Pediatrics Pelvic Health
It can cause a great deal of stress when a child is wetting the bed or experiencing daytime urinary leakage past a certain age. And while it is common for children who are 4 years old and older to experience pelvic health symptoms such as bedwetting, daytime incontinence, and chronic constipation, they do not have to live with it. In fact, the International Children’s Continence Society (ICCS) states that ‘treatment is not only justified but mandatory¹.
Our mission at Mississauga Pelvic Health is to empower children and their families to understand the child’s symptoms/conditions, and to help resolve them.
Why do Pelvic Health Symptoms occur in children?
The pelvic floor is a group of muscles that sit within the pelvis, attaching to the pubic bone (front of the pelvis), tailbone (back of the pelvis), and sitting bones (sides of the pelvis). In children, it’s functions are bladder and bowel control, circulation, core strength, and organ support.
When pelvic health symptoms, the pelvic muscles are either working too much, or not enough. Hypertonicity refers when muscles contract too much, become overworked, and as a result, too tight. Hypotonicity occurs when muscles are not contracting enough, and are too relaxed. Either state can result in pelvic health symptoms in children.
Many factors can contribute to urinary incontinence in children. These include constipation², as well as cognitive-behavioural factors, such as not being able to recognize when to empty their bladder, stress, and anxiety³. Therefore, it is imperative to address these concerns from a holistic, comprehensive, multi-systems approach.
Symptoms and Conditions in Pediatric Pelvic Health
● Daytime Urinary incontinence (during coughing, sneezing, exercise, laughing)
● Nighttime bedwetting (Enuresis)
● Urinary frequency or urgency
● Under-active bladder or urinary retention
● Chronic Constipation or stool retention
● Fecal incontinence
● Pain while voiding bladder or bowels
● Pain in perineal or rectal region
How can Pediatric Pelvic Health Physiotherapy help?
A Pediatric Pelvic Health Physiotherapist is highly trained in the assessment, management, and treatment of symptoms and conditions concerning children’s pelvic health. The assessment process involves a detailed and comprehensive health history taking, which will help your Physiotherapist better understand the child’s concerns. The physical exam is a combination of breathing, postural, movement, muscular, joint, connective tissue, and multi-system assessment. With consent, the pelvic floor will be assessed visually, external palpation, and biofeedback methods . Based on the assessment findings, your Physiotherapist will work with the child, family and liaise with any of the child’s other healthcare providers as necessary to determine the best course of treatment.
What does treatment involve?
Treatment is always tailored and specific to each individual child. Your Physiotherapist will evaluate the health history, the physical exam findings, familial needs, and overall goals into account to determine the best treatment for the child. Treatment options may include:
● Education regarding the child’s symptoms, condition, assessment findings, and treatment plan
● Bladder habit modifications and training
● Bowel habit modifications and training
● Strategies regarding toilet positioning
● Constipation management
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Pelvic floor muscle strengthening and training
● Biofeedback techniques to help increase awareness
● Motor control training and strengthening of the deep core musculature
● Motor control training and strengthening of the abdominal wall, hips and thorax
● Postural education and retraining
● Functional retraining of the neuro-muscular system to achieve the child’s movement and activity goals
● Liaising with the child’s other healthcare professionals to achieve holistic and comprehensive treatment outcomes
If you are unsure of whether Pelvic Floor Physiotherapy will help with your symptoms and condition, we highly encourage you to contact us for a 15 minute Free Phone Consultation. One of our specialised Pelvic Floor Physiotherapists will discuss your concerns with you, and help you determine whether this is the best course of treatment for you.
1. International Children’s Continence Society, 2015. Accessed: October 2, 2021.
2. Constipation in Children (2013). Accessed: October 2, 2021. http://digestive.niddk.nih.gov/ddiseases/pubs/constipationchild/#common
3. Thibodeau, B. A., Metcalfe, P., Koop, P., & Moore, K. (2013). Urinary incontinence and quality of life in children. Journal of pediatric urology, 9(1), 78-83.
4. Urinary Incontinence in Children. (2012). Accessed: October 2, 2021 from http://kidney.niddk.nih.gov/kudiseases/pubs/uichildren/index.aspx