Although millions of children and teens suffer from pelvic floor dysfunction, it often takes a long time to receive the right treatment. In children, the pelvis serves many vital functions. It’s the center connection point between a child's upper and lower body; it is core to how they move, breathe, and regulate normal bodily processes like bowel and bladder function.
If your child is having troubles with his/her bladder, please know they are not having these issues on purpose. Punishing a child or making them feel embarrassed about their day or night time wetting is not the way to handle their problem. Children do not wet their pants on purpose and need to see a specialist who treats the pelvic floor, specifically a pediatric pelvic health specialist.
Children and teens with pelvic floor dysfunction have different needs and goals than adults. Pediatric pelvic physical therapy is a set of physical therapy techniques used to treat problems with the pelvis and pelvic floor muscles’ in children and teenagers.
These problems may cause alterations in the functioning of the bladder and bowel as well as pain. Common conditions include urinary incontinence, difficult or incomplete urination, constipation, fecal incontinence, and bedwetting. By age five, children should not have problems with bedwetting, daytime leakage, or fecal smearing.
Bladder and bowel dysfunction in children is common. Recent studies report incidence percentages between 5% and 15% of both nighttime and daytime incontinence in children (1). Functional constipation has a higher incidence in North America, ranging between 10 and 23% (2). Due to the close anatomical and functional relationship between the colon and the bladder, these two conditions are often correlated. Bladder and bowel dysfunction are very disruptive for the child and the family. The rate of related behavioral and emotional problems in children with these problems is high. Consequently, it is very important to address these problems early on, and the cooperation of the physicians, the family, and the physical therapist are crucial for success.
In some instances, a child or teen can be potty trained for several years and then all of a sudden have some occasions of daytime incontinence or enuresis. This can be caused from a life-changing event such as a move, a new school, or a change in the family dynamic (divorce, new child, etc.).
Pediatric pelvic physical therapy focuses on assessing the child’s pelvic floor muscle system to determine if these muscles might be weak, tight, or present difficulty with coordination for proper bladder and bowel function. It’s also important to assess the child as a whole, and look at any musculoskeletal, motor development, social, or behavioral variables that may influence the problem.
During the first visit, our pediatric pelvic physical therapist will sit with the parent and child to learn about the problem and explore its history and relationships with the orthopedic, social, and behavioral spheres. We will then look at the child’s posture, alignment of the lower extremity, pelvis and hips, gross motor skills, walking, general muscle tone, range of motion, and strength.
Regarding assessing the pelvic floor muscles, this is an issue that likely may raise some concerns and questions. However, let us start by saying that we do not assess the pelvic floor muscles in children internally, as this would be inappropriate. If necessary and considered reasonable by the parent, the pelvic floor muscles could be assessed externally by visualization of the contraction of the anal muscles. However, we find this to be unnecessary in most cases. Furthermore, at Sutton Place Physical and Aquatic Therapy, we use the Butterfly IQ ultrasound to improve our pelvic floor muscles’ assessment. By placing the ultrasound probe in the lower abdomen, we can observe the bladder. By asking the child to contract and relax, we can see if the pelvic floor muscles’ contraction is correct and whether the relaxation is good. According to research, transabdominal assessment of the pelvic floor muscles is correlated to digital palpation. (3) This method is much more appropriate to children as well as being educative, non-stressful, and fun!
The treatment techniques we use will depend on the specific problem and may include:
- Pelvic floor relaxation exercises.
- Pelvic floor strengthening exercises.
- Biofeedback: Biofeedback techniques can be used for relaxation and strengthening and involve using technology to provide a visual representation of the activity of the pelvic floor muscles. In our clinic, we use EMG-based biofeedback which uses external stickers (electrodes) to read the muscular activity and presents kid-friendly visual images on the computer screen, and Ultrasound-based biofeedback, which uses the ultrasound probe to present an image of the bladder that can be used to visualize the effect of the pelvic floor muscles on the bladder, during relaxation and contraction.
- Breathing coordination exercises and other therapeutic exercises or Yoga as necessary for improved range of motion and pelvic stability.
- Behavioral training: to improve toilet habits and techniques, hydration, use of alarms, etc.
Our goal at Sutton Place Physical and Aquatic Therapy is to make the pelvic floor assessment as comfortable as possible for both you and your child or teen. We strive to provide you and your child with a safe and comfortable environment to seek treatment and ask questions for these sensitive issues.
If you are unsure if pelvic floor physical therapy is right for your family, schedule a free 15-minute consultation at 212-317-1600.
References
- Maternik M, Krzeminska K, Zurowska A. The management of childhood urinary incontinence. Pediatr Nephrol. 2015;30(1):41-50. doi:10.1007/s00467-014-2791-x
2.. Levy EI, Lemmens R, Vandenplas Y, Devreker T. Functional constipation in children: challenges and solutions. Pediatric Health Med Ther. 2017;8:19-27. Published 2017 Mar 9. doi:10.2147/PHMT.S110940
3. Arab AM, Behbahani RB, Lorestani L, Azari A. Correlation of digital palpation and transabdominal ultrasound for assessment of pelvic floor muscle contraction. J Man Manip Ther. 2009;17(3):e75-e79. doi:10.1179/jmt.2009.17.3.75E
