions for Controlling Urinary Urge
• The KNACK (squeeze PF before and during cough/sneeze/lift)
• Pelvic Floor Home Exercise Program
• How to fill out a Voiding Diary

From here on, long term and short term goals are provided to the client. All in all, clients are usually treated for 1 to 12 sessions depending on their diagnosis, age, ability to follow HEP plan and insurance regulations. The goal is for them to continue the HEP for life to maintain a healthy PF with good strength, tone, coordination, and free from pain or dysfunction.

Patients are taught to manage their symptoms and pain through manual therapy techniques, behavior modification, biofeedback, neuromuscular re-education, therapeutic exercise/activities, and dietary and lifestyle changes.

How can a pelvic floor occupational therapist differentiate themselves from a pelvic floor physical therapist?

Anjana: Both physical therapists (PTs) and occupational therapists (OTs) have to be trained extensively to treat pelvic floor dysfunctions in women and men. Post graduate training in pelvic floor interventions equips therapists to help their clients better understand the symptoms they are experiencing.

While both PTs and OTs are well trained in designing a personalized program to help alleviate pelvic discomfort via training and strengthening, OTs are additionally knowledgeable in addressing the psychosocial issues that accompany pelvic floor disorders due to their educational background.

As compared with physical therapy, occupational therapy tends to focus more on evaluating and improving the person’s functional abilities. We focus on “functional independence” of the client. Helping clients improve their ability to carry out their daily tasks is a prime goal of the occupational therapist.

Clients experiencing pelvic floor issues including men and women may experience continuous loss of function in all areas of their activities of daily living (ADLs) and instrumental activities of daily living (IADLs) including social occupations, work and leisure due to fear going out in public, ultimately leading to hindrance in optimal participation in life occupations. Pelvic floor OTs are in the right position to address these concerns in our clients.

Do pelvic floor OTs need to perform internal examinations as part of their evaluations and treatment sessions?

Tiffany: It is not necessary to perform internal exams. You can still significantly improve pelvic floor function and strengthening through exercise, biofeedback, behavioral modification, education, and teaching dietary and lifestyle changes.

Many patients with pelvic pain conditions will need manual therapy if they are not improving with these techniques. If an OT would like to work in the area of pelvic pain, then they will need to get further training to perform internal and external PF exams.

Manual therapy is necessary in the pelvic floor bowl with some pain patients, and many times the muscles need to be addressed internally through massage, trigger point release, and scar releases. Both OTs and PTs do not receive education on how to perform pelvic floor exams or manual muscle tests of the PF muscles in school, so it is necessary to get more clinical training through companies such as Herman and Wallace.

It is not necessary to assess the PF internally, but if needed seek out further training. Or connect with a Pelvic Floor OT or PT performing manual therapy in your area. If the patient is not improving with behavioral therapy and biofeedback, then refer to a specialist or become one!

Also, there are many OTs and PTs who enjoy mentoring other therapists in the PF field. There is a list of mentors on BCIA for OTs wanting to specialize in behavioral therapy and biofeedback.

Do you recommend any specialties or certifications for OTs who want to get started?

Anjana: Occupational therapists wishing to pursue pelvic floor occupational therapy have a few options. One way is to find a pelvic floor clinical or work setting with their respective settings to check to see if they can start a women’s health program with a strong focus on pelvic floor. This is not always possible based on the logistics of the setting.

OTs quite often do not start out in pelvic health directly after school, and since this is a newer area as compared to other certifications such as the NDT and PNF. It takes a bit of research, time and effort to find one’s exact niche. First, an OT should seek out courses that teach the basics of bladder and bowel management. It is important to understand the anatomy and physiology of the bladder, bowel, and sexual systems.

There are 3 certifications an OT can prepare for:

Board Certification in Biofeedback for Pelvic Muscle Dysfunction (credentials are BCB-PMD). There are several steps for this certification including an accredited BCIA course, hands-on biofeedback lab, 18 mentoring hours, a certification exam, and 30 clinical hours treating PF dysfunction using biofeedback. Check out BCIA’s website to see which courses are approved for certification. The BCIA courses are excellent for new OTs to this field, because all foundations are taught. Currently there are 25 OTs in this country who are board certified in biofeedback.

The second certification is the Pelvic Rehabilitation Practitioner Certification (PRPC). This is for an OT who has been working in the PF field for a few years. The requirements listed on the Herman and Wallace website include: “Provide documentation of 2,000 documented hours of clinical experience with pelvic therapy patients over the past 8 years, with 500 of those hours of direct patient care taking place in the past 2 years. This includes hours spent on direct patient care related to conditions of pelvic pain, pelvic girdle dysfunction, conditions of bowel, bladder, and sexual dysfunction that relate, in whole or in part, to the health and function of pelvic structures and the pelvic floor. Other conditions that qualify may include dysfunctions of the abdomen, thoracolumbar spine, or the lumbo-pelvic-hip complex. These hours can include care for pediatric, adolescent, adult, and aged patients of any gender.”

Herman and Wallace offers many different educational opportunities, and one can choose to sit for the certification without attending any classes put on by the company.

The website goes on to say: “Herman and Wallace offers a comprehensive course series addressing assessing and treating pelvic floor dysfunction and pelvic pain. Herman and Wallace also offers an exam based certification, The Pelvic Rehabilitation Practitioner Certification, for which therapists are eligible to apply if they can provide documentation of 2,000 patient contact hours related to pelvic patients.

The exam is multiple choice and is offered twice per year, and a passing score allows the therapist to use the credential PRPC after their name.”

Currently there are 4 OTs (including Tiffany Lee) who are PRPC certified. OTs can take a variety of continuing education classes by heading to the following website: Herman & Wallace Continuing Education

In addition, one must note that coursework and certification are different. For example, H&W courses are designed to instruct in immediately-applicable, evidence-based knowledge and skills that can be used in the clinic. Therapists take these courses to earn CEUs and learn these skills, and many take these courses without ultimately pursuing their PRPC.

The third certification is the Pelvic Health Certification through Evidence in Motion.

The following excerpt was taken from their website: “Evaluation and management of the pelvic floor is an area that has been lacking in traditional physical and occupational therapy education, both at the entry and postprofessional levels.

Evidence In Motion’s new Pelvic Health Certification (PHC) will enable you to understand the structure and function of the pelvic floor and prepare you to incorporate it into practice. You will learn how to incorporate the pelvic floor into your treatment for your hip, back, and SI joint patients, and you will also receive valuable instruction on a variety of topics related to the pelvic floor in men and women.”

EIM’s Pelvic Health Certification is designed so that you will:

  • Become a certified, highly skilled, autonomous practitioner with advanced
    clinical competency in pelvic floor physical or occupational therapy.
  • Be trained and equipped to incorporate the pelvic floor into treatment for
    orthopedic dysfunction such as hip, low back, and pelvic girdle pain.
  • Be equipped to incorporate the full musculoskeletal system into treatment for
    patients with primary pelvic floor dysfunction
  • Make evidence-based practice an immediate reality in your clinical practice.
  • Enhance your critical thinking and psychomotor skills to improve decision-
    making and outcomes of care.
  • Have the opportunity to use your Certification credit towards other EIM
    Postprofessional Training, should you decide to do so down the road.”

It is a 12 month program with online didactic learning and hands-on weekend intensives. EIM also offers CEU opportunities for OTs to learn more.

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Another good resource that is cost-effective is MedBridge Online Continuing Education. There are more than 10 online courses that OTs can take related to pelvic rehab, along with their full library of other occupational therapy coursework.

Many Pelvic Floor OTs have also presented at AOTA and state OT conferences. The presentations are still available for purchase for OTs interested in learning more about pelvic floor occupational therapy rehabilitation.

Additional Resources

Certification in Pelvic Floor Rehabilitation: A Guide for Occupational Therapists

Biofeedback Training and Incontinence Solutions Resource Page

WomensHealth4OT Facebook Group

OTs for Pelvic Health Facebook Group

Occupational Therapy in Postpartum Care Facebook Group

Womens Health Occupational Therapy Australia Facebook Group

The Pelvic Guru

Society for Urologic Nurses and Associates

The Prometheus Group 

Biofeedback Foundation of Europe 

Marquette University Treatment of Bowel, Bladder and Pelvic Floor Disorders Course

Celebrating Occupational Therapy Month by Celebrating OTs in Pelvic Rehab

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2 comments

  • Alycia May 31, 2018   Reply →

    So interesting! I see such a high need for this practice area as so many older adults do have incontinence issues and think it’s just a normal part of aging, where as if we could step in and help, what a great gift! And this feels like a great fit for an OT’s expertise.
    As someone who is interested but still trying to figure out all of the aspects, I have a random question…when you say “manual therapy”, what does that consist of? Are there any times you have to do internal work? I’m super interested in pelvic floor rehab, but not sure I’d be comfortable with that aspect. Thanks for the clarity!

    • Sarah Stromsdorfer, OTR/L May 31, 2018   Reply →

      Hi Alycia, I agree that there is a need for OTs to jump into this specialty, and I’m glad to see it as an emerging practice area. Outpatient pelvic floor therapists do sometimes perform manual therapy internally. You can read more about this in this article: Pelvic Floor Manual Therapy I hope this helps!

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