What to Know About Pediatric Pelvic Floor Therapy
Basics and Overview
What is Pediatric Pelvic Floor Therapy?
Pediatric pelvic floor physical therapy is a specialty niche within a niche that is pelvic floor physical therapy. Pelvic floor physical therapists treat urinary dysfunction, bowel dysfunction, sexual dysfunction, low back/pelvic pain, and any prenatal/postpartum related concerns.
So, pediatric pelvic PT treat the same things but for kids. Though a lot of the diagnoses are the same, there is nuance.
A few of the more common things we treat include:
Potty training difficulties
Urinary urgency/frequency
Urinary leakage
Frequent UTIs
Bed wetting
Encopresis
Constipation
Hernias
Painful periods
Scar tissue
Pelvic pain
Benefits of Pediatric Pelvic Floor Therapy
Here’s the thing about pelvic floor issues in children: the symptoms and dysfunction we treat usually affect the entire family to some degree– which leads to one of the coolest parts of our job – we are able to positively impact the entire family.
For example, encopresis (involuntary bowel accidents) and bedwetting are definitely impacting the entire family.
Additionally, these diagnoses are likely impacting the child’s self confidence, so the quicker we can resolve them the better.
Lastly, PT is a very conservative approach to treating these issues. There’s no medication, no surgery, just hands on treatment, lifestyle modifications, and exercises!
Signs a Child Might Need Pelvic Floor Therapy
Signs your child might need pelvic floor therapy include but are not limited to:
Difficulty with potty training
Constipation or straining with bowel movements
Frequently soiling their underwear
Bedwetting
Daytime leakage
Frequent UTIs
Period pain keeping them from school
Avoiding any social settings due to bowel/bladder concerns
Conditions Treated
Pediatric Pelvic Floor Therapy for Bedwetting
Did you know physical therapy can help with bedwetting?
Bed-wetting, or nocturnal enuresis, is involuntary urination while asleep after the age where staying dry at night can be reasonably expected.
Let’s start with how common bedwetting is — nearly 10% of children ages 5-10 experience bedwetting. Most kids are completely potty trained around age 5, but for those that are not by age 7 medical intervention may be necessary.
While some kids outgrow bedwetting on their own, others might need a little help. From a PT perspective, things like constipation, consumption of bladder irritants, inadequate water intake, not getting into REM sleep, and muscle imbalance can play a role in bedwetting.
Consult your child’s provider if:
Your kid is wetting the bed beyond age 7
Your kid begins wetting the bed again after being fully potty trained for several months
Bed-wetting is accompanied by painful urination, unusual thirst, pink or red urine, hard stools, or snoring.
Nocturnal enuresis is one of the most common diagnoses treated by pediatric pelvic floor PTs.
Addressing Constipation Through Pediatric Pelvic Floor Therapy
Ah, one of the most common things we treat – constipation – and not just adults, a lot of kids struggle too.
We see lots of kiddos constipation. Actually most of our patients with bedwetting issues or pelvic pain have underlying constipation that is worsening the issue so we have to treat constipation first.
Our 4 primary suggestions for managing constipation include:
First and foremost, the G.I. system loves water. Make sure your little one is drinking an adequate amount of water (this varies by age).
Tip number two to help you number two is invest in a squatty potty. Squatty potty’s elevate your feet, and when your feet are elevated and your hips are flexed. Your pelvic floor is in a more optimal position to have a bowel movement– similar to how toddlers poop in their diaper/pull up. They even make a special kids squatty potty that looks like a dog.
Tip number three is to make sure your kiddo is getting adequate fiber intake. This also varies by age. My favorite foods to recommend include avocados, legumes, fruits, and vegetables, and nuts. Smoothies are an easy way to get a lot of fiber in quickly and most kids do well with smoothies.
And fourth and finally, magnesium citrate. This comes in several forms, including a powder to add to your water (Calm), capsules, and gummies. I recommend running this by your child’s provider before consuming. If cleared my patients have the best success with taking this at night right before bed.
Managing Pelvic Pain in Children
Two of the biggest sources of pelvic pain we see in children is period pain for the girlies and recurrent UTIs.
Period pain is actually something that can be managed conservatively with pelvic PT and what better time to do it than when they are young? Unfortunately we are told from a very young age that period pain is normal when it is actually not and periods don’t have to keep your daughter from doing things they love.
Both the Academy of Obstetrics and Gynecology and the American Academy of Pediatrics state periods are the fifth vital sign and issues with periods warrant a further workup.
Painful periods keeping her out of school can be a sign of endometriosis, an inflammatory condition where endometrial-like tissue grows outside of the uterus. It affects 1/10 women and takes an average of 6-10 years to be diagnosed. Imagine if we started paying attention to period pain earlier and diagnosing this excruciatingly painful diagnosis didn’t take 10 years.
Recurrent UTIs are also a pediatric pain diagnosis we see more often than you would imagine – this is usually the result of overactive pelvic floor muscles or muscles that are not coordinated and are contracting when they should be relaxing while urinating.
This means urine can be stagnant in the bladder longer than it needs to be, leading to a UTI. These are quite painful for kids, require antibiotics, and leads to missed school.
Overactive Bladder in Kids: How Therapy Helps
Is it an overactive bladder or a hypertonic (tense) pelvic floor? Therapy can help get to the root of the issue!
Did you know the pelvic floor is one of the three main places our bodies carry tension (along with the upper traps and jaw)? Stress shows up in crazy ways in our bodies – even in children – and sometimes it presents as pelvic floor dysfunction.
So how does a tense pelvic floor lead to urinary symptoms? There is a nerve in the pelvic floor called the pudendal nerve that “talks” to the bladder. When this nerve becomes irritated it can lead to increased urinary urgency and frequency. Presenting as “overactive bladder” or a “small bladder”.
Constipation can also lead to increased urinary urgency and frequency as well as a full rectum sits on top of the pelvic floor and can also lead to more pelvic tension and present as urinary symptoms (urgency, frequency, leakage, bedwetting).
Either way - addressing constipation and/or pelvic floor tension through pelvic floor PT helps kids live their best lives without bladder issues.
Techniques and Methods
Exercises Used in Pediatric Pelvic Floor Therapy
As you can imagine, kids aren’t as receptive to traditional PT exercises like banded glute bridges, so I aim to make exercises for kids as fun as possible. Typically, they end up doing banded glute bridges but in a game format like lifting their bottom so a car can roll under it. Creativity is the name of the game.
Other fun things we do include blowing bubbles and blowing up balloons to train different types of breathing, obstacle courses, animal exercises (crab walks, bear crawls, frog jumps, etc) and some yoga. I LOVE to recommend cosmic yoga as a home program for my kids.
I try my best to disguise games as exercise. Sometimes that includes jenga or connect four with a little exercise sprinkled in.
How Biofeedback Works in Pediatric Pelvic Floor Therapy
Biofeedback is a therapeutic modality that uses electronic sensors placed on skin over muscles to give real time feedback of muscle contraction/relaxation/engagement. For the pediatric population they have biofeedback games (that look similar to a mario type of game) that kids can “play” to teach them how to properly engage and relax their pelvic floor muscles.
We do not use this in our offices but use other strategies that are easier for children to use at home as a home exercise program.
Role of Breathing Techniques in Pelvic Floor Therapy
Breathing is so effective for both core coordination and pelvic floor relaxation. Did you know the core and pelvic floor should engage with exhalation and relax with inhalation?
As you can imagine it is very challenging to teach the pediatric population the correct ways to breathe for core exercises and for pelvic floor relaxation purposes so I like to include balloons for core strengthening and bubbles for more gentle breathing. Sometimes I will add a prop like a pilates ball or stuffed animal for them to squeeze while exhaling to increase the amount of core activation.
Parents’ Guide
How to Prepare Your Child for Pelvic Floor Therapy
This likely depends on the age of your child.
In general, you can dress your child in clothes they are able to comfortably exercise in.
Explain to your child in an age appropriate fashion that they will be meeting someone new who is going to help with __ symptoms they are experiencing.
They can expect to move around a little bit with their therapist, and they might play games.
Their therapist will give them homework to work on at home.
You can get more specifics based on the office your child is being seen at when you schedule their first appointment to ensure your child is as prepared as possible.
What to Expect During a Pediatric Pelvic Floor Therapy Session
Typically most pediatric pelvic floor therapy appointments last 30 minutes to an hour.
At my offices each appointment lasts an hour.
Ideally, intake forms are filled out prior to the start of the first appointment, which allows for the first 20 or so minutes to be a more thorough deep dive into the intake forms with more specific questions.
After that, the therapist will typically do some sort of movement analysis, an abdominal assessment, and maybe a breathing assessment.
Based on this assessment, there will be specific exercises prescribed to treat impairments found in the assessments.
You should leave the appointment with an understanding of what is going on, home exercises to work on, and a game plan moving forward.
A primary goal for each pelvic floor therapy evaluation is just making the child comfortable and making the session as fun as possible so that they want to come back and will want to do their exercises at home.
Finding the Right Pediatric Pelvic Floor Therapist Near You
Unfortunately pediatric pelvic floor therapy is very niche, and therefore can be quite challenging to find one. At this moment we do not have a directory specific to pediatric pelvic PTs, but we do have generalized directories.
The two most used are:
Start by finding a pelvic PT near you, and then asking if they specialize in pediatrics. If they don’t, ask them if they know anyone else in the area who does.
Preventive Care
Preventing Pelvic Floor Dysfunction in Children
There are four areas where parents can really help set their kids up for success when it comes to their pelvic health.
Help them eat adequate fiber - this sets them up for success with bowel movements. Ideally they are having a daily bowel movement without straining.
Potty train when they show signs of being ready - before they are ready will only lead to frustration for both the child and parents.
Encourage age appropriate hydration - hydration is also key for having daily bowel movements. So important for both bowel and bladder health!
Encourage daily movement/exercise - not only beneficial for pelvic health, but overall health as well.
Early Signs of Pelvic Floor Issues in Children
Early signs of pelvic floor issues include:
Constipation
difficulty potty training
straining with bowel movements or urination
signs of a weak core
frequent smearing of the underwear (encopresis)
avoiding social issues for fear of having a bladder or bowel accident
For pubescent girlies, painful periods, irregular periods, or pain with ovulation are also a sign of pelvic health issues that a pelvic floor therapist can help with.
Good news! If your child is struggling with any of the above topics, we are currently taking new patients with prolapse in Rockwall, Canton, and Sulphur Springs. If you are interested in scheduling an appointment, please request an appointment here and someone from our team will reach out to you to get you scheduled.
