SU101 - Consensus-Derived Statements on Pelvic Floor Physical Therapy for Treatment of Obstructed Defecation Syndrome from the ASCRS Pelvic Floor Disorders Consortium

Sunday, June 2, 2024

11:19 AM – 11:25 AM ET, USA

Location: Room 314-317

Abstract Podium Presenter(s)

Amber Traugott, MD (she/her/hers)

Associate Professor - Clinical
The Ohio State University Wexner Medical Center
The Ohio State University Wexner Medical Center
Columbus, OH, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

Craig H. Olson, MD FACS

Associate Professor
Texas A&M Medical School, Baylor Scott and White
Texas A&M Medical School
Dallas, TX, United States

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This individual has no financial relationships with ineligible companies.
Liliana Bordeianou, MD

Professor of Surgery
Harvard Medical School / Massachusetts General Hospital
Harvard
Boston

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This individual has no relevant relationships with ineligible companies.
JB

Julia Barten, DPT, PRPC

Physical Therapist
Stanford Health Care
East Palo Alto, California, United States

Disclosure information not submitted.
CC

Cristiane Carboni, PhD

Professor
UFRGS
Porto Alegre, Rio Grande do Sul, Brazil

Disclosure information not submitted.
GG

Gaetano Gallo, Department of Surgery, Sapienza University of Roma, Roma, italy

Assistant Professor
Department of Surgery, Sapienza University of Roma, Roma, italy
Roma, Lazio, Italy

Disclosure information not submitted.
LK

Leise R. Knoepp, MD, MPH

Senior physician
Ochsner Medical System
New Orleans, Louisiana, United States

Disclosure information not submitted.
MM

Meghan Z. Markowski Cucchiara, PT, DPT, WCS, BCB-PMD

Clinical Specialist and Clinical Lead Pelvic Health Physical Therapist
Brigham and Women's Hospital
Ashland, Massachusetts, United States

Disclosure information not submitted.
AM

Amanda McClure, FACS, FASCRS

Chair, Robotic Steering Committee
Trinity Health Ann Arbor
Ann Arbor, Michigan, United States

Disclosure information not submitted.
Anders Mellgren, MD, PhD

Chief, Colon & Rectal Surgery
University of Illinois
Chicago, Illinois, United States

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This individual has no financial relationships with ineligible companies.
WP

William Perry, MBChB MPH FRACS FACS FASCRS (he/him/his)

Assistant Professor
Mayo Clinic
Mayo Clinic
Rochester, MN, United States

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This individual has no financial relationships with ineligible companies.
AS

Allison Snyder, PT, CLT

Physical therapist
Massachusetts General Hospital
Arlington, Massachusetts, United States

Disclosure information not submitted.
Anna R. Spivak, DO (she/her/hers)

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland Clinic Foundation
Cleveland, Ohio, United States

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Katerina O.K. Wells, MD MPH

Colorectal Surgeon
Baylor University Medical Center, Dallas
Dallas, Texas, United States

Disclosure information not submitted.

Senior Author(s)

Brooke Gurland, MD, FACS, FASCRS

Clinical Professor of Surgery
Stanford University
Stanford Surgery
Stanford, California, United States

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This individual has no relevant relationships with ineligible companies.

Purpose/Background: Obstructed defecation syndrome (ODS) encompasses a variety of anatomic and functional pathologies that lead to impaired evacuation of stool. Pelvic floor physical therapy (PFPT) is frequently utilized in the treatment of ODS and posterior compartment prolapse, along with medical and surgical interventions. However, little guidance exists in the literature describing best practices for PFPT in the treatment of ODS and posterior compartment prolapse. The Pelvic Floor Disorders Consortium (PFDC), in collaboration with the International Urogynecology Association (IUGA), developed a set of recommendations on PFPT for the treatment of ODS. These statements achieved consensus by a multidisciplinary group of expert international pelvic floor surgeons and physiotherapists.

Methods/Interventions: Nine interdisciplinary workgroups were appointed from volunteer members of the PFDC, IUGA, and pelvic floor physiotherapists managing bowel dysfunction in their practice. Each workgroup focused on a subtopic on PFPT for the management of ODS or posterior compartment prolapse. Subtopics included referral process, treatment, timing of therapy, coordination of care, and educational resources. Workgroups conducted reviews of the literature and current practices, then created 3-4 proposed consensus statements specific to their subtopic. Statements were reviewed in person with a teleconference option by a larger interdisciplinary group of experts at the 2023 annual PFDC meeting hosted by ASCRS. Slido(R) voting software was used to gather feedback and facilitate discussion. Consensus was achieved if voting reached 70%. Statements reaching consensus were reviewed subsequently at the 2023 IUGA annual meeting for additional feedback.

Results/Outcomes: 188 expert participants specializing in colorectal surgery, urogynecology, urology, pelvic floor physiotherapy, and gastroenterology participated in the consensus meeting. Twenty-three (23) statements met consensus with more than 70% agreement, as listed in Table 1.

Conclusion/Discussion: Published data is sparse regarding best practices for PFPT in the treatment of ODS and posterior compartment prolapse. Our consensus statements confirm that PFPT with a physiotherapist trained in the management of bowel disorders is appropriate and recommended for patients with such disorders. The necessary requirements of such training are poorly standardized, as are some treatment-related techniques and terms. Anorectal testing was not necessary for referral to the physiotherapists. Duration of visits did not meet consensus and should be left to the discretion of the therapist. There is strong support for the treatment of ODS and posterior compartment prolapse in a patient-centered, multidisciplinary care model, requiring active communication amongst providers and sensitivity to patients’ needs for trauma-centered care. Such a model requires adequate support and engagement to be optimally effective. Future efforts should focus on developing evidence-based standards for PFPT bowel training and techniques, and on advocacy for appropriate resources to optimize the care of patients with these complex disorders.