Pelvic Floor Dysfunction In Children

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Pelvic Floor Dysfunction In Children

We talk a lot about pelvic floor dysfunction in adults, but did you realize that kids can have pelvic floor dysfunction too?  In fact, up to 30% of children suffer from incontinence, of which 9-12% suffer from functional constipation.  If these are left untreated, it can lead to dysfunction as an adult.

When it comes to children, we address pelvic floor dysfunction similar to the way we would adults. We look at things like rib positioning, intra-abdominal pressure, nutrition, toileting position and techniques, and psychological factors.  Each one of these is a very important piece to the incontinence puzzle.  However, when working with children, we use our “kid gloves” to address these components.  Let’s look at each piece and how we choose to address them, but first, let’s remind ourselves what bowel and bladder dysfunction looks like, especially for these littles.

Fecal incontinence is the inability to hold stool or the accidental leakage of stool.  This can be caused by increased pelvic floor tension, pelvic floor weakness, or lack of coordination of the pelvic floor muscles.

Constipation is defined as having less than 3 bowel movements per week; stools that are hard, dry, or lumpy; stools that are difficult or painful to pass; or a feeling that not all stool has passed..  We have found that this can often be nutrition related, but also can be because these littles are holding in their stools.  A few reasons these kiddos may hold their stool is pain with defecation, fear of public restrooms, fear of “letting go,” or simply not wanting to quit playing long enough to go use the restroom.  When we choose to hold our bowels, this leads to a vicious cycle of pelvic floor tension, leading to increased stool retention and increased rectal distension, decreased sensation/decreased urge to defecate, which leads us right back to more stool retention.  All this is complicated by the fact that constipation can cause bladder incontinence!

Urinary or bladder incontinence is the accidental leakage of urine, which can again be caused by constipation, pelvic floor tension, pelvic floor weakness, or lack of coordination of the pelvic floor muscles.

The study “Effectiveness of Pelvic Physiotherapy in Children with Functional Constipation Compared with Standard Medical Care,” showed that the effectiveness of Pelvic Floor Physical Therapy was 92.3% effective compared to 63% effectiveness with Standard Medical Care.  It included that with the assistance of Pelvic Floor PT, 88.5% of the participants were able to discontinue the use of laxatives, increase confidence, and improve quality of life scores in both the children and the parents, as compared to only 33.3% provided with Standard Medical Care.

So, how do we treat it? 

Education – First and foremost, we educate these littles AND their parents.  We talk to them about their bodies and explain how their bodies work using models of the pelvis and the pelvic floor, but also with visuals like “The Human Body” – a book by Carron Brown & Rachael Saunders (we call this “the body book”).

Toileting position and techniques – For optimal elimination, we should have our feet flat on the floor (not dangling, which can happen on “adult” toilets), with hips bent to 90 degrees or greater, and a slight forward lean.  This positioning allows the pelvic floor to relax and create the intra abdominal pressure needed for evacuation of the bowels and/or bladder.

Intra-Abdominal Pressure (IAP) – If we have either too much, or too little, intra-abdominal pressure, elimination is difficult.  With too much pressure, our muscles tighten and it is difficult to relax in order for things to pass.  Conversely, with too little pressure, our muscles may be a little too relaxed, and things escape at inappropriate times.  We teach these kiddos how to regulate IAP in order to maintain continence and also be able to eliminate waste when it is appropriate to do so.

Nutrition – Working closely with both the patient and their parents, this is an important piece that can influence outcomes greatly.  We will have parents help fill out a nutrition diary (along with a bowel and/or bladder diary), which can be helpful in seeing patterns of what may be going on within the digestive system and irritating/influencing the bowel and bladder.

Psychological factors – There are many things that play into a child’s pelvic floor dysfunction, and believe it or not, some of these may include things like, beginning school (or a new school), stress at home (maybe a change in parenting/schedule), chaotic routines/too many activities/always “on the go”, maybe even the introduction of a new sibling.  We work with kiddos (and their parents) to hone in on some of these factors, and then teach them how to really “listen to their body,” how it is feeling, what it is telling them, and how that relates to their bowel and bladder habits.

MAP – This is their “homework,” that THEY get to help create and take ownership of their therapy, aiding in their knowledge and understanding of their own body, what it is telling them, and how they can take charge and be in control of their bowel and bladder.  At the end of each session, we update their map to help “map” their way to their success!

How do you get started?

Simply call our office at 402-483-0006 and speak with our amazing front office staff to set up an evaluation.  You may need to have a referral from either your doctor or pediatric specialist, depending on your insurance.