Subscribe to RSS
DOI: 10.1055/s-0045-1804526
Clinical Collaboration Commentary: Breaking Down the Role of Pelvic Health Physical Therapy in Colorectal Care
Funding None.
Abstract
Pelvic health treatment demands an understanding of multiple pelvic subspecialties to adequately address. While there are many providers who identify as pelvic health physical therapists, not all are sufficiently able to manage bowel dysfunction. There is a limited number of certified pelvic health specialists within the United States. The goal of this clinical commentary is to break down the role pelvic health physical therapy (PHPT) plays in treatment for colorectal care. The “background” provides insight into the physical therapy (PT) education process and pelvic health specialization. The “methods” discuss PHPT treatment including patient education, examination techniques, value of tests and images, as well as common colorectal conditions. A table summarizes possible findings and treatment considerations for common colorectal conditions, methods for optimizing pelvic floor muscles (PFMs) are discussed, and pelvic devices are explained. The “results” of referring patients and expectation for goals is reviewed along with a “discussion” of room for improvement and “conclusion” of important takeaways. The depth of the vast subjects covered shall only be briefly summarized in this clinical commentary with the hope that it provides context, explanations, recommendations, and leads to future discussions and research that includes PHPT.
Keywords
pelvic health physical therapy - bowel health - patient education - pelvic floor coordination - rehabilitationPublication History
Article published online:
24 February 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Gurland B, Mishra K. A collaborative approach to multicompartment pelvic organ prolapse. Clin Colon Rectal Surg 2021; 34 (01) 69-76
- 2 Gurland B. ASCRS Pelvic Floor Consortium 2023 Meeting. Paper presented at: American Society of Colorectal Surgery Annual Scientific Meeting; June 3, 2023; Seattle, WA.
- 3 Gurland B. ASCRS Pelvic Floor Consortium 2024 Meeting. Paper presented at: American Society of Colorectal Surgery Annual Scientific Meeting; June 1, 2024; Baltimore, MD.
- 4 Cline SA, McLaughlin K, Arnold N, Austin MM. Distribution of certified pelvic health physical therapists across the United States. J Womens Pelvic Health Phys Ther 2024; 48 (04) 242-248
- 5 APTA Pelvic Health. Live Course Descriptions. Accessed October 29, 2024 at: https://www.aptapelvichealth.org/course-descriptions
- 6 Herman and Wallace. Continuing Education Courses. Accessed October 29, 2024. https://hermanwallace.com/continuing-education-courses
- 7 APTA. Becoming a Physical Therapist. Accessed February 6, 2025 at: https://www.apta.org/your-career/careers-in-physical-therapy/becoming-a-pt
- 8 APTA. Transition DPT FAQs. Accessed February 6, 2025 at: https://www.apta.org/your-career/career-advancement/postprofessional-degree/transition-dpt-faqs
- 9 Huddleston OL. Principles of neuromuscular reeducation. J Am Med Assoc 1954; 156 (15) 1396-1398
- 10 APTA. APTA 100 Milestones of Physical Therapy. Accessed February 6, 2025 at: https://timeline.apta.org/
- 11 APTA. Vision, Mission, and Strategic Plan. Accessed February 6, 2025 at: https://www.apta.org/apta-and-you/leadership-and-governance/vision-mission-and-strategic-plan
- 12 APTA. Become a Board-Certified Women's Health Clinical Specialist. Accessed February 6, 2025 at: https://specialization.apta.org/become-a-specialist/womens-health
- 13 APTA Pelvic Health. About Us: Academy of Pelvic Health Physical Therapy (APTA Pelvic Health). Accessed February 6, 2025 at: https://www.aptapelvichealth.org/about
- 14 APTA Pelvic Health. Residency Education. Accessed February 6, 2025 at: https://www.aptapelvichealth.org/residencies
- 15 Herman and Wallace. Pelvic Rehabilitation Practitioner Certification - PRPC. Accessed February 6, 2025 at: https://hermanwallace.com/pelvic-rehabilitation-practitioner-certification
- 16 Herman and Wallace. PRPC and ABPTS Comparison Chart. Accessed February 6, 2025 at: https://hermanwallace.com/pelvic-rehabilitation-practitioner-certification
- 17 Tian C, Champlin S, Mackert M, Lazard A, Agrawal D. Readability, suitability, and health content assessment of web-based patient education materials on colorectal cancer screening. Gastrointest Endosc 2014; 80 (02) 284-290
- 18 Jacobson CE, Suwanabol PA. Readability of patient education materials from the american society of colon and rectal surgeons website: an opportunity to improve health care access and quality. Dis Colon Rectum 2023; 66 (07) 865-868
- 19 Krebs P, Norcross JC, Nicholson JM, Prochaska JO. Stages of change and psychotherapy outcomes: a review and meta-analysis. J Clin Psychol 2018; 74 (11) 1964-1979
- 20 Azpiroz F, Enck P, Whitehead WE. Anorectal functional testing: review of collective experience. Am J Gastroenterol 2002; 97 (02) 232-240
- 21 Palit S, Lunniss PJ, Scott SM. The physiology of human defecation. Dig Dis Sci 2012; 57 (06) 1445-1464
- 22 Barber MD, Chen Z, Lukacz E. et al. Further validation of the short form versions of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ). Neurourol Urodyn 2011; 30 (04) 541-546
- 23 de Arruda GT, Dos Santos Henrique T, Virtuoso JF. Pelvic floor distress inventory (PFDI)-systematic review of measurement properties. Int Urogynecol J 2021; 32 (10) 2657-2669
- 24 Parcella S. The Ankle Bone is Connected to the Pelvic Floor Muscle Function. November 8, 2018. Accessed February 6, 2025 at: https://pelvicpainrehab.com/blog/the-ankle-bone-is-connected-to-the-pelvic-floor-muscle-function/
- 25 Chen CH, Huang MH, Chen TW, Weng MC, Lee CL, Wang GJ. Relationship between ankle position and pelvic floor muscle activity in female stress urinary incontinence. Urology 2005; 66 (02) 288-292
- 26 Bø K, Anglès-Acedo S, Batra A. et al. International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training. Int Urogynecol J 2022; 33 (10) 2633-2667
- 27 Madhu C, Swift S, Moloney-Geany S, Drake MJ. How to use the Pelvic Organ Prolapse Quantification (POP-Q) system?. Neurourol Urodyn 2018; 37 (S6): S39-S43
- 28 Laycock J, Jerwood D. Pelvic Floor Muscle Assessment: The PERFECT Scheme. Physiotherapy 2001; 87 (12) 631-642
- 29 da Silva JB, de Godoi Fernandes JG, Caracciolo BR, Zanello SC, de Oliveira Sato T, Driusso P. Reliability of the PERFECT scheme assessed by unidigital and bidigital vaginal palpation. Int Urogynecol J 2021; 32 (12) 3199-3207
- 30 Bø K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther 2005; 85 (03) 269-282
- 31 Navarro Brazález B, Torres Lacomba M, de la Villa P. et al. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: a reliability and correlation study. Neurourol Urodyn 2018; 37 (01) 269-277
- 32 da Silva JB, de Oliveira Sato T, Rocha APR, Driusso P. Inter- and intrarater reliability of unidigital and bidigital vaginal palpation to evaluation of maximal voluntary contraction of pelvic floor muscles considering risk factors and dysfunctions. Neurourol Urodyn 2021; 40 (01) 348-357
- 33 Lee TH, Bharucha AE. How to perform and interpret a high-resolution anorectal manometry test. J Neurogastroenterol Motil 2016; 22 (01) 46-59
- 34 Gurland BH, Khatri G, Ram R. et al; Members of the Expert Workgroup on Magnetic Resonance Imaging of Pelvic Floor Disorders. Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. AJR Am J Roentgenol 2021; 217 (04) 800-812
- 35 Sharma A, Rao S. Constipation: pathophysiology and current therapeutic approaches. Handb Exp Pharmacol 2016; 239: 59-74
- 36 Rao SSC, Ahuja NK, Bharucha AE. et al. Optimizing the utility of anorectal manometry for diagnosis and therapy: a roundtable review and recommendations. Clin Gastroenterol Hepatol 2023; 21 (11) 2727-2739.e1
- 37 Rao SS, Bharucha AE, Chiarioni G. et al. Functional anorectal disorders. Gastroenterology 2016; S0016-5085 (16)00175-X
- 38 Heinrich H, Fruehauf H, Sauter M. et al. The effect of standard compared to enhanced instruction and verbal feedback on anorectal manometry measurements. Neurogastroenterol Motil 2013; 25 (03) 230-237 , e163
- 39 Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 1991; 165 (02) 322-327 , discussion 327–329
- 40 Frawley H, Shelly B, Morin M. et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 2021; 40 (05) 1217-1260
- 41 Cormie P, McGuigan MR, Newton RU. Developing maximal neuromuscular power: Part 1–biological basis of maximal power production. Sports Med 2011; 41 (01) 17-38
- 42 Cayco CS, Labro AV, Gorgon EJR. Hold-relax and contract-relax stretching for hamstrings flexibility: a systematic review with meta-analysis. Phys Ther Sport 2019; 35: 42-55
- 43 Kay AD, Husbands-Beasley J, Blazevich AJ. Effects of contract-relax, static stretching, and isometric contractions on muscle-tendon mechanics. Med Sci Sports Exerc 2015; 47 (10) 2181-2190
- 44 Charlanes A, Chesnel C, Jousse M. et al. Verbal instruction to obtain voluntary pelvic floor muscle contraction: acceptability, and understanding. Prog Urol 2021; 31 (04) 231-237
- 45 Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. J Neuroeng Rehabil 2013; 10: 60
- 46 KEGEL Perineometer. J Am Med Assoc 1954; 154 (08) 679
- 47 Kegel AH. Physiologic therapy for urinary stress incontinence. J Am Med Assoc 1951; 146 (10) 915-917
- 48 Lake DA. Neuromuscular electrical stimulation. An overview and its application in the treatment of sports injuries. Sports Med 1992; 13 (05) 320-336
- 49 Dias LV, Cordeiro MA, Schmidt de Sales R. et al. Immediate analgesic effect of transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) on chronic low back pain: randomised placebo-controlled trial. J Bodyw Mov Ther 2021; 27: 181-190
- 50 Yang DY, Zhao LN, Qiu MX. Treatment for overactive bladder: a meta-analysis of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation. Medicine (Baltimore) 2021; 100 (20) e25941
- 51 Horrocks EJ, Thin N, Thaha MA, Taylor SJC, Norton C, Knowles CH. Systematic review of tibial nerve stimulation to treat faecal incontinence. Br J Surg 2014; 101 (05) 457-468
- 52 Sadeghi A, Akbarpour E, Majidirad F. et al. Dyssynergic defecation: a comprehensive review on diagnosis and management. Turk J Gastroenterol 2023; 34 (03) 182-195
- 53 Tantiphlachiva K, Rao P, Attaluri A, Rao SSC. Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clin Gastroenterol Hepatol 2010; 8 (11) 955-960
- 54 Paquette IM, Varma M, Ternent C. et al. The American Society of Colon and Rectal Surgeons' Clinical Practice Guideline for the Evaluation and Management of Constipation. Dis Colon Rectum 2016; 59 (06) 479-492