Littles Have Pelvic Floors Too!
By Keri Martin Vrbanac, Pelvic PT
One of my favourite populations to work with are the littles. I have had some of my most enlightening pelvic floor conversations with people under the age of nine! There are a considerable number of paediatric conditions that can be treated both effectively and efficiently with pelvic floor physiotherapy.
What is important to note right from the start is that there is no internal work when treating children. Using exercise and education, both patients, and their caregivers learn all about the basic mechanisms that control the bowel and the bladder as well as the correct way to use their pelvic floor muscles. And it’s not all work…we have fun too!
Based on the number of children that visit my office, it is easy to surmise that pelvic floor dysfunction is common in children under the age of eighteen. This dysfunction may present as a daytime, nighttime, or all the time condition and can involve the bowel, the bladder or both. Concerned parents are often told “don’t worry, they’ll grow out of it” or “they won’t go to University wetting the bed”. However, I often hear stories from my adult patients that can trace back to a childhood history of bowel or bladder dysfunction.
Why might I see your child?
Bedwetting: Involuntary release of urine while the child is asleep at an age where staying dry at night can be reasonably expected.
Urge Incontinence (daytime leaks): Children will have significant urgency to urinate and may have leakage as a result of this urgency.
Stress Incontinence (daytime leaks): Small amounts of urine leakage when a child exerts themselves or experiences an increase in abdominal pressure. For example, jumping off a swing, running, or sneezing.
Giggle Incontinence: Complete voiding during or immediately after laughing, but normal bladder function when not laughing. This is more prevalent in girls.
Recurring Urinary Tract Infections: A child may experience urinary tract infections regularly and may experience pain, burning and increased feelings of having to urinate.
Increased Daytime Urinary Frequency: This child will void often throughout the day (at least once per hour) and will produce very small volumes of urine. This condition occurs only during the daytime, incontinence is not a usual component and nighttime bladder function is normal.
Voiding Postponement: Daytime leakage with habitual holding maneuvers (sitting on feet, pee dance) which helps the child suppress the urge to urinate OR they may be distracted by an activity or may make the conscious decision not to go to the bathroom when they feel the urge. These children often void less frequently throughout the day.
Constipation: Infrequent and difficult passage of stool. If a child repeatedly resists the urge to poop, stool remains in the rectum and can become dry, large, and hard. This will make it hurt to poop and some children will lose the ability to recognize the urge to have a bowel movement. Sometimes constipated children will appear to have regular bowel movements because soft stool sneaks through the back up in the rectum. They may also experience smears on the underwear.
Encopresis: May be called fecal incontinence or soiling and occurs when a child involuntarily passes stool into the underwear past the age where they should be able to illicit bowel control. This may occur because of constipation.
Pelvic pain: Pain in the abdominal region typically below the umbilicus and may include the low back or the thighs. This pain can be acute or chronic and may be persistent or intermittent.
Treatment may include pelvic floor muscle training (which may involve some very fun video games), education on bowel and bladder management, diet modifications, hydration, the voiding cycle, relaxation of the pelvic floor muscles to encourage complete emptying and the list goes on! Each child is treated as an individual and their treatment plan is tailored specifically for them. The most important thing that comes with paediatric pelvic physio is an abundance of support through what can be a very difficult time for patients, parents, and caregivers! You and your child are not alone and there is help!
Want to learn more about Paediatric Pelvic Physio? Follow me on Instagram @kerivpelvicpt or visit our website at www.abodyinmotion.ca and feel free to DM me with questions!