RECTAL EVALUATION & TREATMENT
300+
Sound Familiar?
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I'm not sure how to integrate rectal evaluation and treatment into my clinical practice
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I do rectal evaluations for "obvious" issues like GI or coccyx pain but don't know about using it for other patients
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How do I bring up rectal treatment with my patients?
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My patient is hitting a plateau and I don't know where to go next
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I'm not sure how to integrate rectal evaluation and treatment into my clinical practice
You're not alone! Rectal evaluation and treatment is a hugely important tool for pelvic PTs, and one that we aren't using as often or as well as we need to be to help our patients!
Rectal Evaluation & Treatment:
The Missing Half of the Pelvic Floor
For too long, transrectal work has been underutilized or saved for “GI-only” cases. This course changes that.
We give you the clinical reasoning, hands-on techniques, and patient communication skills to confidently treat the posterior pelvic floor and finally deliver care that’s truly comprehensive.
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The "Missing Piece"
Rectal evaluation + treatment is often a missing piece for pelvic pain, post-partum, orthopedic symptoms, and more—not just bowel complaints. It's a powerful tool for nearly every diagnosis we see.
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Say It Without the Weird
Build the language and confidence to talk about rectal work in a way that feels natural for both you and your patients.
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Confident, Skilled Technique
From bimanual work to prone positioning, learn exactly what to feel for, how to drape, and what to do next. No more "poking around"—just purposeful, evidence-based treatment you can stand behind.
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Implement with Confidence
Apply everything you learn with practical tools and demonstrations you can start using right away.
I'm Nicole Cozean - I've been where you are!
Like many pelvic health clinicians, I was initially taught to approach rectal treatment as a last resort—used only in “obvious” GI cases or skipped altogether.
But over time, I realized we were missing half the pelvic floor!
Once I started treating rectally with confidence, everything changed. My assessments became more complete. My outcomes improved. And patients started making progress where they had plateaued for months, even years.
This area doesn’t have to be intimidating. It’s powerful, it’s effective—and it’s absolutely essential. That’s why I created the Rectal Evaluation & Treatment course: to give you the confidence, clinical reasoning, and hands-on tools to integrate this work into your practice—without the awkwardness or uncertainty.
Can’t wait for you to join us!
What Do I Get With the Course?
The Rectal course is all online and at your own pace. You'll have lifetime access to the material and the ability to download specific handouts as you go through the material. This course is built to help you confidently incorporate rectal evaluation and treatment into your clinical practice to find the "missing piece" for your patients.
✅ When & Why to Go Rectal - Build clinical reasoning to confidently determine when rectal treatment is necessary and why it matters.
✅ Your Go-To Rectal Decision Tree - Quickly identify which patients can benefit from rectal work—even when it’s not “obvious.”
✅ The "Obvious" GI Issues - Learn rectal applications for constipation, incontinence, coccyx pain, and post-surgical care.
✅ Post-Natal Specific Insights - Rectal considerations for prolapse, painful intercourse, urinary incontinence, perineal tears and other post-natal issues.
✅ Pelvic Pain Deep Dive - Rectal considerations for IC, pudendal neuralgia, painful intercourse, endometriosis, vulvodynia, vaginismus and other pelvic pain.
✅ 'How To' Rectal - Bimanual treatment, positioning (not just side-lying!), draping, and other techniques.
✅ Rectal Anatomy Review - Anatomy is Evidence! Review the connections and anatomy better treated with rectal techniques.
✅ How to Talk About It - Scripts and strategies to bring up rectal care with confidence and clarity (without it feeling weird).
✅ Teaching Rectal Self-Care Techniques - Guide patients in safe, effective rectal self-care techniques they can use between sessions.
✅ 12 Full-Length Modules
✅ Bonus: Practice Assessment – Determine how well you're currently using rectal treatments in your practice.
✅ Bonus: Measurement Techniques – Discussion of the most important outcome measures for rectal issues.
✅ Lifetime Access – Self-paced, online format
Whether you're just starting with rectal work or ready to deepen your approach—this course gives you the tools, clarity, and confidence to integrate rectal treatment into your care with purpose and precision.
"Breaks Down the Awkwardness! Nicole teaches how to make rectal work feel normal for both you and your patients." - Kelly M.
"This course opened my mind to rectal evaluation for so many issues. The format is clear, and the online setup is super convenient." - Beatriz S.
Move beyond the basics with the Rectal Course.
What was the most important thing you learned?
1️⃣ “This course is immediately applicable and person-centered. Nicole goes beyond the basics of rectal work and shows you how to make it relevant and meaningful for every type of pelvic health diagnosis.” – Ginger G.
2️⃣ “An excellent course that walked me through rectal exam and treatment from beginning to end. I no longer feel like I’m guessing, I have a system and a strategy.” – Annette S.
3️⃣ “This course opened my mind to how much rectal evaluation and treatment can do. It gave me the structure to start using it routinely with patients who had been stuck for too long.” – Beatriz S.
4️⃣ “This course completely changed my understanding of why rectal treatment matters. I used to avoid it or only consider it in obvious cases. Now I use it as a primary tool.” – Meghan D.
5️⃣ “Nicole explains exactly why this skill is important and gives clear demonstrations that were actually better than a live course. I loved being able to pause and replay what I needed. I'm so glad I took it.” – Marci S.
6️⃣ “This was my first course focused on rectal evaluation and treatment, and I came out feeling ready. It helped me understand how this approach fits into full-spectrum pelvic floor care.” – Kayla H.
7️⃣ “I now get coccyx pain referrals from ortho colleagues who couldn’t figure it out. This course showed me how to use rectal treatment to finally help patients who couldn’t sit or drive comfortably.” – Maria D.
8️⃣ “The course clearly showed how rectal and vaginal assessments are not interchangeable. It gave me the tools to evaluate the entire pelvic floor more completely.” – Sandra B.
9️⃣ “Nicole helped me see how rectal could be the missing link for patients who weren’t improving. I now feel equipped to educate patients and offer the right treatment.” – Alexi C.
🔟 “I needed clarity on how to assess and treat rectally and this course gave me that plus the clinical reasoning behind it. I started using the techniques right away.” – Julie B.
Own your healing.
This is next-level rectal care.
Nicole Cozean
PT, DPT, WCS
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Founder of PelvicSanity Physical Therapy and Pelvic PT Rising
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Author of "The IC Solution"
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Run the Pelvic PT Rising Podcast
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Creator of the Pelvic PT Huddle
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Co-Founder of PelviCon, the first conference by and for pelvic rehab
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Named ICN Physical Therapist of the Year and first PT to serve on the ICA Board of Directors
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Chapman University Alumnae of the Year
Frequently Asked Questions
Is Herman & Wallace 2A or APTA 2 a prerequisite to this course?
Not at all! They have very different goals and information. Both H&W and APTA courses focus on how to treat GI and colorectal conditions, which does involve rectal treatment.
However, this course focuses on how we can integrate rectal treatment for ALL diagnoses (when appropriate), not just the "obvious" cases. This will teach you rectal considerations for pelvic pain, post-partum issues and orthopedic pain as well as for GI conditions.
This course also has specific and practical rectal treatment techniques like bi-manual treatment, different positions for your patient (not just treating everyone in side-lying), draping techniques, how to bring up rectal treatment with your patient, and more! It's a comprehensive guide to integrating rectal evaluation and treatment into your practice.
How is the course administered?
The entire course is done online and at your own pace. You have lifetime access to the material to review and reference as well! You can watch on either the computer or phone.
Are there patient demonstrations?
Yes! We do practical demonstrations on both pelvic models and real patients to give you the tools you need to confidently assess and treat rectally.
Is the course eligible for continuing education credits?
Yes, it's eligible for 12 contact hours! You'll receive a Certificate of Completion with the contact hours and are welcome to list it or submit it for credit (depending on your state requirements).
Of course, there is no obligation for you to submit it for CEUs if you choose not to.
How much experience do I need to take the course?
You don't need a certain amount of experience to get the most out of this course - we've had participants ranging from just a few months in pelvic health to participants with 10+ years and a WCS.
Remember, you'll also have lifetime access to the content, so if you want to go back and revisit it later, you always can!
Why is the course online instead of in-person?
We've taught the course in-person before, but doing so limits the number of people who can access the material! Keeping the course online also makes it more financially accessible. With more than 12 hours of content, this course (including travel, hotel and the course cost) would likely be more than $3,000 to take in-person.
Are there handouts and slides?
Yes! All Rising courses have downloads, slides and handouts to supplement the material and provide resources for you to be able to immediately apply your new knowledge.
Are all courses created and taught by Nicole?
Yes, all Rising courses are specifically created by Nicole to address major needs in the field. It's the material and framework she's taught to her own staff at PelvicSanity and to thousands of pelvic health practitioners (online and in person).
Are Rising courses eligible for continuing education credits?
We do not get con-ed credits pre-approved by any state for the Rising courses. You will receive a Certificate of Completion with the contact hours and are welcome to submit it for consideration yourself.
In general, with how inexpensive online con-ed credits are (at Medbridge you can get unlimited con-ed for $200 per year) we believe in getting your con-ed out of the way and being free to take the courses that will have the biggest impact for your patients and career.
Do I get a receipt and Certificate of Completion?
Yes! You'll immediately be emailed a receipt following your purchase (so check your email!).
After completing the course and filling out the Course Survey you'll receive your Certificate of Completion with the number of contact hours of the course. These generally are emailed out about two weeks after we receive your Course Survey.
"If you’ve ever struggled to explain rectal work to patients, this course is a must. Nicole gives you the language and tools to educate and
empower your patients." - Kristine G.
"This course helped me understand why some patients weren’t progressing with just vaginal work. Adding rectal has made a massive difference in both comfort and outcomes." - Jenna H.
In looking at our field, I believe one of our biggest limitations is how many of us aren't comfortable evaluating and treating rectally. It's literally half of the pelvic floor!
When I work with out-of-town patients or do remote consultations, I often find patients have been seeking treatment for years without a rectal exam! Or, if they've had one, it was a 'quick check' and never addressed again. For so many of our patients, this is a huge missing piece!
At best, we've taken something like H&W 2A or APTA 2, which focus almost exclusively on "obvious" uses of rectal in GI and colorectal issues. While this is important, it doesn't answer many of the most important questions:
Questions this course will answer include:
✔️ Which of our 'non-obvious' patients can benefit from rectal evaluation and treatment?
✔️ What are the unique considerations for pelvic pain diagnoses? Post-partum issues? "Orthopedic" complaints?
✔️ How do we actually perform a rectal evaluation and treatment? How do we use bimanual treatment to maximize effectiveness? How do we drape? How do we perform rectal treatment in more than just side-lying position?
✔️ How do we bring this up with patients? How do we educate properly?
✔️ How do we teach home care programs that incorporate rectal treatment?