2026 Urogynecology for the Advanced Practice Provider-Concurrent Session 2

Video Transcription

Video Summary

The transcript featured three related lectures on bowel and pelvic floor disorders.<br /><br />First, Dr. Schaefer-Mock discussed traditional, evidence-based, and functional medicine approaches to IBS. He emphasized that IBS should not always be treated as a stand-alone diagnosis, but often reflects underlying problems such as food sensitivities, SIBO/SIFO, dysbiosis, leaky gut, brain-gut axis dysfunction, or maldigestion. He reviewed guideline-based evaluation for red flags and tests to rule out celiac disease, inflammatory bowel disease, giardia, and bile acid diarrhea. He also explained the “5 R” functional medicine framework: remove, replace, reinoculate, repair, and rebalance. Treatments included low-FODMAP and other diets, food sensitivity testing, antimicrobial and antifungal therapies, enzymes, probiotics, microbiome strategies, and mind-body approaches like CBT, hypnotherapy, deep breathing, and vagus nerve exercises.<br /><br />Next, Dr. Lisa Hickman presented on accidental bowel leakage. She defined fecal and anal incontinence, reviewed prevalence and impact, and explained continence physiology. She outlined causes such as obstetric injury, diarrhea, constipation with overflow, neurologic disease, and rectal pathology. Evaluation includes detailed history, stool consistency assessment, physical exam, questionnaires, and sometimes imaging. Management focuses on education, stool optimization, fiber, antidiarrheals, bile acid binders, pelvic floor physical therapy, biofeedback, devices, injections, sphincteroplasty, and sacral neuromodulation.<br /><br />Finally, Dr. Duarte Thibault reviewed diagnostic testing for defecatory disorders. She explained when to use anorectal manometry, defecography, endoanal ultrasound, and colonic transit studies. These tests help distinguish dyssynergia, rectal prolapse, sphincter defects, and slow-transit constipation, guiding treatment and pelvic floor therapy.

Asset Subtitle

1. Traditional Evidence-Based and Functional Medicine Approaches to Irritable Bowel Syndrome (IBS)

- Speaker: Shaffer Mok, MD

At the end of this lecture, learners will be able to:

Define IBS and its' subtypes
Properly diagnose IBS and rule out differential disease
Identify the diagnostic modalities
Know traditional medical therapies
Have a functional medicine perspective to IBS

2. Accidental Bowel Leakage: Evidenced-based Diagnosis and Management

- Speaker: Lisa Hickman, MD

The learning objectives for this session are:

To understand the normal anatomy and physiology of anal continence
To review the epidemiology and risk factors for accidental bowel leakage
To appreciate the evaluation and management of accidental bowel leakage

3. Mastering Diagnostic Tools for Defecatory Disorders

- Speaker: Mary Duarte Thiabault, MD

This lecture reviews the proper use of diagnostic tools for defecatory dysfunction and equips participants with the foundational skills to interpret study results.

Learning Objectives:

Define the clinical indications for anorectal manometry, defecography, Sitz marker studies, and endoanal ultrasound.
Describe standard techniques used to perform each of these diagnostic evaluations.
Interpret key findings from anorectal physiology and pelvic floor imaging studies.

Keywords

irritable bowel syndrome

IBS

functional medicine

food sensitivities

SIBO

dysbiosis

leaky gut

fecal incontinence

anal incontinence

pelvic floor disorders

anorectal manometry