Pediatric Pelvic Floor Dysfunction

Although millions of children suffer from pelvic floor dysfunction, most don’t get the help they need. Typically, children are toilet trained by age 4, with only very occasional accidents. After age 4, childhood bowel and bladder dysfunction is considered a major medical problem and greatly affects the quality of life for the whole family.

If your child is experiencing any of the following common symptoms, pediatric pelvic floor physical therapy can help!

  • Child is over 4 years old and still wears pull ups
  • Medication is needed for bladder or bowel control
  • Leaking urine/loss of urine (enuresis)
  • Bedwetting (nocturnal enuresis)
  • Waking up at night to urinate (nocturia)
  • Giggle incontinence – leaking urine before or during laughing
  • Frequent urination or overactive bladder (urinating over 8 times in a 24-hour period)
  • Infrequent urination or underactive bladder
  • Urinary retention (not fully emptying bladder)
  • Constipation/diarrhea, painful bowel movements, over/underactive bowels
  • Bowel incontinence, inability to empty bowels
  • Excessive gas, abdominal bloating

These conditions are common, but not normal.

Incontinence is a very common problem in childhood. One in five otherwise healthy 5-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 4 years of age or older, active treatment should be considered.

Your child is NOT alone.

  • 20% of pediatrician visits are for incontinence problems
  • 15% of visits to gastrointestinal doctors are for lower bowel dysfunction
  • 3% of pediatrician visits are for constipation
  • 5 million youngsters complain of nocturnal enuresis (nighttime bedwetting)

The pelvic floor is made up of muscles and other tissues that form a sling from the pubic bone to the tailbone. They help to support the abdominal and pelvic organs, and to control bladder and bowel activity.

Pelvic floor dysfunction refers to a wide range of problems that occur when the pelvic floor muscles are overactive and in spasm, and are often weak and too tight. The tissue surrounding the pelvic floor organs may have increased sensitivity and irritation or decreased sensitivity, causing the resulting dysfunction seen in children.

What is pediatric pelvic floor physical therapy?

We meet with each child and their parent/s or guardian to get a complete history and details of current problems. Then we do an examination of the muscles of the abdomen and pelvis with a parent present. Treatment often consists of:

  • Biofeedback
  • Behavioral and diet modification
  • Patient and family education on bladder function and its relationship to pelvic floor muscles, bladder health and irritants, the voiding cycle, and controlling urinary urge and bladder retraining
  • Soft tissue mobilization (myofascial release and deep tissue massage if needed)
  • Hot and cold therapy
  • Stretching and strengthening of pelvic floor and surrounding muscles as appropriate
  • Muscle retraining
  • Ultrasound
  • Independent home exercise program
  • Relaxation techniques
  • A bladder schedule to improve bladder habits
  • Constipation management

Ideally, 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 still some urine left in the bladder. In order for the bowels to empty, the pelvic floor muscles must relax. Children will learn exercises to relax and engage the pelvic floor muscles at the appropriate time, void and empty completely, and avoid urinary and/or bowel leakage.

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. Your child will be taught the correct way to use the pelvic floor muscles, which allows them to control elimination.

Therapy continues with your child learning correct postures for toileting, foods that may irritate 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.