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Bowel Pathology, Function, Dysfunction and the Pelvic Floor

Herman & Wallace Pelvic Rehabilitation Institute

Objectives

Upon completion of this continuing education seminar, participants will be able to:
1. Identify the structures and functions of the digestive system, and have a general understanding of bowel disease.
2. Understand general medical assessment, medical tests and outcomes, medications given and how they relate to pelvic floor function/dysfunction.
3. Palpate and treat more specific musculature via the anorectal canal to improve chronic constipation and paradoxical pelvic floor function.
4. Explain the functions of the pelvic muscles during continence and defecation.
5. Instruct in general nutritional guidance for continence and bowel health.
6. Effectively utilize sEMG biofeedback to increase or decrease pelvic floor muscle activity 7. Assess and provide corrective exercises for abdominal wall separation.
8. Apply principles of differential diagnosis for pelvic muscle dysfunction versus bowel disease.
9. Create an appropriate plan of care based on a patient’s symptoms and physical examination.
10. Select the most appropriate physical findings and use of validated questionnaires to determine a treatment plan.

Target Audience

This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Confirmation Notes

As this continuing education course includes lab work, all course attendees should come prepared to participate as both clinician and patient.

Agenda

Day One:
8:00 Registration 8:30 Introduction to digestive system function and dysfunction 10:00 Break 10:15 Digestive Lab and palpation, sphincter release/colon massage 12:30 Lunch 1:30 Review of digestive and anorectal muscle anatomy, defecation process 2:30 Diastasis lab and taping for correction 3:00 Break 3:15 Vaginal/Rectal Lab: Muscle mapping Lab: Supine/Prone/Sidelying palpation and treatment 5:00 Adjourn

Day Two:
8:00 Questions 8:15 Medical side of constipation: tests, medications and treatment 9:15 Medical side of fecal incontinence: tests, medications and treatment 10:00 Break 10:15 Lab: balloon manometry 12:00 Lunch 1:00 Over-the-counter products and medications lecture for treatment of chronic constipation and fecal incontinence 3:00 Break 3:15 SEMG lecture for coordination training for paradoxical pelvic floor function 4:30 Adjourn

Description

This intermediate, two-day course covers comprehensive evaluation and treatment techniques for bowel pathologies and dysfunctions, including fecal incontinence, chronic constipation, and the relationship between constipation and rectal and/or abdominal pain. According to the National Digestive Diseases Information Clearinghouse, constipation affects up to 15% of the population, and fecal incontinence affects almost 1 in 12 people. Interestingly, research by Nurko and Scott in 2001 has described both incomplete emptying and constipation as being associated with fecal incontinence. How does the pelvic rehabilitation provider determine on which dysfunction to focus? And which factors influencing bowel dysfunction are modifiable? What is the role of the pelvic floor muscles in relation to bowel health? All of these questions and more are addressed in Lila Abbate's specialty course on bowel pathology, function and dysfunction. As knowledge of the pelvic structures and nervous system are critical in understanding the pelvic rehabilitation provider's role in bowel dysfunction, anatomy and physiology of the gastrointestinal system and pelvis will be discussed throughout the course. The implications of the pelvic floor muscles specific to bowel dysfunction will be instructed so that the participant can increase comfort level with examination, evaluation, and intervention strategies. The Bowel Pathology, Function, Dysfunction & the Pelvic Floor course covers the use of food and fluid diaries, over-the-counter and home remedies, and use of prescription medication to treat bowel dysfunction. Relevant, basic nutrition principles will be instructed so that a provider can make recommendations towards healthy digestion based on the results of completed food and fluid diaries. This course includes comprehensive lab-based skill acquisition with internal (vaginal or rectal) palpation, sphincter muscle releases, abdominal wall massage to improve bowel motility, palpatory skills for the visceral evaluation and treatment of the sphincter and large intestine motility, and corrective taping techniques for the abdomen when needed. Therapists will also learn how to utilize anorectal manometry balloons in the clinic which is a technique that can help in increasing sensitivity or decreasing sensitivity to rectal filling, depending on the patient's presentation and needs. In addition, although participants in this continuing education course will not be instructed in the basic use of an sEMG (surface electromyographic) biofeedback device, therapists will learn how to recognize and treat paradoxical pelvic floor muscle contractions, and will be able to prescribe home biofeedback when appropriate utilizing current, evidence-based principles.
Having a familiarity with the medical evaluation of bowel dysfunctions can be very useful in the clinic, and this bowel course will instruct in common medical tests, interpretation, and meaningfulness to the pelvic rehabilitation provider. Typical physical therapy outcomes tools for pelvic floor and bowel health will be instructed so that participants can properly measure baseline and discharge outcomes.

Date And Locations
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