I never imagined that bowel movements and urination would become a daily topic of conversation. Then I had kids. It instantly became the norm to pay attention to whether the baby went poop each day, what it looked like, how many times, etc. As my child got a few years older the questions changed, but the topic stayed the same – do you have to go potty, does your stomach hurt, when was the last time you went, etc…
When your child is having issues with constipation or bed wetting, it can be difficult to properly diagnose. As a parent, you can’t help but wonder if this is just a normal part of growing up, or if you should be concerned.
By six years old, most children should have full control of their bowel and bladder function. Yet, it is estimated that up to 20% of pediatric healthcare visits revolve around bladder and bowel problems. And, up to 25% of children visiting a pediatric gastroenterologist experience bouts of constipation or encopresis (bowel leakage or soiled undies).
These issues can be frustrating for both parents and children. But, help is available through pediatric pelvic floor physical therapy – a safe and effective treatment options for infants, toddlers, and children.
Common pediatric pelvic floor issues include:
Pediatric bed wetting & daytime incontinence – Most children begin to stay dry the entire night between the ages 3 and 5. The primary reason for nighttime leakage is constipation, followed by not fully emptying during the day. Our bodies are designed to hold urine and children should not have to get up to urinate at night.
Pediatric Constipation – Constipation is one of the most common gastrointestinal complaints among children, but can also be a contributor to urinary leakage or the urgency to go. Pediatric bladder and bowel dysfunction can continue well into adulthood so it’s important to get this taken care of early on. Contributing factors to constipation can include diet, emotional issues, and sometimes busy children simply ignoring the signs that they have to go.
Diastasis Recti – A common issue in infants, especially those born prematurely, diastasis recti is a separation between the left and right side of the rectus abdominis muscle, which is the muscle that covers the front surface of the belly. This can also lead to poor trunk control, which can affect the bowels as well.
Other diagnosis that affect the pelvic floor in children – voiding dysfunction (when your child’s bladder is not emptying, or they are not urinating normally or fully), urinary urgency and frequency, vesicoureteral reflux (backflow of urine into the kidney), and pelvic pain.
Treatment for pediatric pelvic floor issues
Physical therapy can be a safe and effective way to help a child gain control of his or her bladder. By focusing on a group of muscles and soft tissue, called the pelvic floor, which support the pelvic organs and help control bladder function. When these muscles are too tight, too weak, or in spasm it can cause problems in children because the pelvic floor muscles aren’t working well with the bladder.
Children who are experiencing issues with bladder and bowel control may be more prone to bladder infections, constipation, difficulty sensing when the bladder is full, or other problems resulting from not completely emptying the bladder. This can also lead to urinary or bowel leakage and wetting during the day or night.
Pediatric pelvic floor treatment techniques may include:
- Biofeedback – Helping children learn to strengthen or relax their pelvic floor muscles in order to improve bowel or bladder function and decrease pelvic floor pain
- Behavorial and diet modification
- Soft tissue mobilization – Using hands-on techniques on muscles, ligaments and fascia with the goal of optimizing muscle function
- Stretching and strengthening of pelvic floor and surrounding muscles
- Relaxation techniques
Physical therapy may help if:
- Child is 5 years or older and still wears pull-ups
- Medication is needed for bladder or bowel control
- Urinary incontinence or leakage
- Bed wetting (nocturnal enuresis)
- Laughing causes urine leakage
- Frequent urination or overactive bladder
- Infrequent urination or underactive bladder
- Constipation/diarrhea, painful bowel movements, over/underactive bowels
With a parent present, a physical therapist with specific training in pediatric pelvic floor therapy will examine the muscles of the abdomen, pelvis, and pelvic floor area. Consultation and treatment often consists of muscle retraining, biofeedback, patient and family education, behavior and diet modification, soft tissue massage, stretching and strengthening of the pelvic floor and surrounding muscles, and a home exercise program. We have expert physical therapists on site who are specifically trained to work with this population.
If you feel your child may be suffering from any form of pelvic floor dysfunction, call our Coopersville office at 616.997.6172 or schedule a free consultation with Melissa VanKampen, physical therapist assistant and our lead expert in pediatric pelvic floor treatment. Melissa has taken numerous continued education courses in pediatric pelvic floor issues related to constipation and bed wetting.
Get more information about pediatric incontinence and pelvic floor dysfunction from Herman & Wallace, the pelvic rehabilitation institute.