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Pelvic Floor Level 2A - St. Louis, MO - September 27-29, 2013 (Sold Out)

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.
Level: Intermediate

Contact hours: 22.5 (CEUs vary by state)
Price: $695 (Early registrant price of $675 for registrations received one month before course start date.)
Prerequisites: Pelvic Floor 1, through Herman & Wallace or Pelvic PT 1 through the APTA is required. Exceptions to this policy may be granted on a case-by-case basis, to enquire about such exceptions please contact us.
Required Assignments and Readings


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This continuing education course is a three-day intermediate-level seminar designed as a next step in completing the clinicians’ ability to more comprehensively evaluate and treat the female and male pelvic floor. The participant will have the opportunity to learn about two common bowel dysfunctions, fecal incontinence and constipation, and how the pelvic rehabilitation provider can play a crucial role in overcoming these issues that affect quality of life so dramatically. In the US, adult estimates of fecal incontinence is over 8%, and greater than 15% in people over age 70. (Whitehead, 2010) According to the National Institutes of Health, constipation affects up to 15% of people, and is one of the most common gastrointestinal complaints that affects 42 million people. (Constipation, 2013) Pelvic rehabilitation providers are able to teach patients how to significantly improve quality of life through simple behavioral techniques and approaches that optimize abdominopelvic health.


Participants will learn how to evaluate the patient who presents with bowel dysfunction including fecal incontinence and constipation, and also with defecation disorders such as paroxysmal puborectalis, irritable bowel syndrome (IBS), and fecal urgency. Knowledge of pelvic anatomy expands into the gastrointestinal system with detailed instruction about the rectum and anal canal, anal sphincters, and with instruction in important physiologic principles such as the gastrocolic reflex, sampling response, and intrinsic defecation reflex. There are other conditions that can cause pain or bleeding such as hemorrhoids, fistulas, fissures, and proctalgia fugax; the clinician will learn how to apply skills of external and internal pelvic muscle assessement (via the anorectal canal) for these conditions.


Many pelvic rehabilitation providers attend this course to learn clinical skills for coccyx pain and for pudendal neuralgia, two conditions that are included on Day 2 of this continuing education course. As either condition can contribute to chronic pelvic pain, this course provides significant lab time so that participants will have the opportunity to practice any new skills. Day 3 of the course introduces the participant to pelvic rehabilitation of the male patient with an emphasis on topics of male pelvic anatomy, urinary incontinence, prostatectomy, and male pelvic pain. The content in this course prepares the therapist to work with male pelvic conditions by reinforcing what is common to the care of both men and women, as well as teaching that which is unique for the male patient. Current medical evaluation (with tests such as defecography, manometry), medical management (for anorectal pain and for colorectal conditions), and evidence-informed clinical interventions will be instructed.

Special Considerations:

As this continuing education course includes extensive lab work, all course attendees should come prepared to participate as both clinician and patient. Rectal pelvic floor muscle examinations will be taught in labs.


Constipation. (2013) National Institutes of Health. Retrieved January 22, 2014 from http://digestive.niddk.nih.gov/ddiseases/pubs/constipation
Whitehead, W. E., Borrud, L., Gode, P. S., Meikle, S., Mueller, E. R., Tuteja, A.,...Ye, W. (2009). Fecal incontinence in US adults: epidemiology and risk     factors. Gastroenterology, (137)2, 512-517.

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Upon completion of this continuing education seminar, participants will be able to:

1.   Describe anatomy of the colorectal region.
2.   Explain physiology of the gastrointestinal system including pathophysiology pertaining to bowel dysfunction.

3.   Perform examination and evaluation of pelvic floor function related to anorectal structures.
4.   Recognize types of fecal incontinence and develop plans of care for intervention including behavioral training and education.
5.   Recognize and treat constipation, name the signs, symptoms, and interventions for hemorrhoids, fissures, fistulas, and other common colorectal conditions.
6.   Identify specific pelvic floor muscles and key bony landmarks within the anorectal canal.
7.   Perform external and internal rectal myofascial treatment techniques such as Thiele’s massage and trigger point release.
8.   Perform patient education and behavioral training for constipation, fecal incontinence and pelvic pain syndromes.
9.   Describe and teach three SEMG downtraining (relaxation) strategies for the overactive pelvic floor.
10. Describe and demonstrate coccyx evaluation and treatment using internal and external coccyx mobilizations.
11. Describe male urogenital and pelvic floor anatomy, identify signs and symptoms of prostatodynia
12. List key medical diagnostic procedures for colorectal conditions.


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Day One:
8:00 Objectives and pre-test
9:00 Colorectal anatomy/ physiology, dysfunctions
10:00 Break
10:15 Ano-Rectal Examination /Muscle mapping
Lab: Side lying assessment/ visual inspection/ Muscle testing pelvic floor
11:30 Anal incontinence evaluation/ common medical tests/ outcome measures
12:30 Lunch
1:30 Treatment for Anal Incontinence Behavioral and Self care treatment / Bowel Training
3:00 Case Study - FI 3:30 SEMG Muscle Assessment for Incontinence
Lab: SEMG Practicum
4:30 Finish post test and review
5:00 Adjourn

Day Two:
8:00 Questions and pre-test
8:15 Overview colorectal conditions and the pelvic floor
9:45 Break
10:00 Constipation classification/ outcome measures
11:00 Constipation treatments (behavioral and exercise)
11:45 SEMG biofeedback treatment for constipation / pain conditions
Lab: SEMG practicum
12:45 Lunch
1:45 Coccyx dysfunctions
Lab: External coccyx techniques
3:00 Break
3:15 Internal rectal – coccyx assessment
Lab: Prone internal coccyx assessment. Muscle identification and treatments
4:30 Finish post test and review
5:00 Adjourn

Day Three:
8:00 Questions and pre-test
8:30 Male Pelvic Anatomy
9:30 Post prostatectomy incontinence evaluation & treatment guidelines
10:30 Break
10:45 Pudendal Nerve Entrapment (PNE) – sign symptoms history taking
11:45 Lab – Complete review of rectal techniques/bony landmarks
12:45 Lunch
1:30 Prostatodynia/Male Chronic Pelvic Pain
2:45 Break
3:00 Case Study – Male Pain/Questions
3:30 Finish post test
4:00 Adjourn


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Stacey Futterman, MPT

Stacey Futterman, PT, MPT, WCS, BCB-PMD

Stacey Futterman, PT, MPT, WCS, BCB-PMD certified, received her Master’s Degree in Physical Therapy from Nova Southeastern University in South Florida in 1996. After graduation she relocated to Chicago where she began specializing in women’s health issues including the treatment of incontinence, pelvic pain and prenatal/postpartum musculoskeletal issues. She returned to the east coast in 2003 and is now the owner of 5 Point Physical Therapy, a specialty physical therapy clinic for male and female pelvic dysfunction in New York City. Stacey, along side Dr. Deborah Coady, recently presented for International Pelvic Pain Society’s annual meeting in Chicago on their research of hip pathology and its relationship to pelvic pain. She has been featured on CBS New York and has presented for the APTA National Conference 2007 for the treatment of male pelvic pain.

Pamela A. Downey, MSPT, DPT, BCIA-PMDB

Pamela A. Downey, PT, DPT, WCS, BCB-PMD

Pamela A. Downey, PT, DPT, WCS, BCB-PMB, is a Board Certified Clinical Specialist in Women’s Health Physical Therapy and Board Certified in Biofeedback for Pelvic Muscle Dysfunction. Owner of Partnership in Therapy, a private practice in Coral Gables, Florida, she treats women and men with pelvic floor dysfunction, related urogynecological and colorectal issues, spine dysfunction, osteoporosis and complaints associated with pregnancy and the postpartum period. Her mission is to educate and integrate healthy lifestyles for patients on the road to wellness.

Dr. Downey has been honored to teach with the Herman and Wallace Institute since 2006. She is an Adjunct Professor in the Physical Therapy Program at the University Of Miami Miller School of Medicine in Coral Gables, Florida, and Nova Southeastern University in Fort Lauderdale, Florida. A certified Polestar Pilates Educator, she utilizes Pilates and therapeutic exercise interventions specifically designed for patients with pre/post-natal, pelvic floor muscle and other lumbo-pelvic pain-related dysfunctions.

Dr. Downey received her Bachelor of Arts from Sarah Lawrence College and her Master of Science and Doctorate in Physical Therapy from the University of Miami School Of Medicine. She is actively involved in professional activities of the Section on Women’s Health of the American Physical Therapy Association, presently sitting as Coordinator of Research Submissions for annual meetings and as a manuscript reviewer for the Journal of Women’s Health. Dr. Downey has lectured nationally and internationally at professional conferences and is the author of multiple published research articles and a book chapter on chronic pelvic pain in the medical text, Women’s Health in Physical Therapy.

Course Location
Additional info
Washington University School of Medicine

Street Address:
4444 Forest Park Avenue
St. Louis, MO 63108
(Map will open in a new window)

Recommended Lodging:

The Parkway Hotel
(314) 256-7777

H&W makes a best effort to find recommended lodging for participants. However, our primary focus is the excellence of the course itself. Participants are encouraged to explore travel options and make the best choice to fit their needs. Hotels.com, Hotwire.com and similar sites may also offer excellent deals to save on travel costs.

Nearest Airport:

Lambert – St. Louis International Airport
(map will open in new window)

Transportation to the course:

The Parkway is one block from the course site. There is also Metrolink transportation to and from the course. The St. Louis Metro Link (mass transit system) is only 1 ¼ blocks from our Hotel. It provides inexpensive transportation from the airport and throughout the city.



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Herman & Wallace is not able to apply discounts retroactively! Please contact us BEFORE registering if you are eligible for one of the discounts below.

Discounts Currently Available for this Event:

Multi-Course Discount (10%)
Group Discount (10% - 20%)
JTA Survey Credit/Discount ($50)
Student Discount (10%)
Retake/Audit Discount ($100)