Setting your kids up for bathroom success: Pediatric Pelvic Health

By Melissa Wong, Reg. PT

I recently attended a pelvic health course hosted by the American Physical Therapy Association, in Washington, DC. The topic was on the Assessment and Treatment of the Pediatric Pelvic Floor. It sounds like an odd topic, as many assume pelvic floor issues affect females only; but kids, like men, have pelvic floors too. And kids can have pelvic floor issues, just like any of us. In fact, research has shown that some bowel and bladder issues such as night time bed wetting (known as enuresis) has a genetic component to it (von Gontard, 2001), and that a delay in bladder control during childhood is a strong predictor for overactive bladder, enuresis, and dysfunctional voiding later on life (Wen, 2007).

In this blog post, i will discuss common conditions and situations in which children and adolescents may benefit from pelvic floor physiotherapy. Consider the next four children described below and how physiotherapy is able to benefit them.

Bed Wetting and Daytime Wetting:

Lily is a 4 and a half year old girl who continues to wet her bed almost every night. She is typically dry throughout the day but then occasionally has accidents during the day, especially when she is outside playing with her older brother and cousins. Her mom and dad do not know what else they can do to help with her ongoing leakage.

Neurological Conditions:

Jamie is a 9 yer old boy with Autism Spectum Disorder. He did not crawl as a baby and his gym teacher has mentioned that his balance is not very good. He likes to draw and color but does not like loud places or playing with other kids. He can achieve dry days on the weekends but still has a occasional accidents of both urine and feces at school. His classroom special needs assistant has commented on the enormous size of his stool and has complained to his parents that she is tired of helping him change his clothes throughout the day.

Urinary Urgency and Frequency:

Margaret is 13 year old girl who loves soccer. She plays on her school soccer team and in two different soccer leagues. She has never had an issue with urine leakage. In the past 3 months she has noticed that she is constantly going to the bathroom. She is unable to make it through a soccer practice without excusing herself for the bathroom, and has found that she has had a few accidents either on the way to the bathroom or on the soccer field while rushing to the bathroom. She has started to get teased by her classmates about her bathroom habits.

Pelvic Pain

Ruth is an 18 year old girl who has always had painful periods. She often misses 2-3 days of classes every month because of her pain. She has recently become sexually active. She was diagnosed with a urinary tract infection 3 months ago, and was on a course of antibiotics. Since then the burning with urination has not resolved.

Assessment and Treatment:

In each case, assessment was done with both the child and parent(s). Information about bowel and bladder habits, daily activities, food and fluid intake, and medical history was taken. Physical assessment of flexibility, balance, and strength was also performed.

Specific treatment varied for each child, but in each case, the child and family were given strategies for toileting, diet and fluid intake, and pain management to try at home and school. In a few of the cases, the child and family filled in a bladder diary to help track fluid intake and bladder habits. Each child was also provided with a home exercise program to help address their issues on a global level, not specifically the pelvic floor. The exercises were fun and encouraged overall body strength and flexibility.

Please visit the pediatric section of out website for other conditions that children may experience and may be appropriate for physiotherapy treatment. Help your child gain an upper hand on their pelvic health at a young age, because good habits developed now will help set them up for pelvic health success into their adult and elderly years.