This 2.5 day course is the next step for therapists who focus on the pediatric pelvic floor patient population. It is designed to expand your knowledge of development of normal bowel patterns in children, introduce the new Rome IV criteria (Zeevenhooven et al. 2017), and review the anatomy and physiology of the GI system with emphasis pediatric Functional Gastrointestinal Disorders (FGID).
According to van den Berg et al, up to 30 percent of children suffer from constipation and account for approximately 3% to 5% of all visits to pediatricians.
Early intervention can avoid stool-withholding patterns with worsening constipation leading to prolonged bowel issues into adulthood (Chase, Lewina, 2017) with psychosocial consequences.
This course will delve into the most common types of functional constipation and tests and measures used to assess it. Special emphasis on constipation with coexistence of fecal incontinence (Nurko, Scott. 2011) and the psychological effects of these disorders will also be presented.
Additionally, participants who have not yet been trained will learn external and internal anorectal PFM evaluation of the pediatric perineum. Indications for rectal balloon training and determining the appropriate patient will be instructed with lab. Functional defecatory positions for breathing and PFM relaxation, manual therapy techniques of the abdominal wall and viscera will be taught. Video demonstrations of pediatric patients are also presented. Treatment techniques and progressions, including management of supplements and dietary influences will be discussed.
- Understand digestive anatomy and physiology
- Understand the function of the PFM as it relates to defecation
- Understand FGID in children and be able to identify potential medical “red flags” requiring referral to the physician.
- Review tests and measures for FGID
- Understand medications used for bowel dysfunction and titration for long term bowel health
- Assess bowel diaries and provide education for diet/medication/supplement titration
- Recognize the psychosocial and behavioural component for proper referral and rectal balloon treatment
- Observe use of perianal surface electromyography (sEMG) and identify PFM discoordination in the pediatric patient
- Understand how to use sEMG biofeedback to increase or decrease pelvic floor muscle activity
- Complete an evaluation of a pediatric patient diagnosed with bowel disorders
- Assess and provide exercises and techniques for diastasis recti.
- Learn techniques to stimulate BM and rectal sensation using rectal balloon training and OTC medications
- Treatment progressions for children with pediatric bowel disorders using manual therapy and breathing techniques
- Implement an appropriate plan of care based on a patient’s symptoms and physical examination
Pediatric Incontinence & Pelvic Floor Dysfunction Live Course (level 1) is required. In order to participate in the rectal component of this course, including balloon catheters, you must have completed PHS (or equivalent or be approved) level 1 internal training. If you do not have level 1 internal training, you are welcome to register but will need to sit out internal labs.
Participants should have a basic knowledge of biofeedback and pelvic floor muscle anatomy.
All participants must also complete the required pre-readings/assignments prior to the class.
This course is open to physiotherapists, naturopathic doctors, physicians, pediatric nurse practitioners and nurses. Content is not intended for use outside the scope of the learner’s license or regulation. This course should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.
Sunday: 8:00am – 4:00pm
Registration begins on the first day 15 minutes prior to the start time.
This course is both lecture and lab format
Zeevenhooven, J, Koppen I, Benninga, M. The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatric gastroenterology, Hepatology and Nutrition. January 2017.
Nurko S, Scott S. Coexistence of constipation and incontinence of children and adults. Best practice & research Clinical gastroenterology. 2011;25(1):29-41. doi:10.1016/j.bpg.2010.12.002.
van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006; 101:2401.
Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr 2005; 146:359.
Chase J, Lewina S. childhood incontinence and pelvic floor muscle function; can be learned from adult research? JPUrol (2017) 13, 94-101