Pediatric Pelvic Physiotherapy

Pelvic floor dysfunction is extremely common and it is not only an adult problem! Did you know…

• Urinary incontinence affects 15% of girls and 22% of boys.
• Boys are 50% more likely to leak urine than girls.
• 1 in 5 otherwise healthy five-year-olds and 1 in 7 school-age children are incontinent during the day and/or the night.
• 10% of 6-year-olds continue to wet themselves.
• 1 to 3% of 18-year-olds wet their beds.
• 10 to 25% of bedwetting children also wet during the day.
• 10 to 25% of bedwetting children also have bowel control issues.
• 72% of children who wet the bed had 1 or 2 parents who wet the bed when they were young and are 5 times as likely to wet than children whohad dry parents.
• If a child presents with symptoms at 5 years of age or older, active treatment should be considered.

Daytime Conditions

Urge Incontinence

• Children will have significant urgency to urinate and may have leakage as a result of this urgency.
• These children may feel a sudden urge and are unable to get to the bathroom on time.

Stress Incontinence

• Small amounts of urine leakage when a child exerts themselves or experiences an increase in abdominal pressure.
• Examples of these include jumping off of a swing, running or sneezing.

Voiding Postponement

• Daytime leakage with habitual holding maneuvers.
• Withholding maneuvers, the child may suppress the urge to urinate.
• These children often void less frequently throughout the day.
• May be distracted by an activity or may make the conscious decision not to go to the bathroom when they feel the urge (i.e. defiance).

Under-Active Bladder

• Children that are not able to empty their bladder completely
• They may have to push urine out or strain and they may have dribbles or interrupted flow

Overactive Bladder

• Children who have urinary urgency, frequency, and/or may be rising at night to pee.
• May or may not have urine leakage.
• Constipation is more common in this group.

Dysfunctional Voiding 

• The child may have a habitual contraction of the urethral sphincter and pelvic floor muscles during voiding.
• The urine flow may be “staccato” (e.g. slow, fast, slow), which is referred to as an “intermittent stream.”

 
Giggle Incontinence 

• Complete voiding during or immediately after laughing but normal bladder function when not laughing.
• More prevalent in girls.

 
Extraordinary Daytime Urinary Frequency 

• This child will void often throughout the day (at least once per hour) and will produce very small volumes of urine.
• Occurs only during the daytime.
• Incontinence is not a usual component.
• Night-time bladder function is normal.

Bladder Outlet Obstruction 

• Urine outflow is impeded and there can be a mechanical cause
• There will be increased bladder pressure but a slow urine flow rate

Night Time Conditions

Enuresis (Bedwetting)

• Involuntary release of urine while the child is asleep at an age where staying dry at night can be reasonably expected.
• May occur as a single condition or may be accompanied by other daytime conditions.
• May be the result of a number of factors including bladder function (structural or anatomical), emotional stressors, psychological, neurological or other underlying health conditions.

Bowel Conditions

Constipation 

• Infrequent and difficult passage of stool.
• If a child repeatedly resists the urge to poop, stool remains in the rectum and can become dry, large and hard.
• This will make it hurt to poop and some children will lose the ability to recognize the urge to have a bowel movement.
• Sometimes constipated children will appear to have regular bowel movements because soft stool sneaks through the back up in the rectum.
• This may come out as smears on the underwear as well.

Encopresis 

• May be called fecal incontinence or soiling and occurs when a child involuntarily passes stool into the underwear past the age where they should be able to illicit bowel control.
• This may occur as a result of constipation

Pelvic Pain

Pelvic Pain in Children is Described As:

• Severe pain in the pelvic region.
• Pain that comes and goes.
• Dull aching pain.
• Sharp pains or cramping.
• Pressure or heaviness deep within the pelvis.
• Pain while having a bowel movement.
• Pain upon sitting down.

Common Causes of Pelvic Pain May Include:

• Tension in the pelvic floor muscles.
• Bowel issues including constipation or IBS.
• Urinary tract infections.
• Polycystic ovarian syndrome.
• Organ involvement: kidneys, appendix.

How Can a Pelvic Physiotherapist Help Your Child?

Pelvic health physiotherapists are registered physiotherapists who are devoted to the treatment of the pelvic floor muscles and pelvic health concerns. Through continuing education and examinations, pelvic health physiotherapists become certified to treat the conditions that impact the muscles, tendons, ligaments, nerves, and organs found in the pelvic region and those areas that surround the pelvis. Like physiotherapists in other settings, the goal is to assist pediatric patients in resuming their normal daily and/or nightly routines as quickly as possible.

With the use of age-appropriate tools, education, and training, pelvic physiotherapists assist children and their families in taking control of a child’s bladder and bowel function. Your child will be taught the correct way to utilize their pelvic floor muscles along with learning about proper toileting positions, foods, and drinks that may be irritating to the bladder or bowel, how to hydrate properly, and how to ensure proper emptying.

As each child is an individual, so too will their treatment plan be individualized. Following a thorough assessment, this plan will be developed with your input, your child’s input and the recommendations for treatment from your pelvic physiotherapist.

The Program May Include Some or All of the Following:

• Pelvic floor muscle visual evaluation and therapeutic exercise instruction.
• A bladder schedule to improve bladder habits.
• Education on bladder function and its relationship to the pelvic floor muscles, bladder health and irritants, the voiding cycle, controlling urinary urge, and bladder retraining.
• Biofeedback of the pelvic floor muscles to relearn how to strengthen and improve muscle function.
• Activities of daily living training.
• Constipation management.
• Skincare and proper wiping techniques and toileting positions.
• An independent home exercise program which is VERY important!

Where Do You Begin?

You will want to schedule your child’s initial assessment with a pelvic physiotherapist trained in pediatrics. The therapist will complete a very thorough assessment and will discuss the findings directly with your child while a parent or guardian is present.  A treatment program will begin on your child’s first visit and will include child/family education. As well, any and all questions that you or your child may have will be answered.

Paying particular attention to your child’s diet, their toileting habits including the number of visits throughout the day, their hydration, and encouraging them to take time to completely empty their bowel or bladder are strategies that can be used while you are waiting to see your therapist. Education will be a very significant part of your child’s treatment so do not be afraid to ask questions. Your pediatric pelvic physiotherapist is here to help you and your child.