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 does poop, but not everyone can 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 Pelvic Floor.
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 very weak. 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:
● Past medical history
● Current voiding patterns such as when and how often
● Diet and water intake
● Current concerns you have for your child
● A postural assessment in sitting, standing, and lying
● A recommended, but optional, 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 with recurrent UTIs
● 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:
It is not normal or typical for your child to experience constipation, bed wetting, or
incontinence and they will NOT “grow out of it” past age 5
These problems ARE NOT a life sentence; there are non-invasive ways to address
incontinence and constipation
That you are your child’s greatest ally and advocate! Any concerns you have are valid and
Have questions about incontinence, constipation, or your child’s toilet routine? Consider contacting us at Marshall Pediatric Therapy and scheduling a Pelvic Floor Evaluation today!