Long before I ever thought of physical therapy, before I knew what a pelvic floor was, I had a favorite picture book as a child titled “Everyone Poops.” Perhaps, even you read it yourself. Picture after picture of different animals and their piles of poop made me giggle, and I marveled at how even the tiniest ant pooped as I did.

But, what I didn’t know until I became a pediatric therapist, is that everyone 

poop with ease. And, even more importantly, the number of children affected by constipation and/or related urinary incontinence. According to van den Berg et al, up to 30 percent of children suffer from constipation and accounts for approximately 3% to 5% of all visits to pediatricians. Chronic constipation can result in a variety of long-term and short-term impairments including progressive bowel issues, enlarged rectum, colon dysfunction, and urinary incontinence at either daytime or nighttime.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), by 5 years of age, over 90% of children have daytime bladder control. However, that leaves 10% of children over the age of 5 with daytime or nighttime leaks or complete incontinence.

With all that said, you might be asking yourself “how can a physical therapist help my child with their bowel and bladder problems?” I would have to agree it sounds a little out of the box. When I first became a pediatric therapist, I never saw myself impacting the way kids can void and manage their bathroom time. But, with lots of research, additional training, and a whole lot of love, I’ve been able to work with families and kids to achieve their goals and resolve daily leaks, decreased awareness of when they need to void, nighttime leaks, and constipation. How? By specifically targeting a group of muscles called the 

I like to tell parents to think of their child’s pelvic floor as a bowl. It sits at the base of the pelvis, and like a bowl, holds in liquids such as urine or solids such as feces. Now, imagine that the bowel is made out of really thin paper, or in other words is 

Do you think it would still hold in liquids well? I’d say not. A weak pelvic floor can result in leaks, daytime or nighttime, or urgency, i.e. when your child does the “potty dance” and can hardly make it to the bathroom in time. Together with other core muscles, the pelvic floor plays a role in posture, breathing, and relaxation for when we actually do need to use the restroom.

Which brings us to constipation. When the pelvic floor muscles are overactive or have trouble relaxing, your child may experience painful bowel movements or straining. This can result in withholding patterns, and over time causes chronic constipation. Chronic constipation can also lead to incontinence or leakage, as an impacted bowel press on our bladder and urethra.

But, how might a Physical Therapist address these issues, and what does a pelvic floor PT session look like?

First, an evaluation would occur. This would include:

●  Current voiding patterns such as when and how often

●  Current concerns you have for your child

●  A postural assessment in sitting, standing, and lying

, visual inspection of your child’s perineum

●  Discussion with you and your child about voiding awareness

Once you and your therapist determine what needs your child has, you meet with your therapist on a weekly or twice weekly basis.

This is where it gets tricky; pelvic floor therapy is a commitment. It requires additional homework for you as a parent, with various strategies, charts, and logs completed in order to best monitor your child’s progress. BUT, the end result is wholly worth it.

So what does the therapist do exactly? Your therapist will implement a variety of techniques, including core strengthening, biofeedback, SEMG biofeedback, games, pictures, and relaxation techniques to get your child engaged and their muscles working correctly. Each week, activities will progress or change to further challenge your child and achieve their goals.

Thinking your child might need pelvic floor therapy? Great candidates for this type of therapy include

●  Children leaks or “accidents” after being toilet trained for at least 1 year

●  Children that are having difficulty toileting training past age 5

●  Children experiencing leaks at night

●  Children with diagnosed constipation

●  Children who need >5-10 minutes to complete their bathroom routine

●  Children who report pain or discomfort when urinating or having a bowel movement

●  Children or adolescents who leak with activity, such as sports, jumping, running, or giggling

●  Children who have difficulty “holding” when they have the sensation to urinate

●  Children who experience “streaking” of feces in their underwear consistently

If you take nothing else away from this article, I hope that you know the following 3 things:

Have questions about incontinence, constipation, or your child’s toilet routine? Consider 

 us at Marshall Pediatric Therapy and scheduling a Pelvic Floor Evaluation today!

It Hurts When I Poop, I Dance When I Pee, Why Your Child's Pelvic Floor is as Important as Their ABC's 

W-sitting is when a child sits on their bottom with their knees bent and feet positioned outside of their hips. If you’re standing above your child, you will see their legs and body make the shape of a W. 

Why Do Physical Therapists Not Like W Sitting? 

Prolonged W sitting can lead to the following issues: 

A child could be W sitting for many reasons such as core/trunk weakness, excessive hip flexibility and/or joint hypermobility, or low muscle tone. They may also W sit because it is easier for them! With a wider base of support, it requires less muscle work. 

With prolonged W sitting, some children can develop tight hip and leg muscles. Here are some ideas to try at home with your child! 

For a calf stretch, you can have your child sit or lie on their back. Holding your child’s foot in your hand, apply light pressure at the base of the toes and flex the foot up towards their head. Hold for 30 seconds once you feel resistance. There are two muscles in the calf, so keep their knee straight for a gastrocnemius muscle stretch, and you can bend their knee to stretch their soleus muscle. 

○ To prevent toeing-in, start by holding your child’s heel with one hand. With the other hand hold the front of foot at the base of their toes, and gently pull toes in outward direction, toward the pinkie toe side. 

If your child W sits, they most likely have weak core and hip muscles. Here are some activities to try at home! 

Encourage the child to “fix their legs” by demonstrating different floor positions such as sitting with legs crossed, legs in front, or side sitting. Other positions may include offering a child a low bench or stool to sit on. 

W Sitting

The ability to hold an object in one hand and move it without assistance from the other hand.

Children start to develop these skills between 2-4 years old with a single object. The order of development of these skills are first finger to palm translation, palm to finger translation, rotation, and lastly shift. By the ages of 6-7, children are able to manipulate and stabilize more than one small object within their hand. This allows children to use these in-hand manipulation skills more purposefully and functionally to complete everyday tasks. 

A child with poor in-hand manipulation can be observed manipulating objects with both hands and/or stabilizing the object with a table or body. Children who have difficulty with in-hand manipulation may be unable to complete certain tasks, require additional time, or may appear clumsy when handling objects. Many daily tasks required these higher level hand skills. Examples include: using a fork and knife, adjusting grip on paper when cutting with scissors, positioning a grip when writing/drawing, manipulating clothing fasteners, and operating tools. 

Poor or delayed in-hand manipulation skills can result in difficulties with the following: 

The components of in-hand manipulation: 

 The ability to turn an object end over end. An example of this is flipping a pencil over in one hand to use the eraser instead of writing with the tip of the pencil.

Simple rotation is the ability to roll a small object between the thumb and finger tips. An example of simple rotation is using the fingertips and thumb to open a small jar. 

 Complex rotation is the ability to turn an object end over end. An example of this is flipping a pencil over in one hand to use the eraser instead of writing with the tip of the pencil.

simple or complex rotation is being performed while holding an object with the hypothenar aspect of the hand (ring and pinky finger). 

 The ability to move objects between the fingers. A couple examples of this are when you try to separate two pieces of paper that are stuck together, or when you move your fingers closer to the end of your pen/pencil to begin writing. 

the ability to move an objects in a linear manner with finger tips while holding an object with the hypothenar aspect of the hand (ring and pinky finger). 

 Translation can be broken into two separate skills: finger to palm translation and palm to finger translation. Kids use finger to palm translation when they pick up small objects like pebbles, marbles, or cheerios one at a time, moving them with the fingers of only one hand into their palm. They use palm to finger translation when they move those small objects from their palm back to their fingertips one at a time to place them on the floor or table.

 the ability to move an object from fingertips to the palm of the hand. Ex: picking up marbles with fingers and thumb and moving them into the palm. 

 the ability to move an object from the palm of the hand to the finger tips. Ex: moving coins from the palm of the hand to the finger tips to insert them into a piggy bank.  

 holding an object with the hypothenar aspect of the palm (ring and pinky finger) while moving objects from palm to fingertips or fingertips to palm.

Activities that promote in-hand manipulation skills

In-Hand Manipulation

With the unpredictable weather and virtual school instruction, it can be hard to find ways to keep your child moving and active! Obstacle courses provide a great way to allow children to work on a wide array of skills with one fun activity and just a few simple household items.

Obstacle Courses allow children to address multiple skills they may need to practice in one activity. By selectively choosing specific activities in your obstacle course, children can engage in activities that challenge them and build their own self-confidence no matter their age or abilities. Obstacle Courses build multiple skills that children will utilize throughout their daily routines including:

Tips and Tricks to Build an Obstacle Course at Home!

Work together with your child to brainstorm fun activities to include in your obstacle course. Some children will love to pick a theme (ex: volcanoes, sharks) and use their imagination throughout the entire course! Help your child identify activities that will provide an appropriate challenge and a sense of accomplishment. Based on your child’s age and abilities adjust the number of activities you may include in your obstacle course. Younger children or those who are working on sequencing and memory can benefit from 3-6 step obstacle courses, while older children and those whose strengths include planning and memory may be able to complete obstacle courses with 5-10 different activities.

So what activities can you include to address specific skills your child may need to work on? Below are some ideas for you to try and to spark your own creativity!

One of the great benefits of obstacle courses is that common household items can be used to foster challenges and fun for your child.

Ways to Make Your Obstacle Course More Challenging:

Ways to Make Your Obstacle Course Accommodating to Your Child’s Abilities:

Before engaging your child in the obstacle course you have created, review each step to ensure understanding and safety rules. This is especially important for children who have difficulty with planning, memory, and sequencing. Then, run through your obstacle course with your child! Have fun and enjoy watching your child work towards their goals while engaging in active play!

Physical Therapy

It Hurts When I Poop, I Dance When I Pee, Why Your Child's Pelvic Floor is as Important as Their ABC's

W Sitting

In-Hand Manipulation

Let’s Make an Obstacle Course!