Experience Level: Intermediate
Contact Hours: 21 hours
This is a satellite offering of our course, Pelvic Floor Level 2A. A satellite means that participants will be gathering in a given location and watching the instructor present remotely on the same screen. During labs, participants will pair up and be guided by the local lab assistants at the satellite course location.
This continuing education course is comprised of 7 hours and 45 minutes of prerecorded lectures followed by 14 hours of live, interactive remote learning and is an 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 the quality of life so dramatically. In the US, the estimate of adult 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 assessment (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 in 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. The course also 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.
Please note, the Pelvic Floor series of courses typically fill up about 2-3 months before the scheduled course date. Satellite lab courses are often limited to very small groups of around ten, meaning seats are scarce. It is highly recommended you sign up as soon as you are able so you do not miss out on a seat. It is expected that participants will only register for satellites in which they are within driving distance, and adhere to all state and local COVID guidelines, including wearing a mask at all times during the course.
As this continuing education course includes extensive lab work, all course attendees should come prepared to participate as both clinician and patient. Vaginal pelvic floor muscle examinations will be taught in labs. Labs will be conducted under the supervision of instructors and teaching assistants. There will be a ratio of at least one instructor/assistant for every ten participants. Past participants have found that wearing comfortable clothing that is easy for changing (such as skirts or athletic shorts) is very useful for labs. Due to temperature variations from clinic to clinic we would recommend wearing comfortable layers.
The Herman & Wallace Institute welcomes all professionals who are appropriately licensed at our courses. Being born with a vagina and other female anatomy is not a prerequisite for attending or participating fully in our courses. No one participant will be required to partner with any other one participant during labs.
Vaginal examination and internal myofascial manual therapy prior to 32 weeks gestation is not the common standard of medical practice. Participants who are pregnant who wish to participate fully in the entire course including in lab must bring a clearance letter from their physician allowing them to participate in the labs is required. Participants who are pregnant also have the option of bringing their own lab model for examination, or they have the option of working in a group of three during lab times.
PLEASE NOTE: This course includes internal assessment and exam techniques, which will be practiced in partnered pairs in lab time. H&W strives to foster an environment that is safe and supportive. Survivors of past trauma should be aware that performing or experiencing internal exam may be triggering, and that many, regardless of their histories, feel strong emotions when practicing these techniques. In order to foster an environment that is non-triggering and safe for all participants, we recommend all participants consider the emotional impact they may experience during the course, and consider consulting a trauma counselor or therapist prior to attending. Read more about What to Expect During Courses with Internal Lab Work.
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.
Pelvic Floor Level 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 inquire about such exceptions please contact us.
1. The National Digestive Diseases Information Clearinghouse Handout on Fecal Incontinence
2. The National Institute of Diabetes and Digestive and Kidney Diseases Article on Constipation
3. The International Pelvic Pain Society Article on Pudendal Nerve Entrapment (PNE)
4. The European Urology Association'sGuidelines on Chronic Pelvic Pain
5. Principles of Biofeedback from Professor Tim Watson's website electrotherapy.org
Gray's Anatomy for Students - Available at a 25% Discount for Herman & Wallace registrants with promo code 70484. Registrants who already own a copy of this or a corresponding textbook are not required to purchase an additional one.
Additional Helpful Resources:
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
Recorded Lecture: Watch Before the Live Component of the Course
1. Colorectal Anatomy & Physiology (75 Min)
2. Medical Testing & Rehab Examination (45 Min.)
3. Fecal Incontinence (60 Min.)
4. Constipation (60 Min.)
5. Anatomy: Pelvic Floor, Penis, Scrotum & Contents (60 Min.)
6. Pudendal Nerve Dysfunction (45 Min.)
7. Topics in Inclusive Care (60 Min.)
8. Colorectal Conditions (45 Min.)
15 min. prior to start-time: Log in to Zoom Meeting, Zoom basic and etiquette, roll call
0:00 Questions from Day 1, Post-test Day 1
Notice this schedule starts each day at 0:00. The course does not start at mid-night! This schedule is meant to show the duration of each component of the course, not the actual start-time of each lecture. The actual start time of this a given day's Zoom meeting of this course will appear in the title of the remote course page on our website, as well as in the Teachable sections of the course in which you are registered.
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.
Destiny Bochinski, PT, DPT
Destiny is originally from Oregon but relocated to southern California after earning her Bachelor’s in Biology from Linfield College, where she also minored in Theatre Arts. She then went on to earn her Doctor of Physical Therapy from Chapman University in 2008. She developed a passionate interest in pelvic health when she attended the midwife-assisted home births of her two nephews. Since then, she has enjoyed educating patients, colleagues, physicians, nurses, and the community through in-services, classes, and podcasts delivered in a variety of venues. She is thrilled to be part of the faculty at Herman & Wallace.
Destiny treats men and women with urinary, gynecologic, colorectal, and orthopedic dysfunctions as the lead pelvic health physical therapist at a hospital-based outpatient clinic in Encinitas, California. She believes her primary role is as an educator for her patients to empower them to become advocates for their own health and active participants in their rehabilitation.Outside of work, Destiny enjoys spending time with her 2 children and husband, hiking, swimming, yoga, and tasting wine.