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What Does a Pelvic Floor Session Look Like for a Kid?

Pelvic floor physical therapy is becoming more well known in the women’s health arena, but the secret is out…everyone has a pelvic floor! The pelvic floor is a multi-layered group of predominantly skeletal muscle that sits like a bowl in the bottom of your pelvis. The pelvic floor has many functions, including providing support for abdominal organs, stabilizing joints in the hip and pelvis, and most notably, maintaining bowel and bladder continence. Like any of our skeletal muscles, the pelvic floor muscles can sometimes become tightened, weakened, exhausted, over-stretched, or uncoordinated, and requires appropriate early childhood motor development to mature properly. When there are issues with the pelvic floor muscles, we experience changes in bowel bladder habits, such as episodes of incontinence (leakage of pee or poo), constipation, prolonged bedwetting, changes in urgency, loss of urge sensation, pelvic pain, or frequent urinary tract infections.

If you have been around any children, you know that these issues are all too common. What you may not know is that physical therapy can help. The following conditions can be successfully treated with the intervention of a trained physical therapist:

  • Constipation
  • Prolonged bedwetting (typically after age 5)
  • Frequent UTIs
  • Increased or decreased urinary frequency
  • Urge/stress incontinence
  • Daytime incontinence
  • Encoparesis (leakage of stool)
  • Pelvic pain or pain with urination/defecation
  • Post-operative tethered cord release, Hirschprung’s pull through procedures, colostomy reversal

Physical therapists use many techniques to address bowel and bladder issues and restore pelvic floor function in a child, all while having fun! Many interventions will look like traditional physical therapy activities, but there are a few that are unique to a pelvic floor physical therapy session. (All intervention is performed externally, and often without requiring the child to remove any clothing.)

>Standard urotherapy: Standard urotherapy often involves a family keeping a detailed bowel and bladder diary over the period of a few days. Families will track a child’s food/fluid intake, urination, bowel movements, and any episodes of urinary or fecal incontinence. A therapist can then assess the patterns in the diary and help families identify if dietary/fluid intake changes, potty schedule adjustments, etc. are needed. Urotherapy may also include education on proper potty posture and good toileting hygiene.

>Normalization of respiratory mechanics: The pelvic floor muscles and the diaphragm (the muscle involved with breathing) have a very important relationship. They should lift and lower together with each breath we take. If there are gross motor delays or postural abnormalities that affect the positions of either of these muscles, this relationship is affected, causing decreased bowel motility and inability to fully empty bowels or bladder.

>Pelvic floor muscle isolation and coordination with biofeedback: Pelvic floor muscles are tricky to isolate and confusing for kiddos to contract and relax volitionally (it’s hard for adults as well!). If appropriate, a pelvic PT may utilize animated biofeedback to better understand how to control the pelvic floor muscles voluntarily. A child’s parent or guardian will be asked to place 2 electrodes on the child’s perineum (area around the anus) and 1 electrode on hip or abdomen. These electrodes ONLY RECORD muscle activity. The child will not feel any abnormal sensation. These electrodes will be connected via a cord to a computer system with different games and animations. The therapist is able to set a goal for the child, to relax or contract pelvic floor muscles, and the animation or game is controlled by the child’s muscle activity. This helps children to find their pelvic floor muscles, contract or relax appropriately, and make connections between their brain and pelvic floor muscles using a concrete visual.

>Manual Therapy: A therapist may utilize abdominal massage techniques to increase bowel motility.

>Traditional therapeutic exercise and activity to improve posture, deep core strength, and pelvis/hip range of motion. Exercises and kinesiotaping may be used to assist in closure of diastasis recti.

Bowel and bladder issues in childhood can be very stressful for both a child, and their family. Seeking care of a pelvic floor PT can help restore function, continence, and self-esteem! If you believe your child could benefit from pelvic floor physical therapy, contact our office at 502-633-1007 to set up a free 15 minute screening!

– ​Lauren Hirsch, PT, DPT