Pelvic floor and your kid… what you need to know Part 1
WHAT? Pelvic Floor Physiotherapy and KIDS?
Pelvic floor physiotherapy is not just for adults. Even our little people have pelvic floors, and they do have issues with those pint-sized pelvic floors sometimes.
Ok sure, but what could they need help with exactly?
Pediatric Pelvic Floor refers to children under the age of 18. So we are looking at a wide variety of issues that can be addressed with pelvic floor physio.
- Daytime Leaking (“Accidents”): leakage of urine in inappropriate places over the age of 5 can occur during the day and at night
- Bed wetting (Nocturnal Enuresis): leakage of urine at night WITHOUT daytime symptoms or issues
- Constipation: stools that are often infrequent and hard to pass (but did you know you can be constipated and still poop every day?!)
- Poop Accidents (Encopresis): leakage of stool in inappropriate places
What should I be watching for?
If your child is having issues with any of the above, they may benefit from pelvic floor physiotherapy for kids. One of the biggest contributing factors to ALL of the issues listed above, is constipation itself.
How does constipation affect day time wetting, bed wetting, and poop accidents?
When we are constipated (and this is true of adults as well), our rectum stretches and stores stool instead of emptying fully. This stretching eventually leads the stored stool in the rectum to put pressure on the bladder. This irritates the bladder leading to increased trips to the bathroom, and accidents throughout the day. This same pressure is what can cause night time wetting; essentially the poop takes up so much space the bladder just has to void.
If a child is constipated they can’t have poop accidents though, right?
FALSE! Depending on how long this has been going on, the child may also still poop regularly. There are a couple ways poop accidents can happen.
As the colon is stretched, the normal receptors in the bowel that signal your brain that you need to poop don’t work as well, similar to a deflated balloon. The receptors need to be stretched against tension to work well. As your bowel collects and stores stool in the stretched out colon, you become constipated. But, softer liquid stool can sneak around the hard stool (this is called bypass). Sometimes people think their child has diarrhea when they see bypass and the idea that they are constipated seems far-fetched, but it’s true!
This can happen in young children, pre-teens, and teenagers. The longer constipation goes undiagnosed/treated, often the harder it is to resolve.
What does Pelvic Floor Physio for kids look like?
We require a parent or guardian to be present at all appointments with children for pediatric pelvic floor therapy. At the first appointment we will take a detailed history including potty learning statistics, diet, bathroom habits, social impact, among other things. We will also take a look at movement, strength, stability, and we usually do some sort of abdominal exam. Many children that are having issues have been poked, prodded, and had some scary procedures done, so at physio my goal is to make it fun, engaging, and not painful whenever possible. But this isn’t enough, we also need to make it something important for the child as well!
Giving them things that they can do to take ownership, and see change in – like a poop and pee diary – is very important. Ensuring that we are celebrating the successes, and down-playing the misses is also crucial.
Why is it important to address pelvic floor issues in childhood?
Clinically, we see a possible correlation between adult pelvic floor dysfunction and childhood issues. In the population of clients seen for pelvic pain conditions as adults (dyspareunia, vulvodynia), there is often a history of constipation and childhood toileting issues. Adults that have increased voiding frequency, urge incontinence, and a ‘weak bladder’ often speak of pre-teen and teenage issues as well.
What can I do?
Start out right, keep poop mushy, a peanut butter or hummus consistency is key. Often kids will start solids and become constipated, some will have one instance of constipation and have difficulty because they are scared of being painful (which leads to a vicious cycle). If your child has a history of straining, large stools (the whoa that might clog the toilet ones), works hard to get stool out, has poop ‘stains’ on their underwear, or has had multiple days without passing a stool, constipation could be an issue.
Regardless of how it starts, pelvic floor dysfunction in children can and should be attended to by a qualified physical therapist.