We are so excited to begin offering pelvic physiotherapy services to the paediatric population at ALPHA Midtown!
The pelvic floor muscles in children have the same function and role to play as they do in adults. Some may think the pelvic floor muscles are only for pregnant folks and only need to be rehabilitated after a person has given birth, but this perception couldn’t be further from the truth. The pelvic floor muscles, located at the bottom of the pelvis, are needed all throughout our lives. Throughout infancy and adolescence the pelvic floor muscles continue to develop as we grow and learn to roll over, crawl, and eventually walk. The pelvic floor muscles are an integral component of our deep inner core unit. They act to provide stability within the spine, hips, and pelvis to support larger movements of the body, such as running, jumping, and play. Not only are the pelvic floor muscles part of our core, but they play an integral role in urinary and bowel control. Children (and adults) need to optimally coordinate pelvic floor relaxation when on the toilet to ensure full emptying. Those muscles also need to be flexible and strong to contract and provide a powerful closure mechanism needed to prevent leakage of stool or urine.
For some children, the development of their continence control (ie. remaining dry in their underwear or diapers during the day and night) can occur very early, around 2-3 years of age. Typically, it is expected that bladder and bowel control is established by 5 years old. For some children, they may not yet have reached this developmental milestone by the time they head off to school. Some children may develop control of their bladder and bowel early for a period of time, but may regress at an older age and start to have leakage of stool or urine in their underwear.
As incontinence of stool or urine persists over time, this can negatively impact the mental health of the child. They may avoid social activities- like overnight camps or sleepovers for fear of having an accident and being teased.
The pelvis holds some very valuable organs such as the rectum and bladder. It is important for children to understand what is going on in their bodies and how the rectum and bladder can affect each other. Persistent constipation is the most common culprit for causing symptoms like bladder and/or bowel incontinence, urinary urgency, urinary frequency, incomplete bladder/bowel emptying and even urinary tract infections. Although some children may have a bowel movement every single day, it does not necessarily mean that their rectum is clear and empty from a hard/compacted stool. This hard fecal matter stretches out the lower part of the rectum and can irritate sensitive nerves surrounding the bladder. The stool that is sitting in the rectum may cause the anal sphincter to fail and thus liquidy stool above may leak out in the underwear. This is called encoporesis (a blog topic unto itself that will be saved for another day).
Pelvic physiotherapy aims to educate children on how important it is to develop and maintain healthy bowel and bladder habits – through hydration, healthy eating, optimal posture and breathing during toileting, and supporting increased awareness of internal signals that may suggest the need to evacuate.
If the bladder and bowel rely on coordinated relaxation of the pelvic floor muscles for proper evacuation of stool or urine, this can be a pretty tricky thing for children to understand when the muscles are inside their body. I like to use pictures and models to show children where their pelvic muscles are and how they work. Biofeedback is an incredible tool that uses surface electrode stickers placed near the anus (external only) to provide a visual display of the activity of the pelvic floor muscles while the child is learning how to properly contract and relax their pelvic floor muscles. Biofeedback training helps children identify their pelvic floor muscles and change how those muscles may be used during day to day activities. This treatment is very empowering and engaging as well as a whole lot of fun as it includes games. The games promote motivation and focus through cartoon characters and objects trying to gather as many stars or carrots as they can through the trail.
An example of a biofeedback game is here below:
Based on the biofeedback assessment and training, a home exercise program is prescribed to support the child’s learning in session. Pelvic floor physical therapists are trained to assess your child’s overall core strength and balance. The pelvic floor is a part of the core system, and if there are any issues identified, a home exercise program to support the development of core strength, stability, and postural alignment will also be provided.
Contact Leeanna for a consultation to discuss if paediatric pelvic floor physical therapy may be the right fit for your child.
–Leeanna Maher, Registered Pelvic Physiotherapist
Book with Leeanna, here!
