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Pediatric Pelvic Health

What is Pediatric Pelvic Physiotherapy?

Pelvic floor dysfunctions are more common than you can imagine and one of the reasons that you may not know this is…shhhhhhhhhh…we do not talk about them! This is not only an adult problem. Many children suffer from daytime and night time conditions which may include:
  • 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
  • the child may have urgency, frequency, and/or may be rising at night to pee and may or may not have urine leakage
  • constipation is more common in this group
  • 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.
  • Daytime leakage with habitual holding maneuvers
  • With holding 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)
  • 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
  • These children may not be able to empty their bladder completely
  • They may have to push urine out or strain and they may have dribbles or interrupted flow
  • the child may have a habitual contraction of the urethral sphincter and pelvic floor muscles during voiding
  • the urine flow may be “staccato” (slow, fast, slow for example)
  • this is referred to as an “intermittent stream”
  • Small amounts of urine leakage when a child exerts themselves or experiences an increase in abdominal pressure
  • For example, jumping off of a swing, running, or sneezing.
  • 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
  • Daytime leakage with habitual holding maneuvers
  • With holding 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)
  • complete voiding during or immediately after laughing but normal bladder function when not laughing
  • far more prevalent in girls
  • this child will void often throughout the day (atleast once per hour) and will produce very small volumes of urine
  • occurs only during the daytime
  • incontinence is not a usual component and night time bladder function is normal
  • urine outflow is impeded and there can be a mechanical cause
  • there will be increased bladder pressure but a slow urine flow rate

These conditions are common but NOT normal!

Incontinence is a very common problem in childhood. One in five otherwise healthy five year olds and one in seven school age children are incontinent during the day or night. Enuresis (bedwetting) afflicts 5 to 10 % of children below the age of ten years and can also be experienced by older children and teenagers. If a child continues to experience symptoms at 5 years of age or older, active treatment should be considered.

Tell me more…

Pediatric Incontinence Including Daytime Leakage and/or Bedwetting Dysfunctional Elimination in children occurs when the pelvic floor muscles (PFM) are not working together with the bladder and/or bowel, and the normal voiding or emptying reflexes may have been disrupted. This can lead to a chronic abnormal pattern of elimination which does not allow the bladder or bowel to empty completely. Some children experience difficulty urinating or controlling their bladder function, frequent bladder infections, constipation, not urinating enough during the day, or an inability to sense bladder fullness. Children may periodically have leakage during the day or wake up wet in the morning or both. This can be embarrassing and uncomfortable. If your child has experienced any of the above symptoms, there is help available!

What are Pelvic Health Physiotherapists?

Pelvic Health Physiotherapists are registered Physiotherapists who are devoted to the treatment of pelvic health concerns. Through ongoing continuing education and examinations, pelvic health physiotherapists must be certified to treat pelvic conditions. Like physiotherapists in other settings, our goal is to assist our patients in resuming normal daily and/or nightly routines as quickly as possible. Our ultimate goal being the ability to help patients and families decrease the impact that their pelvic health concerns are having on their lives!

How can Pelvic Physiotherapy help your child?

Optimally, the bladder and pelvic floor muscles work opposite each other to successfully urinate. When the bladder muscle contracts, some children do not completely relax their pelvic floor muscles. Their bladder may not empty and there is residual urine left in the bladder. In order for the bowels to empty, the pelvic floor muscles must relax. Your child will learn exercises to: relax and engage the pelvic floor muscles at the appropriate time, void and empty completely, as well as to avoid urinary and/or bowel leakage.

It’s not all work… we have fun too!

Animated surface biofeedback may also be used to teach your child how to relax the pelvic floor muscles while emptying his/her bowel or bladder and strengthen the muscles in between voids. A specific home program will be developed for your child. Using the tools of education and exercise about the basic mechanisms that control the bladder and bowel, your child will be taught the correct way to utilize the pelvic floor muscles, which allows your child to control elimination. Therapy continues with your child learning correct postures for toileting, foods that may be irritating to the bladder and how to create a regular pattern of filling and emptying the bladder through a toileting schedule. Therapy can help your child achieve dry days and dry nights.

What can we expect with pediatric pelvic therapy?

Expect help! Once you have scheduled your first appointment with us, we will need to gather important information to ensure we provide you with the best possible care. A patient information packet will need to be completed and provided to our staff when you arrive for your first appointment. The patient information packet will include a description of what to expect, as well as a patient history questionnaire. Your patient information can be emailed to you or printed here. You may be asked to complete a bladder/bowel diary with your child for at least 3 days prior to or during your first appointment. This entails documenting amounts and type of food and fluids your child drinks as well as voiding patterns.

After a thorough evaluation has been performed, you, your child, and your therapist will develop a treatment program. This 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
  • biofeedback of the pelvic floor muscles to relearn how to strengthen and improve muscle function
  • Activities of daily living training
  • education on bladder function and its relationship to the pelvic floor muscles, bladder health and irritants, the voiding cycle, and controlling urinary urge and bladder retraining
  • Constipation management
  • Skin care and proper wiping techniques and toileting positions
  • An independent home exercise program which is VERY important!!

Let’s get started…

Once you have decided to initiate treatment, the next step will be to email or call our clinic and we will schedule your child’s initial assessment. Children, along with their parent or guardian, will be seen for 1 hour to complete their initial assessment. Your physiotherapist will then work with you to develop a recommended treatment schedule. This will usually begin with 1 time per week and these sessions will be 30 minutes in length. Patients are seen an average of 6-10 visits however this will depend on assessment findings, goals, and progression through the treatment plan. At your child’s first visit, the physiotherapist will discuss with you and your child, the previously completed questionnaires, the bladder log and the medical history. 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.
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