Lila Abbate PT, DPT, OCS, WCS, PRPC is the creator and instructor of Bowel Pathology, Function, & Dysfunction and Coccydynia and Painful Sitting. She also co-wrote the course Pudendal Neuralgia and Nerve Entrapment with fellow H&W faculty member Pamela Downey. 

Often pelvic health physical therapists are nervous about treating patients with bowel dysfunction and constipation. Lila Abbate's mentor, Elise Stettner, is proud to be a PT who treats bowel conditions. “Any PT can treat urinary symptoms. The patients who are really suffering are those with bowel dysfunctions.” She passed this passion on to Lila, who is the creator and instructor of the Bowel Pathology, Function, & Dysfunction scheduled next on November 13-14, 2021.

Bowel dysfunctions and constipation are often embarrassing for those who suffer from them and thus are often under-reported, which may lead to statistical underrepresentation. The statistics that we do have show that the average prevalence of constipation worldwide in adults is 16%, and for adults over the age of 60 is over 33.5%. (1) Everyone has a different normal for bowel habits which makes it hard to define a normal frequency. Constipation can generally be defined as less than three bowel movements per week and can present as infrequent bowel movements or difficult passage of stools that lasts for several weeks.

There are many potential facets to pelvic floor muscle problems concerning constipation. Lila shares that she recommends that therapists provide a muscle activity assessment in a sitting position, and can even utilize computerized-biofeedback, with the patient's hip and knees at different heights can help determine the best position for muscle relaxation during defecation. At times, it can also be useful to incorporate abdominal massage in resolving a patient's constipation. Abdominal massage for bowel function is useful in motivating peristalsis in the gut, plus there are no known side effects. This is a safe and non-invasive way to manage constipation and can be taught to the patient for them to perform on their own as needed.

In the Bowel Pathology, Function, & Dysfunction Remote Course Lila focuses on teaching registrants about the details of normal gut motility, bowel function, medical tests, and medications relating to diagnosing and treating the medical side of bowel dysfunction. Some of the highlighted lectures are about fecal incontinence, chronic constipation, and abdominal pain and how they relate to pelvic floor muscle dysfunction and physical therapy interventions. 

Also commonly encountered in pelvic rehabilitation practices are patients with coccyx pain. You may not think of constipation when treating coccydynia. However, defecation is one of the functional complaints that can be present. The coccyx can interfere with defecation as documented in a case study by Salar et al. They reported that the patient presented with an anteverted coccyx, and complained of "worsening rectal pain developing an hour before defecation and lasting for several hours afterward.” (2)

Lila Abbate also instructs the Coccydynia and Painful Sitting Remote Course. This course is a 1-day deep dive into treating patients who complain of coccyx pain with sitting and defecation. Lila shares that "The coccyx course is orthopedically-based and. I take my love of manual, osteopathic treatment, and combine it with the women’s health internal treatment aspects so that we can move more quickly to get patients back on the path to improved function and recovery." 

When asked about the approach she took in creating the course, Lila explains, "this course looks at patients from a holistic approach from the top of their heads down to their feet. In taking on the topic of coccydynia, I focused on honing basic observation skills and using some of my favorite tools in my toolbox. These include the Hesch Method, integrated systems model, traditional osteopathic, and mobilization approaches mixed with internal vaginal and rectal muscle treatment skill sets."

Join faculty member Lila Abbate this November at her upcoming course  Bowel Pathology, Function, & Dysfunction scheduled for November 13-14, 2021, or plan ahead and register for the Coccydynia and Painful Sitting Remote Course scheduled for February 4, 2022.

1.  Forootan, M; Bagheri, N; Darvishi, M. Chronic Constipation: A review of the literature. Medicine (Baltimore) 2018: May. PMID: 29768326 PMCID: PMC5976340 doi:10.1097/MD.0000000000010631
2. Salar et al.: Defecation pain and coccydynia due to an anteverted coccyx: a case report. Journal of Medical Case Reports 2012 6:175. doi:10.1186/1752-1947-6-175