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2019 Pelvic Health Physical Therapy Level 2 *Bowel Dysfunction* - St. Louis, MO
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9/14/2019 to 9/15/2019
When: September 14-15, 2019
7:30 AM
Where: Washington University in St. Louis Physical Therapy Program
4444 Forest Park Ave
Room 2700
St. Louis, Missouri  63108-2212
United States
Contact: SoWH Office

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Course Description & Objectives

This evidence-based 2-day course provides clinically relevant information and training in the examination, evaluation and intervention of bowel dysfunction. Labs offer skills immediately applicable in the clinic and include complete internal rectal pelvic floor muscle and external abdominopelvic examination and treatment techniques. Lectures include the anatomy, pathophysiology and physical therapy evaluation/treatment of pelvic floor dysfunction-related bowel dysfunction. Concepts of pelvic floor muscle motor control training, rectal balloon training, coccygeal mobilization, and clinical application of modalities will be reviewed. Clinical decision-making and an integration of skills acquired at CAPP Pelvic Health Level 1 will be included.

Upon the completion of this course, participants will be able to perform the following:


  1. Describe the anatomic, physiologic and neurological components of defecation and dysfunctional defecation.
  2. Perform an appropriate evaluation of a patient with bowel disorder diagnoses to include fecal and anal incontinence, irritable bowel syndrome, constipation and obstructed defecation.
  3. Demonstrate ability to perform rectal pelvic floor muscle examination for patients with bowel dysfunction.
  4. Assess coccygeal function and joint mechanics for patients with pelvic pain or bowel dysfunction.



  1. Differentiate between musculoskeletal impairments related to bowel dysfunction and signs and symptoms associated with non-musculoskeletal pathology requiring further medical examination.
  2. Develop functional goals for musculoskeletal impairments identified in patients with bowel disorders based on a systematic interview and examination of the patient.
  3. Demonstrate understanding of colon and anorectal function testing for bowel disorders.



  1. Develop an evidence-based and appropriate plan of care for physical therapy intervention of musculoskeletal impairments for patients with bowel dysfunction.
  2. Perform manual myofascial release techniques, trigger point release techniques, coccyx mobilization for the treatment of patients with bowel dysfunction.
  3. Describe and perform appropriate clinical application of surface electromyographic (sEMG) biofeedback for bowel dysfunction diagnoses.
  4. Describe and perform appropriate clinical application of digital rectal biofeedback and rectal balloon biofeedback as an intervention for patients with bowel dysfunction.
  5. Provide behavioral intervention strategies to improve bowel function such as diet, lifestyle changes, and proper toileting techniques and posture.



2-day Bowel Dysfunction Version

Day 1: 7:30 am – 5:30 pm *Registration begins at 7:00 AM*
Day 2: 7:30 am – 5:30 pm

Contact Hours: 17.25 hours



Open to: Licensed Physical Therapists, Physical Therapist Assistants, 2nd Year and 3rd Year Student Physical Therapists*

We recommend students have some orthopedic/musculoskeletal coursework in their curriculum prior to attending the course.

Pre-requisites: Successful completion of the Pelvic Health Physical Therapy Level 1 course. Experience of 6 months or more in regularly managing patients with pelvic physical therapy, or working in a clinic with other experienced pelvic physical therapists, is strongly recommended prior to attending this course; lack of experience may greatly inhibit participant comprehension and attainment of skills during the course.

Attendance: Participants are expected to stay through the entire course; please make your travel plans accordingly. Deduction of contact hours hours and ineligibility to participate in the CAPP process (for those attending CAPP courses) will occur for participants who leave the course early.

Lab Participation & Consent: Participants will be working in groups of 2 during labs. This course includes extensive labs with intra-vaginal & intra-rectal assessment & examination. The Internal Consent & Release Form.pdf must be filled out and turned in to the instructor on Day 1 of the course (this form is provided on-site). If the course participant does not turn in the completed form on Day 1, he/she will not be permitted to take the course. All participants must participate in labs as both “therapist” & “patient.” Participants who cannot participate as lab subjects are required to provide their own lab partners. Failure to participate as a lab subject, or to provide required lab partner if needed, will result in forfeiture of course completion and registration costs. If you are not sure whether you need a medical model or if you are unfamiliar with the process of obtaining a medical model, please read: Medical Models for Internal Pelvic Assessment.pdf. Participants that MUST provide their own lab partners include (but are not limited to):

  • ALL Male participants
  • Pregnant women (except with written physician permission for FULL participation)
  • Active vaginal infections
  • Active STD or herpes lesions
  • Active bladder or rectal infections
  • Severe pelvic/vaginal/rectal pain that inhibits examination
  • Lack of prior vaginal exam by a physician
  • Active OB/GYN cancer

Pre-Reading AssignmentsPre-readings are articles and cases that must be read and reviewed prior to Day 1 of the course. Pre-readings will be provided electronically to course participants prior to the course.

English Language Proficiency: If you are a foreign-educated physical therapist/assistant, you will need to pass the TOEFL(Test of English as a Foreign Language) and meet the score requirements. There are some exemptions to the TOEFL requirement for individuals who are exempt under the USCIS regulations. TOEFL scores must be reported directly to SoWH for the purposes of determining eligibility for course attendance. The minimum TOEFL scores we require are the following: Reading: 21; Listening: 18; Writing: 24; Speaking: 26.