Can Occupational Therapists Support Pelvic Health Without Performing Internal Pelvic Floor Assessments?

As an occupational therapist practicing in pelvic health, I often get asked this question—by students, by occupational therapists (OTs) looking to transition into pelvic health, and even by other healthcare professionals. The short answer? Yes, absolutely! The long answer? Keep reading to find out.

What is an internal pelvic floor assessment?

An internal pelvic floor assessment is performed by inserting a gloved finger(s) into the vagina or rectum to assess muscle tone, strength, coordination, and the presence of conditions like prolapse or scar tissue restrictions. It provides valuable insight into what’s happening internally, and physiotherapists with additional training commonly perform these assessments to guide their treatment plans.

Internal pelvic floor assessments are not considered within the scope of practice at this time for OTs in Quebec and most provinces across Canada. But don’t let that discourage you—here’s why!

Pelvic health is more than just Kegels

When I first stepped into the world of pelvic health, I felt completely out of my depth. Without the ability to perform internal pelvic floor assessments, I worried that I was missing a crucial piece of the puzzle—like I wasn’t fully equipped to help my clients. For this reason, I thought I needed to master every other technical skill, from assessing movement patterns to analyzing muscle activation, to make up for what I couldn’t do.

But in chasing that knowledge, I almost overlooked what mattered most: what my client was actually telling me. They weren’t just describing their symptoms—they were sharing how intimacy had become something they dreaded and how they felt disconnected from their body after childbirth. They weren’t just looking for exercises—they were looking for understanding.

This was a lightbulb moment for me. Pelvic health isn’t just about muscles—it’s about the whole person. And as OTs, this is where we shine.

When someone walks into my treatment room with pelvic pain, urine leaks, or constipation, there's more to their experience than just physical symptoms. They’re also dealing with:

·      The frustration of feeling unheard or dismissed

·      The emotional toll of intimacy struggles

·      The stress of balancing work, family, and their own needs

·      The fear that their body will always feel this way

And often, the pelvic floor itself isn’t the root cause, it’s a nervous system stuck in overdrive, a body holding onto stress, a person carrying years of worry in their tissues.

This is why pelvic health extends far beyond Kegels. While strengthening exercises can be helpful, they are not a one-size-fits-all solution. A client with pelvic pain, for example, may need relaxation—not more contraction. Another client may struggle with urine leaks and urgency not because of muscle weakness but because of nervous system dysregulation. Strengthening alone does not improve function.

The power of a holistic, multidisciplinary approach

Pelvic health concerns rarely exist in isolation. They intersect with nutrition, mental health, gynecology, urology, and more. This is why referral networks are important. Just as a geriatric patient with a hip fracture needs a multidisciplinary team to ensure a safe return home, pelvic health clients benefit from collaborative care that looks at the whole person—not just their pelvic floor muscles.

Occupational therapy fits beautifully into this model. We are experts in blending the physical, psychological, social, and environmental aspects of function. While internal pelvic floor assessments offer valuable information, there are many other ways to assess and intervene effectively.

Real-world impact: A case example

I once worked with a client who had been experiencing urine leaks for 25 years. She had given birth vaginally twice, and at the time she came to see me, her children were young adults. But it wasn’t until a recent separation from her husband that she decided to seek pelvic health therapy.

Of course, I did not perform an internal pelvic floor assessment. Instead, I listened to her story, validated her experiences, assessed her breathing, and explored her daily habits, routines, and stressors. What became clear was that her nervous system was in a heightened state of fight-or-flight, and I suspected that the emotional toll of her separation was affecting her pelvic floor function.

Through external observation—by placing the pads of my fingers on her perineum—we discovered that her breathing and pelvic floor muscle movement were uncoordinated. To address this, we worked on synchronizing her breath with pelvic floor movement using a combination of tactile, verbal, and visual cues. Over time, she learned how to engage and relax her muscles in a way that supported continence and managed pressure changes. By focusing on nervous system regulation, breathwork, and body awareness, she saw a significant decrease in leaks. After a few sessions, she reported that her pad was noticeably less soaked.

My client also shared that understanding her body better made her symptoms more manageable. I can’t stress this enough: helping our clients understand their bodies is fundamental to pelvic health. This is empowerment.

Eventually, I did end up referring this client to my pelvic health physiotherapist colleague because it felt like the right call at the time. The verdict? Her pelvic floor muscles were functioning just fine—good strength, tone, and coordination. In other words, weakness wasn’t the culprit. That’s not to say strength and mobility in other areas (like the glutes, hips, or thorax) don’t play a role, but it goes to show that a "weak" pelvic floor isn’t always the reason for leaks. Said another way, pelvic floor muscle weakness is not necessarily predictive of dysfunction.

Why OTs are essential in pelvic health

OTs are uniquely positioned to address the psychosocial, emotional, cognitive, and functional aspects of pelvic health and here are just a few ways we can do just that:

• Toileting mechanics & habits: We address posture, movement, positioning, and equipment needs to optimize elimination and prevent straining.

• Environmental & lifestyle modifications: We support stress management, quality sleep, hydration, and nutrition, while integrating movement, mindfulness, and healthy routines into daily life. Additionally, we provide equipment recommendations to help clients modify their environments to support their pelvic health needs.

• Pain & sensory processing: We work with people who experience pelvic pain or sensitivity, including discomfort during intimacy, by leaning into our understanding of sensory processing and using sensory regulation strategies to help them feel more comfortable and in control.

• Social participation: We help people work through anxiety or discomfort around social events, travel, and everyday activities that their symptoms have made more challenging.

• Sexual health: We prioritize sexual health as a fundamental part of overall wellness—not just as a bonus or afterthought. We recognize that safe, pain-free intimacy is essential to human identity and quality of life.

This holistic approach is what makes OTs so valuable in pelvic health. It’s not just about what we assess—it’s about how we help our clients integrate that knowledge into their lives in a way that feels safe, sustainable, and empowering.

Collaboration, not competition

Internal pelvic floor assessments are valuable, and certified practitioners who perform them are incredible partners in pelvic health care. But an internal assessment is not the only way to make a difference. When OTs and physiotherapists collaborate, we provide more holistic, patient-centered care.

At the end of the day, pelvic health is about meeting clients where they are, listening to their stories, and addressing the barriers that prevent them from engaging fully in their lives. And that? That is the heart of occupational therapy.

Final thoughts

When I look back at my early days in pelvic health, I realize that my biggest strength wasn’t in knowing every biomechanical detail—it was in listening. In seeing the whole person, not just their symptoms.

So, if you’re an OT wondering whether you can support pelvic health, the answer is yes. There is so much to offer in this space, and our profession is perfectly suited for it.

Find your niche. Build your referral network. And remember—pelvic health is about the whole person, not just their pelvic floor.